Impact of COVID-19 on Incidence, Treatment, and Survival of Patients with Hepatocellular Carcinoma in the Netherlands

The impact of the coronavirus disease 2019 (COVID-19) on hepatocellular carcinoma (HCC) care is unclear. This study reports on HCC patterns during the COVID-19 pandemic in the Netherlands. Patients diagnosed with HCC between 2017 and 2020 were identified from the Netherlands Cancer Registration. Monthly incidence rates were compared between 2020 and 2017-2019. Patient, tumor, process, and treatment characteristics and survival were compared between 2020 and 2017-2019, and between COVID-high (April and May 2020) and COVID-low (June and July 2020) months. The incidence of HCC was lower in May 2020 (IRR 0.56, = 0.001) and higher in June 2020 (IRR 1.32, = 0.05) compared to the same months in 2017-2019. In 2017-2019, 2134 patients presented with HCC, compared to 660 in 2020. Time-to-treatment was shorter in 2020 (median 60 vs. 70 days, < 0.001). The percentage of patients undergoing any treatment did not differ, yet if treatment was not performed this was more commonly due to comorbidity in 2020 (52 vs. 39%, < 0.001). No other differences were found in patient, tumor, process and treatment characteristics and survival between COVID-high and COVID-low months. This study demonstrated no impact of the COVID-19 pandemic on HCC patients, despite a decrease in HCC diagnoses.