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Updated: Apr 12, 2026
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Diagnostic delays are common among patients with hepatocellular carcinoma
Nishant Patel1, Adam C Yopp2, Amit G Singal3
1From the Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System; and Harold C. Simmons Cancer Center, and the Departments of Surgery and Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.
Insights
Nearly 20% of hepatocellular carcinoma (HCC) patients face diagnostic delays exceeding three months. Hepatic encephalopathy increases delay risk, while electronic medical records and abnormal ultrasounds decrease it, impacting tumor growth.
Area of Science:
- Hepatology
- Oncology
- Medical Diagnostics
Background:
- Hepatocellular carcinoma (HCC) frequently presents at advanced stages.
- The prevalence and clinical significance of diagnostic delays in HCC patients are not well understood.
- Timely diagnosis is critical for effective hepatocellular carcinoma management.
Purpose of the Study:
- To identify and characterize factors associated with diagnostic delays in hepatocellular carcinoma (HCC) patients.
- To understand the clinical implications of delayed HCC diagnosis.
Main Methods:
- Retrospective review of consecutive cirrhosis and HCC patients (January 2005 - July 2012).
- Kaplan-Meier analysis to determine time from presentation to diagnosis.
- Multivariate logistic regression to identify correlates of diagnostic delays (defined as >3 months).
Main Results:
- Of 457 HCC patients, 49.5% were diagnosed as outpatients, with 38.5% experiencing diagnostic delays.
- Diagnostic delays were associated with hepatic encephalopathy (OR, 2.29) and negatively with electronic medical records (EMR) implementation (OR, 0.28) and abnormal ultrasound (OR, 0.36).
- Patients with hepatic encephalopathy had higher delay rates (56%), while those presenting with abnormal ultrasounds (27%) or after EMR implementation (26%) had lower rates.
Conclusions:
- Approximately 20% of hepatocellular carcinoma patients experience diagnostic delays exceeding three months.
- These delays can contribute to significant interval tumor growth.
- Identifying factors influencing diagnostic delays is crucial for improving HCC patient outcomes.
Background:
Most patients with hepatocellular carcinoma (HCC) present at advanced stages. The prevalence and clinical impact of delays during diagnostic evaluation among patients with HCC is unclear.
Purpose:
To identify and characterize factors associated with diagnostic delays among patients with HCC.
Methods:
Records were reviewed for consecutive patients with cirrhosis and HCC at a large urban hospital between January 2005 and July 2012. Time from presentation to diagnosis was determined using Kaplan-Meier analysis. Diagnostic delay was defined as time to diagnosis exceeding 3 months, and multivariate logistic regression was used to identify correlates of diagnostic delays.
Results:
Among 457 patients with HCC, 226 (49.5%) were diagnosed as outpatients. Among these, median time-to-diagnosis was 2.2 months, with 87 patients (38.5%) experiencing a diagnostic delay. Diagnostic delays were positively associated with the presence of hepatic encephalopathy (odds ratio [OR], 2.29; 95% CI, 1.03-5.07) and negatively associated with presentation after implementation of the electronic medical records (EMR) (OR, 0.28; 95% CI, 0.15-0.52) and presentation with an abnormal ultrasound (OR, 0.36; 95% CI, 0.19-0.67) on multivariate analysis. Higher rates of diagnostic delays were observed among those with hepatic encephalopathy (56% vs 35%), whereas lower rates were seen in those who presented after EMR implementation (26% vs 60%) and those who presented with an abnormal ultrasound with or without an elevated alpha fetoprotein level (27% vs 50%). Among 49 patients with mass-forming HCC and diagnostic delay, 18% had interval tumor growth of 2 cm or greater.
Conclusions:
Nearly 20% of patients with HCC wait more than 3 months from presentation to diagnosis, which can contribute to interval tumor growth.
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