Decreased overall survival in patients with hepatocellular carcinoma during the COVID-19 pandemic.

Background: The coronavirus disease-2019 (COVID-19) pandemic had a profound influence on screening, diagnosis and treatment of cancer patients worldwide. Due to overloaded health care facilities, screening and surveillance visits for early cancer detection were postponed or completely omitted. This included surveillance of patients with liver cirrhosis who are at risk for development of hepatocellular carcinoma (HCC) and resulted in a decrease in HCC diagnoses. We therefore aimed to analyze the impact of the COVID-19 pandemic on HCC diagnoses and survival of HCC patients in our tertiary care center in Germany. Methods: We conducted a monocentric retrospective study in which we analyzed data of 175 patients diagnosed with HCC before (March 2018 through February 2020) or during the COVID-19 pandemic (March 2020 through February 2022). Results: Compared to patients diagnosed with HCC prior to the COVID-19 pandemic, a significantly higher percentage of patients was diagnosed with HCC in more advanced stages during the COVID-19 pandemic. This was associated with a significantly lower overall survival (OS) in patients diagnosed with HCC during the first year of the pandemic. Importantly, stage-dependent survival was not different between patients diagnosed before and during the COVID-19 pandemic, strongly indicating that diagnostic delay during the pandemic did not play a major role at our center. Conclusions: Taken together, our data indicate that the COVID-19 pandemic significantly impacted on HCC patient care. Specifically, our data suggests that HCC diagnosis was delayed during the pandemic in a relevant percentage of patients translating into reduced survival in our patient cohort.