title: Survival after diagnosis of hepatocellular carcinoma and potential impact of treatment in a hepatitis B or C infected cohort.
abstract: OBJECTIVE
  Little is known about the patterns of care and the impact of hepatocellular carcinoma (HCC) treatment on health outcomes at a population level. We conducted a population-based cohort study to examine HCC survival trends among people diagnosed with hepatitis B (HBV) or hepatitis C virus (HCV) infection, to determine predictors of receiving potentially curative therapy for HCC, and to examine the impact of HCC treatment on survival in New South Wales, Australia.
  
  
  METHODS
  The Kaplan-Meier method was used to estimate survival, logistic regression to determine predictors of potentially curative therapy and Cox proportional hazards models to determine the impact of HCC treatment on survival. Years of potential life lost (YPLL) were calculated.
  
  
  RESULTS
  During the period 1993-2007, 1081 cases of HCC were diagnosed. Median survival increased from 10.4 months during 1993-1997 to 18.4 months during 1998-2002, with no further improvement thereafter. Younger age at diagnosis (<65 years), being Asian-born and having multiple comorbid conditions increased the odds of receiving curative therapy. The effect of HCC treatment on the risk of mortality was similar between the HBV- and HCV-related HCC groups. Tumor-specific therapies had adjusted hazard ratios ranging 0.06-0.25 and palliative/supportive therapy alone had adjusted hazard ratios ranging 0.76-1.08. The average YPLL per person was 23.3.
  
  
  CONCLUSIONS
  The burden of viral hepatitis-related HCC is substantial. Despite treatment advances in recent years, there has been no significant improvement in HCC survival. Efforts to improve HCC screening and early diagnosis are required to deliver curative treatment which clearly has a survival advantage.
authors.affiliation: The Kirby Institute for infection and immunity in society, The University of New South Wales             Storr Liver Unit, Westmead Hospital and Westmead Millennium Institute, University of Sydney             HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney, New South Wales, Australia             Dalla Lana School of Public Health, University of Toronto             The Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Hla-Hla
authors.initials: HH
authors.lastname: Thein
authors.forename: Scott R
authors.initials: SR
authors.lastname: Walter
authors.forename: Heather F
authors.initials: HF
authors.lastname: Gidding
authors.forename: Janaki
authors.initials: J
authors.lastname: Amin
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Law
authors.forename: Jacob
authors.initials: J
authors.lastname: George
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dore