Assessing the mortality rate for patients with liver cancer not vaccinated against COVID-19

The most common types of primary liver cancer are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). The mortality rate for patients with HCC and SARS-CoV-2 infection increases according to the stage of the cancer. This was the conclusion of an international multicentre study analysing the risk of death in patients with liver cancer and COVID-19.

The work was led by the Barcelona Clinic Liver Cancer (BCLC) at the Hospital Clínic - IDIBAPS and CIBEREHD, together with the Department of Gastroenterology and Hepatology at the Fondazione IRCCS CA' Granda Ospedale Maggiore Policlinico in Milan. The study included the largest cohort of patients with liver cancer and COVID-19 worldwide. It described the early mortality rate (30 days after) with a diagnosis of COVID-19 and how mortality was at 20.7% within a month of infection, for the most advanced stages of HCC. These results can be used as a reference to inform patients about the prognosis of this type of cancer, in the context of SARS-CoV-2 infection if they are not vaccinated against it.

Of the 250 patients in 38 countries included in the study, 40% (100 people) died with 48% of the deaths related to COVID-19. Early mortality with diagnosis of COVID-19 was 14.7% in patients with HCC. The study results showed a higher mortality rate related to COVID-19 in patients with a more advanced stage of HCC. The system developed by the Barcelona Clinic Liver Cancer (BCLC) group was used to assess the stage, of which there are 5, ranging from early cancer stages (BCLC-0/A) to more advanced (BCLC-D). The early mortality rate was seen to increase in patients with more advanced HCC: being 6.1% in patients in BCLC-0/A stage, 11.8% in BCLC-B, 20.7% in BCLC-C and 34.5% in BCLC-D. This mortality was maintained even when patients with stage BCLC-D were excluded; these are patients without an option for oncological treatment and with a high cancer-related early mortality. "The results of this study lead us to consider the BCLC classification at the time of SARS-CoV-2 infection as a predictive factor for early mortality in patients with liver cancer," said Maria Reig, head of Barcelona Clinic Liver Cancer-IDIBAPS and researcher at CIBEREHD.

Liver cancer is the 3rd leading cause of cancer death in the world and the leading cause of death in patients with liver cirrhosis. Previous studies have reported an increase in hepatic decompensation and mortality in patients with cirrhosis and COVID-19. However, data related to mortality in patients with liver cancer and SARS-CoV-2 infection had not been demonstrated globally. This study is the second part of the international project, CERO-19, evaluating the impact of the pandemic on the management of liver cancer. Between February and December 2020, 250 patients from 38 different centres were included. These patients were over 18 with a diagnosis of hepatocellular carcinoma or intrahepatic cholangiocarcinoma, two types of liver cancer, and a positive diagnosis of COVID-19. They were followed up until June 2021 or their death.

Dr Maria Reig is head of Barcelona Clinic Liver Cancer and Barcelona Clinic Liver Cancer at IDIBAPS and CIBEREHD, and is the final signatory of the study. The first author is Sergio Muñoz-Martínez, from the same team. Also participating were Drs. Alejandro Forner, Jordi Bruix and Marco Sanduzzi-Zamparelli of Barcelona Clinic Liver Cancer (BCLC) at the Clínic – IDIBAPS - CIBEREHD.

Image: Researchers from Clínic-IDIBAPS and CIBEREHD participating in the study

Study reference: Muñoz-Martínez S, Sapena V, Forner A, Bruix J, Sanduzzi-Zamparelli M, et al. Outcome of liver cancer patients with SARS-CoV-2 infection: An International, Multicentre, Cohort Study. Liver Int. 2022 May 24 doi: 10.1111/liv.15320.