P89 Who doesn’t turn up? Exploring patient characteristics associated with non-attendance with regular hepatocellular carcinoma surveillance: a systematic review and meta-analysis

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Background and Aims In 2020, hepatocellular carcinoma (HCC) was the sixth most diagnosed cancer and had the third highest mortality globally.1 Five-year survival is around 18%,2 stressing the importance of routine six-monthly surveillance, which increases the likelihood of early detection and receipt of curative treatment.3 Surveillance adherence is around 52%.4 HCC disproportionately affects socioeconomically deprived and under-served groups, and these groups also have low uptake of population screening programmes.5 We aimed to explore characteristics associated with non-adherence with regular surveillance for HCC. Method This study updated a previous systematic review and meta-analysis of HCC patients,3 to include recent studies and to explore alternative outcomes in relation to attendance at regular surveillance. Ovid and Embase databases were searched from July 2020-November 2023, in addition to the original searches from January 2014. We included cohort studies of patients with diagnosed HCC, which reported data on prior attendance in a surveillance programme. Data were extracted on attendance, sociodemographic characteristics, risk factors for liver disease and underlying aetiology of disease. Data were analysed using STATA, meta-analysis was conducted where appropriate and sensitivity analyses were conducted excluding studies with high risk of bias. Likelihood of surveillance attendance was reported using odds ratios with 95% confidence intervals (CI). Results Overall, 36 studies with a total of 1,398,994 HCC patients were included in the meta-analysis. Of these, 51.6% attended regular surveillance, and 48.4% did not. Male patients had significantly lower odds of attending surveillance compared to females (OR = 0.73, 95% CI 0.66–0.82). Former and current smokers had significantly lower odds of attending surveillance compared to non-smokers (OR=0.79, 95% CI 0.68–0.92). Patients with HBV had significantly lower odds of attending regular surveillance compared to patients with HCV (OR = 0.62, 95% CI 0.50–0.77). Patients with HCV also had significantly higher odds of attending regular surveillance when compared against other aetiologies (OR=2.34, 95% CI 1.84–2.96). Patients with MASLD had significantly lower odds of attending surveillance when compared with other aetiologies (OR = 0.62, 95% CI 0.43–0.91). Conclusion Amongst patients with a diagnosis of HCC, the following were less likely to have been attending a regular HCC surveillance programme: Male patients, patients with HBV or MASLD and current/former smokers. This suggests potential targets for interventions aiming to increase surveillance uptake. References Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021;71(3):209–49. Vogel A, Meyer T, Sapisochin G, et al. Hepatocellular carcinoma. The Lancet. 2022;400(10360):1345–62. Singal AG, Zhang E, Narasimman M, et al. HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: a meta-analysis. Journal of Hepatology. 2022;77(1):128–39. Zhao C, Jin M, Le RH, et al. Poor adherence to hepatocellular carcinoma surveillance: a systematic review and meta-analysis of a complex issue. Liver International. 2018;38(3):503–14. Frederiksen BL, Jørgensen T, Brasso K, et al. Socioeconomic position and participation in colorectal cancer screening. British Journal of Cancer. 2010;103(10):1496- 501.

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