Objective: 

This study aimed to enhance hepatocellular carcinoma (HCC) screening to achieve earlier diagnosis of patients with hepatitis C (HCV) cirrhosis in our Safety-Net population.

Background: 

Adherence to HCC screening guidelines at Safety-Net hospitals is poor. Only 23% of patients with HCC at our health system had a screening exam within 1-year of diagnosis and 46% presented with stage IV disease. HCV-induced cirrhosis remains the most common etiology of HCC (75%) in our patients.

Methods: 

In the setting of an established HCV treatment clinic, an HCC screening quality improvement initiative was initiated for patients with stage 3 fibrosis or cirrhosis by transient elastography. The program consisted of semiannual imaging. Navigators scheduled imaging appointments and tracked compliance.

Results: 

From April 2018 to April 2021, 318 patients were enrolled (mean age 61 years, 81% Black race, 38% uninsured). Adherence to screening was higher than previously reported: 94%, 75%, and 74% of patients completed their first, second, and third imaging tests. Twenty-two patients (7%) were diagnosed with HCC; 55% stage I and 14% stage IV. All patients were referred and 13 (59%) received treatment. Median time to receipt of treatment was 77 days (range, 32–282). Median overall survival for treated patients was 32 months.

Conclusions: 

Implementation of an HCC screening program at a safety-net hospital is feasible and facilitated earlier diagnosis in this study. Patient navigation and tracking completion of imaging tests were key components of the program’s success. Next steps include expanding the program to additional at-risk populations.

中文翻译：

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针对高危患者实施肝细胞癌筛查计划 安全网医院：全国传播模式

客观的： 

本研究旨在加强肝细胞癌 (HCC) 筛查，以实现安全网人群中丙型肝炎 (HCV) 肝硬化患者的早期诊断。

背景： 

Safety-Net 医院对 HCC 筛查指南的遵守情况较差。在我们的卫生系统中，只有 23% 的 HCC 患者在诊断后 1 年内接受了筛查检查，46% 的患者患有 IV 期疾病。HCV 诱发的肝硬化仍然是我们患者中 HCC 最常见的病因 (75%)。

方法： 

在已建立的 HCV 治疗诊所中，通过瞬时弹性成像针对 3 期纤维化或肝硬化患者启动了 HCC 筛查质量改进计划。该计划包括半年一次的成像。导航员安排成像预约并跟踪合规性。

结果： 

从 2018 年 4 月到 2021 年 4 月，共有 318 名患者入组（平均年龄 61 岁，81% 是黑人，38% 没有保险）。对筛查的依从性高于之前报道的水平：94%、75% 和 74% 的患者完成了第一次、第二次和第三次影像学检查。22 名患者 (7%) 被诊断患有 HCC；55% 为 I 期，14% 为 IV 期。所有患者均被转诊，其中 13 名患者 (59%) 接受了治疗。接受治疗的中位时间为 77 天（范围：32-282 天）。接受治疗的患者的中位总生存期为 32 个月。

结论： 

在本研究中，在安全网医院实施 HCC 筛查计划是可行的，并且有助于早期诊断。患者导航和跟踪成像测试的完成情况是该计划成功的关键组成部分。下一步包括将该计划扩展到其他高危人群。