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Clin Transl Gastroenterol
Clin Transl Gastroenterol
CLTG
CT9
Clinical and Translational Gastroenterology
2155-384X
Wolters Kluwer Philadelphia, PA

CTG-24-0289
10.14309/ctg.0000000000000764
00014
3
Correspondence
Response to Mattiuzzi and Lippi
Liang Jeff MD 12*Jeff.Liang@cshs.org

Lee Yi-Te MD 12*Yi-Te.Lee@cshs.org

https://orcid.org/0000-0001-7834-9825
Yang Ju Dong MD, MS 234
1 Division of Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA;
2 Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA;
3 Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA;
4 Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Correspondence: Ju Dong Yang, MD, MS. E-mail: judong.yang@cshs.org.
9 2024
26 8 2024
15 9 e1© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcWe appreciate the interest of Mattiuzzi and Lippi in our study (1,2). We would like to respond to the comments raised by the authors.

In our original study, we found that hepatocellular carcinoma (HCC)-related mortality did not change in the first year of the COVID-19 pandemic compared with the years immediately preceding the pandemic (age-adjusted mortality rate was 2.78, 2.73, and 2.76 per 100,000 patients in 2018, 2019, and 2020, respectively) (1). Mattiuzzi et al observed a similar finding with an extended follow-up period to 2022. It is noteworthy that the mortality rates provided by the authors using the CDC WONDER database are not incidence-based mortality rates (3), so the reported HCC mortality rates would be affected by both incidence rates and survival probability and should be interpreted with caution. For example, our study showed a significant decrease in the incidence rate of HCC in 2020 (vs expected incidence rates), especially in the elderly and individuals of Black race and Hispanic ethnicity (1). These underdiagnosed HCC patients could cause a drop in the mortality rate and may mask the potentially worse outcomes during the COVID-19 pandemic. Although we did not observe an inferior survival among patients with HCC diagnosed in 2020, these could be attributed to the limited follow-up period. Further investigation on the HCC incidence and survival rates would be helpful to clarify the cause of unchanged HCC mortality during the COVID-19 pandemic.

In addition, further subgroup analyses by race/ethnicity, age, and tumor stage would be helpful for better understanding the impact of COVID-19 on mortality among different HCC groups. For example, we observed that a higher proportion of patients with advanced HCC did not receive any treatment while no significant differences in treatment receipt in patients with localized HCC. Evaluating the incidence-based mortality rates and survival in these patients could provide robust evidence on whether COVID-19 affects the treatments and outcomes in HCC in the United States.

In conclusion, future analyses using granular data sets with detailed clinical characteristics are warranted to better elucidate the impact of COVID-19 on patients with HCC.

CONFLICTS OF INTEREST

Guarantor of the article:

Specific author contributions: Jeff Liang and Yi-Te Lee contributed equally to this article.

Financial support: J.D.Y.'s research is supported by the National Institutes of Health K08CA259534 and R21CA280444. National Institutes of Health had no role in the collection of data; the design and conduct of the study; management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Potential competing interests: J.D.Y. provides a consulting service for AstraZeneca, Eisai, Exact Sciences, FujiFilm Medical Sciences, Gilead Sciences, and Eisai.

* Jeff Liang and Yi-Te Lee contributed equally to this article.
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REFERENCES

1. Liang J Lee YT Yeo YH . Impact of the early COVID-19 pandemic on incidence and outcomes of hepatocellular carcinoma in the United States. Clin Transl Gastroenterol 2024;15 (7 ):e00723.38829967
2. Mattiuzzi C Lippi G . Epidemiological analysis on the impact of early COVID-19 pandemic on mortality for hepatocellular carcinoma in the United States. Clin Transl Gastroenterol. 2024. doi:10.14309/ctg.0000000000000724. In this issue.
3. Chu KC Miller BA Feuer EJ . A method for partitioning cancer mortality trends by factors associated with diagnosis: An application to female breast cancer. J Clin Epidemiol 1994;47 (12 ):1451–61.7730854
