Top level research in hepatology: COVID-19 and beyond

Abstract

The world has now been living with COVID-19 for more than a year; it has had an enormous impact not only on our daily lives, but also on healthcare and research. When the first wave hit the healthcare system, oncological care was, however, one of the areas of medicine that was felt to be “essential” (whatever that may imply). In the current issue of JHEP Reports, S. MuñozMartinez et al. report on a survey among 76 high volume centres worldwide investigating the impact of the COVID-19 pandemic on the care for patients with hepatocellular carcinoma (HCC). The results are worrying: more than 80% of centres made adjustments to their screening programmes, diagnostic procedures were substantially delayed and although between 60 and 80% of centres maintained several types of treatment, most of the procedures were rescheduled, e.g. over 60% of surgical procedures. Transplant programmes were put on hold in 44% of the centres. Many centres could continue to include patients in clinical trials, although that activity was also substantially reduced. This data is worrisome, as it is not to be excluded that these changes might have an impact on the long-term outcomes of patients with HCC. The CERO-19 (Liver Cancer Outcome in the COVID-19 pandemic) project continues to collect data that will inform us on these latter issues, but the data presented here should already alarm us and be taken into account when deciding on health policy measures to deal with future waves of COVID-19. In the same issue, Ganne-Carié et al. tackle another important issue in HCC, namely aetiology-related differences. In this study, the authors focused on HCCs that were diagnosed during 6-montly surveillance in patients with cirrhosis related to viral hepatitis, alcohol use or a combination of both as an underlying aetiology. The first interesting finding was the lower 5-year incidence in those with alcohol-related liver disease, compared to viral or mixed aetiology. At diagnosis, tumour burden was comparable between aetiologies, but early BCLC stages were nevertheless less frequent in the alcohol-related liver disease group. The latter is explained by the poorer physical condition with more impaired ECOG performance status. Median survival in these cases was lower, but when adjusting for tumour size and ECOG score, as well as Child-Pugh score, there was no aetiologyspecific difference, suggesting that the poorer condition of the patients was of more impact than the aetiology. Of course, alcohol abuse comes with a psychosocial and nutritional context