| Abstract: | BACKGROUND: Hepatocellular carcinoma (HCC) is the most rapidly increasing cause of cancer mortality in New Zealand due to endemic hepatitis B virus (HBV) infection and recent hepatitis C virus (HCV) and obesity epidemics. AIM: To describe the changing landscape of HCC referred to a national HCC service over a 20-year period, including trends in underlying liver disease, screening uptake and access to curative treatments, and to determine the impact of screening on outcomes with a comparison between screened detected and non-screened detected cases. METHODS: All newly diagnosed cases of HCC referred to New Zealand Liver Transplant Unit between 1998 and 2017 were included. Data on patient demographics, liver disease aetiology, screening status and treatment modalities were collected. RESULTS: HCC diagnosis rates have increased from 24 cases in 1998 to 250 in 2017, an increase of 20% per annum. The total of 1985 HCC cases was divided into three cohorts (Era 1: 1998-2009; Era 2: 2009-2014; Era 3: 2014-2017), each comprising 661-662 patients. During the study period, overall survival improved (P = 0.005). The proportion with screen-detected HCC was similar across the three cohorts (44% in Era 1, 42% in Era 2 and 47% in Era 3). Five- and 10-year survival was higher in screen-detected cases (49 and 43%) than in non-screen detected cases (14 and 10%), P < 0.0001. Survival was higher in patients with HCV and HBV than in those with non-alcoholic steatohepatitis (NASH) or alcoholic liver disease (ALD) - 5 and 10-year survival was 40 and 34% in HCV-HCC, 30 and 26% in HBV-HCC, 15 and 14% in NASH-HCC, 13 and 10% in ALD-HCC, P < 0.0001. CONCLUSION: Better outcomes in patients with HBV- or HCV-related HCC than in those with NASH-related or ALD-related HCV may reflect better screening uptake and better access to curative therapies. |
