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

M. Alavi, N.Z. Janjua, M. Chong, J. Grebely, E.J. Aspinall, H. Innes, H. Valerio, B. Hajarizadeh, P.C. Hayes, M. Krajden, J. Amin, M.G. Law, J. George, D.J. Goldberg, S.J. Hutchinson, G.J. Dore

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Abstract

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. 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). 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.
Original languageEnglish
Pages (from-to)473-481
Number of pages9
JournalJournal of Viral Hepatitis
Volume25
Issue number5
Early online date30 Nov 2017
DOIs
Publication statusPublished - May 2018

Keywords

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

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    Alavi, M., Janjua, N. Z., Chong, M., Grebely, J., Aspinall, E. J., Innes, H., Valerio, H., Hajarizadeh, B., Hayes, P. C., Krajden, M., Amin, J., Law, M. G., George, J., Goldberg, D. J., Hutchinson, S. J., & Dore, G. J. (2018). Trends in hepatocellular carcinoma incidence and survival among people with hepatitis C: an international comparison. Journal of Viral Hepatitis, 25(5), 473-481. https://doi.org/10.1111/jvh.12837