title: Hepatocellular carcinoma in Australia's Northern Territory: high incidence and poor outcome.
abstract: OBJECTIVE
  To describe the epidemiology, clinical features, management and outcomes of hepatocellular carcinoma (HCC) in the Northern Territory over the past decade.
  
  
  METHODS
  An NT-wide epidemiology study covering the period 1991-2010 and a clinical cohort study including patients diagnosed during 2000-2011. HCC diagnoses were provided by the NT Cancer Registry and cross-checked against clinical records.
  
  
  METHODS
  Age-adjusted incidence of HCC; management; clinical features; and median and 1-year survival.
  
  
  RESULTS
  There were 145 incident cases of HCC in the NT during 1991-2010, giving an age-adjusted annual incidence of 22.7/100 000 (95% CI, 17.2-26.8) for Indigenous Australians and 4.0/100 000 (95% CI, 2.1-5.8) for non-Indigenous Australians - an incidence rate ratio of 5.9 (95% CI, 4.7-7.4). There was no significant change in annual age-adjusted incidence over this period. The most common causative factors were hepatitis B virus in Indigenous people and hepatitis C virus in non-Indigenous people. Most people were diagnosed late, only 13/80 were diagnosed by screening, and outcomes were poor, with 28/80 overall surviving to 1 year. Outcomes were better among those managed through a centralised multidisciplinary service than among those who were not (adjusted hazard ratio for death at 1 year, 0.35 [95% CI, 0.16-0.81]).
  
  
  CONCLUSIONS
  HCC incidence remains high in the Indigenous people of the NT. More resources are needed for HCC surveillance and management programs in this population.
authors.affiliation: Menzies School of Health Research, Darwin, NT, Australia. joshua.davis@menzies.edu.au.
authors.forename: Christopher
authors.initials: C
authors.lastname: Parker
authors.affiliation: Menzies School of Health Research, Darwin, NT, Australia.
authors.forename: Steven Y C
authors.initials: SY
authors.lastname: Tong
authors.affiliation: Health Gains Planning Unit, Northern Territory Government, Darwin, NT, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Dempsey
authors.affiliation: Menzies School of Health Research, Darwin, NT, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Condon
authors.affiliation: Royal Darwin Hospital, Darwin, NT, Australia.
authors.forename: Suresh K
authors.initials: SK
authors.lastname: Sharma
authors.affiliation: South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, SA, Australia.
authors.forename: John W C
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Monash Medical Centre, Melbourne, VIC, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Sievert
authors.affiliation: Menzies School of Health Research, Darwin, NT, Australia.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Davis
mesh_terms: D017677:Age Distribution; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015876:Northern Territory / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors