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Med J Aust. 2018 Oct 15;209(8):348-354.

Surveillance improves survival of patients with hepatocellular carcinoma: a prospective population-based study.

Author information

1
St Vincent's Hospital Melbourne, Melbourne, VIC thai.hong@svha.org.au.
2
Austin Hospital, Melbourne, VIC.
3
University of Melbourne, Melbourne, VIC.
4
Monash Health, Melbourne, VIC.
5
Eastern Health, Melbourne, VIC.
6
Western Health, Melbourne, VIC.
7
St Vincent's Hospital Melbourne, Melbourne, VIC.
8
Alfred Hospital, Melbourne, VIC.

Abstract

OBJECTIVES:

To determine the factors associated with survival of patients with hepatocellular carcinoma (HCC) and the effect of HCC surveillance on survival.

DESIGN, SETTING AND PARTICIPANTS:

Prospective population-based cohort study of patients newly diagnosed with HCC in seven tertiary hospitals in Melbourne, 1 July 2012 - 30 June 2013.

MAIN OUTCOME MEASURES:

Overall survival (maximum follow-up, 24 months); factors associated with HCC surveillance participation and survival.

RESULTS:

272 people were diagnosed with incident HCC during the study period; the most common risk factors were hepatitis C virus infection (41%), alcohol-related liver disease (39%), and hepatitis B virus infection (22%). Only 40% of patients participated in HCC surveillance at the time of diagnosis; participation was significantly higher among patients with smaller median tumour size (participants, 2.8 cm; non-participants, 6.0 cm; P < 0.001) and earlier Barcelona Clinic Liver Cancer (BCLC) stage disease (A/B, 59%; C/D, 25%; P < 0.001). Participation was higher among patients with compensated cirrhosis or hepatitis C infections; it was lower among those with alcohol-related liver disease or decompensated liver disease. Median overall survival time was 20.8 months; mean survival time was 18.1 months (95% CI, 16.6-19.6 months). Participation in HCC surveillance was associated with significantly lower mortality (adjusted hazard ratio [aHR], 0.60; 95% CI, 0.38-0.93; P = 0.021), as were curative therapies (aHR, 0.33; 95% CI, 0.19-0.58). Conversely, higher Child-Pugh class, alpha-fetoprotein levels over 400 kU/L, and later BCLC disease stages were each associated with higher mortality.

CONCLUSIONS:

Survival for patients with HCC is poor, but may be improved by surveillance, associated with the identification of earlier stage tumours, enabling curative therapies to be initiated.

KEYWORDS:

Hepatitis B; Hepatitis C; Liver cirrhosis; Liver diseases, alcoholic; Liver neoplasms; Neoplasms, epidemiology; Preventive medicine; Survival analysis

PMID:
30309301

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