Geographical variations in incidence, management and survival of hepatocellular carcinoma in a Western country

Abstract

Population-based studies have highlighted large and sometimes unexpected differences between countries in the survival of patients with malignancy. As these differences are considered to indicate the overall effectiveness of health systems, in addition to the incidence of the cancer or quality of registration, variations within a given country should be minimal. However, similar to between countries differences, this study shows differences within the same country in the incidence, curative treatment rate, and survival of patients with HCC. Evidence that access to care and survival varies within a country can strengthen the impetus for government and clinicians to address these disparities.

The oncologic burden of hepatitis C virus infection: A clinical perspective

“…Of note, this median survival time was significantly shorter than that for HBV‐infected patients who developed HCC (22.3 months) . Similar results were reported from a nationwide study in France …”

Hepatocellular carcinoma in Australia 1982‐2014: Increasing incidence and improving survival

“…The most recent year of diagnosis for which reliable 5‐year survival data are available is 2009 with an estimate of 19.6%. These results are slightly superior to recent data from other Western countries including a median survival of 9.4 months and 5‐year survival of 9.6% from a cohort of more than 30 000 French patients diagnosed between 2009 and 2012, 11.7% 5‐year survival in the EUROCARE cohort in those diagnosed up to 2007, and approximately 8‐month median survival in the US SEER database for those diagnosed in the 2000s . The lack of robust clinical data for these patients, such as aetiology of liver disease, makes identifying the causes of the improving survival challenging.…”

“…These deficits limit our ability to make meaningful comment on the drivers of the increasing survival. We did not have access to state by state nor region by region data, and as recently identified, significant variations between geographical locations may exist. A study over such a long period of time is subject to several biases, particularly with regard to incidence rates and survival estimates.…”

Hepatocellular carcinoma is diagnosed at a later stage in alcoholic patients: Results of a prospective, nationwide study

“…Although alcohol is a dominant risk factor associated with HCC in certain parts of the world, 19,20 specific clinical data on alcohol-related HCC are scarce. 10,11 Various assumptions can be made to explain why patients with alcohol-related HCC have reduced survival Cancer in comparison with patients with non-alcohol-related HCC: a diagnosis at a later stage due to lower rates of HCC screening, worse liver function and/or ongoing alcohol consumption preventing curative options, and discrimination against alcoholic patients leading to less aggressive treatment options.…”