title: Trends in relative survival in patients with a diagnosis of hepatocellular carcinoma in Ontario: a population-based retrospective cohort study.
abstract: BACKGROUND
  The incidence of hepatocellular carcinoma (HCC) is increasing and survival rates are poor. Our objectives were to estimate the relative survival over time in patients with HCC in Ontario and to examine potential factors associated with excess mortality risk.
  
  
  METHODS
  We performed a population-based retrospective cohort analysis involving patients with a diagnosis of HCC in Ontario between 1990 and 2009 using data extracted from the Ontario Cancer Registry. Relative survival was estimated by controlling for background mortality using expected mortality from Ontario life tables. A generalized linear model was used to estimate the excess mortality risk for important factors.
  
  
  RESULTS
  A total of 5645 patients had HCC diagnosed during the study period; 4412 (78.2%) of these patients were male. Improvements in 1-year relative survival were observed across all age groups over time: the highest was among those patients less than 60 years of age who had a diagnosis of HCC during 2005-2009, with 1-year survival exceeding 50% for both sexes. However, the overall 5-year relative survival did not exceed 28%. The excess mortality risk decreased with increased years of follow-up, recent diagnosis, and curative or noncurative treatments for HCC, whereas excess mortality risk increased with age.
  
  
  CONCLUSIONS
  Although improving, the prognosis for HCC remains poor. Our findings highlight the importance of effective prevention and treatment for HCC to reduce the burden of disease and improve health care systems.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. ; Ontario Institute for Cancer Research/Cancer Care Ontario, Toronto, Ont. ; Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Hla-Hla
authors.initials: HH
authors.lastname: Thein
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
authors.forename: Edwin
authors.initials: E
authors.lastname: Khoo
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Campitelli
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ont.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Zaheen
authors.affiliation: National Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ont.
authors.forename: Qilong
authors.initials: Q
authors.lastname: Yi
authors.affiliation: Canadian Cancer Society, Toronto, Ont. ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
authors.forename: Prithwish
authors.initials: P
authors.lastname: De
authors.affiliation: Ontario Institute for Cancer Research/Cancer Care Ontario, Toronto, Ont. ; Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: C C
authors.initials: CC
authors.lastname: Earle