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

BACKGROUND: 

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.

 

METHODS: 

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.

 

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 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.

 

CONCLUSION: 

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.