title: Staging and therapy for patients with hepatocellular cancer in a defined population from 2000 to 2011 - active palliative treatment improved overall survival.
abstract: BACKGROUND
  Sweden's western region has successively introduced the use of validated non-invasive diagnostic algorithms and treatment allocation for hepatocellular cancer (HCC). The aim was to analyse whether between 2000 and 2011 these changes in strategy had an impact on survival.
  
  
  METHODS
  Data concerning diagnosis, survival and treatment for 687 individuals with HCC were retrieved from the regional cancer centre's register and hospital charts. The 12-year period was divided into three four-year cohorts (A-B-C).
  
  
  RESULTS
  There was an increase in the crude incidence rate of HCC from 2.7 to 4.2 per 100 000 inhabitants (p < 0.0001) over the period studied. Imaging was increasingly used for diagnosis over the three time periods (1.4%, 7.9% and 29%; p < 0.0001). Alcohol abuse was the most common aetiology for underlying liver disease (42%). The median survival time for all HCC patients improved over time - period A: 3.8 months, period B: 5.1 months and period C: 7.0 months (p = 0.0007). The 209 patients without any underlying liver disease had a worse survival than the 377 with a reported underlying liver disease (p = 0.0001). Active palliative treatment (APT) increased from 17% to 35% during period C (p < 0.0001). For these patients, median survival increased from 8.8 months to 14.2 months. Best supportive care was used less over time.
  
  
  CONCLUSIONS
  Overall survival improved when more patients had APT, mainly trans arterial chemoembolisation (TACE).
authors.affiliation: a Transplant Institute, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden and.
authors.forename: Per
authors.initials: P
authors.lastname: Lindnér
authors.affiliation: b Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Holmberg
authors.affiliation: a Transplant Institute, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden and.
authors.forename: Magnus
authors.initials: M
authors.lastname: Rizell
authors.affiliation: a Transplant Institute, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden and.
authors.forename: Larsolof
authors.initials: L
authors.lastname: Hafström
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult