Trends in hepatocellular carcinoma incidence and survival among people with hepatitis C: an international comparison

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Original languageEnglish
JournalJournal of Viral Hepatitis
Early online date30 Nov 2017
DOIs
StateE-pub ahead of print - 30 Nov 2017

Abstract

Background: This study evaluates trends in hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) incidence and survival in three settings, prior to introduction of direct-acting antiviral (DAA) therapies. Methods: HCV notifications from British Columbia (BC), Canada, New South Wales (NSW), Australia, and Scotland (1995-2011/2012/2013, respectively) were linked to HCC diagnosis data via hospital admissions (2001-2012/2013/2014, respectively), and mortality (1995-2013/2014/2015, respectively). Age-standardised HCC incidence rates were evaluated, associated factors were assessed using Cox regression, and median survival time after HCC diagnosis was calculated. Results: Among 58,487, 84,529, and 31,924 people with HCV in BC, NSW, and Scotland, 734 (1.3%), 1,045 (1.2%), and 345 (1.1%) had an HCC diagnosis. Since mid-2000s, HCC diagnosis numbers increased in all jurisdictions. Age-standardised HCC incidence rates remained stable in BC and Scotland, and increased in NSW. The strongest predictor of HCC diagnosis was older age [birth <1945, aHR in BC 5.74, 95% CI 4.84, 6.82; NSW 9.26, 95% CI 7.93, 10.82; Scotland 12.55, 95% CI 9.19, 17.15]. Median survival after HCC diagnosis remained stable in BC (0.8 years in 2001-2006 and 2007-2011) and NSW (0.9 years in 2001-2006 and 2007-2013), and improved in Scotland (0.7 years in 2001-2006 to 1.5 years in 2007-2014). Conclusions: Across the settings, HCC burden increased, individual-level risk of HCC remained stable or increased, and HCC survival remained extremely low. These findings highlight the minimal impact of HCC prevention and management strategies during the interferon-based HCV treatment era, and form the basis for evaluating the impact of DAA therapy in the coming years.

Keywords

  • HCV, liver disease, primary liver cancer, population-based, data linkage

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