Shifts in Cohort Eligibility With Deimplementation of Race-specific Guidance for Hepatocellular Carcinoma...

Clinical guidance for hepatocellular carcinoma (HCC) surveillance for patients with chronic hepatitis B virus (HBV) recently removed race from eligibility criteria, and replaced it with country of origin from a HBV-endemic country and PAGE-B score greater than 10. This study sought to determine adherence to prior race-based guidance and how demographic cohort eligibility would shift using new criteria.

This was a retrospective cohort study of patients with chronic HBV with an outpatient office visit at our institution from June 1, 2022, to June 1, 2023. Patients with a personal history of cirrhosis, HCC, or comorbid viral hepatitis were excluded. HCC surveillance practices were extracted using chart review. PAGE-B scores were calculated utilizing lab data within 3 months of the office visit. Cohort eligibility for screening was compared using criteria from each guidance document. Descriptive and comparative statistics were conducted in Python.

Two hundred fifty-nine patients were included (51% Asian, 27% Black, and 12% White). Sixty percent (n = 156) of patients were eligible for surveillance under the race-based guidance, and clinicians adhered to this guidance by ordering surveillance in 94% of eligible cases. Under the new nonrace-based guidance, 63% would be eligible for surveillance, with discordance in surveillance eligibility in 28% of cases. Of patients who would no longer be eligible for HCC surveillance, 97% were Black. Fifty-three percent of patients who would newly warrant surveillance were White, and eligibility was primarily driven by PAGE-B score.

Clinicians had been largely adherent to the race-based guidance. New guidance would shift cohort eligibility toward White patients, primarily due to PAGE-B criteria, with 97% of Black patients becoming no longer eligible.