{
  "abstract": "Introduction Hepatocellular carcinoma (HCC) is a rapidly growing cause of cancer mortality, sparking concerted efforts towards ‘precision surveillance’ via risk stratification and better diagnostics. Low adherence to surveillance standards is widely reported, though measurement fraught with heterogeneity and limitations. This study aims to evaluate the performance of current HCC pathways in the UK.Methods A multi-centre retrospective study was conducted via the ToRcH-UK, BASL and BSG networks. Case capture included patients that attended a surveillance scan in a 2-week period or those that developed incident HCC in a 6-month period, generating two separate cohorts. Local teams performed audit with follow up 1/1/22 - 30/1/24. Surveillance adherence was measured using a proportion of time covered (PTC) method, assuming 6-months cover per test. Regression analysis was performed to identify factors associated with PTC and Barcelona Clinic Liver Cancer (BCLC) stage.Results A total of 68 UK hospitals participated including specialist (47%) and non-specialist liver centres (53%). Surveillance pathways included a dedicated radiology procedure code (26%), pathway navigators (21%), interventional programmes (15%) and automated recall (9%). LI-RADS was used for ultrasound (11%) and CT/MRI (64%). Patients in surveillance (n = 1,715) had overall PTC rates of 38% for alpha-fetoprotein, 63% for surveillance scans, and 67% for all abdominal imaging. Over two years, HCC incidence in surveillance was 2.5% (41 cases), with 41% at early stage (BCLC 0-A). Cumulative incidence by aMAP risk—low (0%), medium (1.1%), high (5.2%)—was significant (p < 0.001), with no events in the low-risk group. Among patients with incident HCC (n = 723), the rates of early-stage diagnosis (BCLC 0-A) were 44% and curative first-line treatment 27%. Only 48% had known cirrhosis and 42% were enrolled in surveillance prior to diagnosis. Presentation occurred through incidental findings (38%), surveillance (37%), and symptomatic channels (24%). The rate of first-line treatment utilisation was 79%, with frailty and HCC progression the most common reasons for non-utilisation. Surveillance was associated with early diagnosis (BCLC 0-A; p<0.001) and curative treatment receipt (p=0.025).Conclusions Underperformance appears to stem from a combination of failures in identifying cirrhosis and suboptimal surveillance, compromising early-stage diagnosis and access to curative treatment. Future efforts should harness both service improvement and emerging innovations to improve equitable access to curative treatment.Abstract O8 Figure 1Proportion of time covered (PTC) determines HCC surveillance adherence across test categories. All abdominal scans is cumulative of surveillance and non-surveillance imaging, where the whole liver has been imaged by any modality with or without contrast",
  "authors": [
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "On behalf of ToRcH-UK"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Christopher Mysko"
    },
    {
      "affiliations": [
        "University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom"
      ],
      "name": "Yazan Haddadin"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, United Kingdom"
      ],
      "name": "Giovanna McGinty"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Maja Kopczynska"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Stephanie Landi"
    },
    {
      "affiliations": [
        "NHS Blood and Transplant, London, United Kingdom",
        "Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Jade King"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Daren Griffiths"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Azita Rajai"
    },
    {
      "affiliations": [
        "Stockport NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Sarah Guthrie"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Syed Mujtaba Hasnain Nadir"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Ayodele Sasegbon"
    },
    {
      "affiliations": [
        "Cwm Taf Morgannwg University Health Board, Wales, United Kingdom"
      ],
      "name": "Pedram Modarres"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Huw Purssell"
    },
    {
      "affiliations": [
        "Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom"
      ],
      "name": "Kimberley Butler"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Oliver Street"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom",
        "University of Leeds, Leeds, United Kingdom"
      ],
      "name": "Oliver Tavabie"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom",
        "University of Leeds, Leeds, United Kingdom"
      ],
      "name": "Ian Rowe"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Karen Piper Hanley"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom",
        "University of Birmingham, Birmingham, United Kingdom",
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom"
      ],
      "name": "Neil Hanley"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Varinder Singh Athwal"
    }
  ],
  "title": "O8 SHiNE-UK: a national evaluation of hepatocellular carcinoma surveillance, routes to diagnosis and treatment utilisation",
  "uid": "3721c974-1ace-5574-80c7-5d641dd44cda"
}