Predictors and survival in hepatitis B-related hepatocellular carcinoma in New South Wales, Australia.
OBJECTIVE
Incidence and mortality of hepatocellular carcinoma (HCC) has increased markedly over the last three decades in Australia. An increasing proportion of HCC cases is related to chronic viral hepatitis including hepatitis B virus (HBV) infection. However, there is very limited data on HBV-related HCC survival.


METHODS
Data on HBV-related HCC cases was obtained from a community-based linkage study. HCC cases notified to the New South Wales (NSW) Central Cancer Registry (CCR) during the period 1994-2002 were linked to HBV notifications from the NSW Health Department. Age, sex, country of birth, year of diagnosis, tumor stage were extracted from the CCR database. Survival analysis was conducted to determine median survival and identify predictors of survival.


RESULTS
Over the 9-year study period, 278 HCC cases were linked to chronic HBV infection. The majority of cases were male (83.5%) and overseas-born (93.6%); Asian-born cases accounted for 72.1%. Median survival following HCC diagnosis was 15.0 months. HCC survival was poorer among older age groups (P < 0.0001), and among cases with regional spread (hazard ratio, 3.23; 95% confidence interval, 1.83-5.69; P < 0.0001) and distant metastases (hazard ratio, 3.85; 95% confidence interval, 2.44-6.08; P < 0.0001). Sex, region of birth and study period (1994-1997 vs 1998-2002) were not associated with HCC survival.


CONCLUSIONS
The vast majority of HBV-related HCC were overseas-born, however, region of birth was unrelated to HCC survival. The continued extremely poor HCC survival, including lack of improvement in HCC survival in more recent years, suggests low uptake of HCC screening programs. Public health strategies including early diagnosis and appropriate referral for antiviral therapy assessment and increased HCC screening among high-risk populations are required to reduce HCC incidence and improve HCC survival.
Nguyen
Van T T
VT
School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia. v.nguyen@unsw.edu.au
Amin
Janaki
J
Law
Matthew G
MG
Dore
Gregory J
GJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000821:virology; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000208:ethnology / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009517:New South Wales / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult