Improving survival in patients with hepatocellular carcinoma related to chronic hepatitis C and B but not in those related to non-alcoholic steatohepatitis or alcoholic liver disease: a 20-year experience from a national programme
Hepatocellular carcinoma (HCC) is the most rapidly increasing cause of cancer mortality in New Zealand due to endemic Hepatitis B (HBV) infection and recent Hepatitis C (HCV) and obesity epidemics.
All newly diagnosed cases of HCC referred to NZLTU between 1998 and 2017 were included. Data on patient demographics, liver disease aetiology, screening status and treatment modalities were collected.
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 3 cohorts (Era 1: 1998 to 2009; Era 2: 2009 to 2014; Era 3: 2014 to 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 3 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 NASH or 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.
Better outcomes in patients with HBV-related 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.
Intern Med J. 2019 Mar 25. doi: 10.1111/imj.14304. [Epub ahead of print]
New Zealand Liver Transplant unit (NZLTU), Auckland City Hospital, Auckland, New Zealand.