Hepatocellular Carcinoma Incidence and Survival Among People With Hepatitis C An International Study

This study assessed trends in HCC diagnosis rates, contribution of risk factors to HCC diagnosis, and survival after HCC diagnosis among people with HCV infection.

Trends in Hepatocellular Carcinoma Incidence and Survival Among People With Hepatitis C An International Study 
M. Alavi; N. Z. Janjua; M. Chong; J. Grebely; E. J. Aspinall; H. Innes; H. Valerio; B. Hajarizadeh; P. C. Hayes; M. Krajden; J. Amin; M. G. Law; J. George; D. J. Goldberg; S. J. Hutchinson; G. J. Dore

J Viral Hepat. 2018;25(5):473-481
Volume 25, Issue 5 May 2018
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Abstract

This study evaluates trends in hepatitis C virus (HCV)–related hepatocellular carcinoma (HCC) incidence and survival in three settings, prior to introduction of direct–acting antiviral (DAA) therapies. HCV notifications from British Columbia (BC), Canada; New South Wales (NSW), Australia; and Scotland (1995–2011/2012/2013, respectively) were linked to HCC diagnosis data via hospital admissions (2001–2012/2013/2014, respectively) and mortality (1995–2013/2014/2015, respectively). Age–standardized HCC incidence rates were evaluated, associated factors were assessed using Cox regression, and median survival time after HCC diagnosis was calculated. Among 58 487, 84 529 and 31 924 people with HCV in BC, NSW and Scotland, 734 (1.3%), 1045 (1.2%) and 345 (1.1%) had an HCC diagnosis. Since mid–2000s, HCC diagnosis numbers increased in all jurisdictions. Age–standardized HCC incidence rates remained stable in BC and Scotland and increased in NSW. The strongest predictor of HCC diagnosis was older age [birth <1945, aHR in BC 5.74, 95% CI 4.84, 6.82; NSW 9.26, 95% CI 7.93, 10.82; Scotland 12.55, 95% CI 9.19, 17.15]. Median survival after HCC diagnosis remained stable in BC (0.8 years in 2001–2006 and 2007–2011) and NSW (0.9 years in 2001–2006 and 2007–2013) and improved in Scotland (0.7 years in 2001–2006 to 1.5 years in 2007–2014). Across the settings, HCC burden increased, individual–level risk of HCC remained stable or increased, and HCC survival remained extremely low. These findings highlight the minimal impact of HCC prevention and management strategies during the interferon–based HCV treatment era and form the basis for evaluating the impact of DAA therapy in the coming years.

In conclusion, this international comparison of population–level data provides evidence for the rising burden of HCV–related advanced liver disease in BC, NSW and Scotland, highlighting the combined impact of ageing, suboptimal HCV treatment efficacy and uptake, and low levels of HCC screening and early diagnosis. Over the coming years, the population–level burden and individual–level risk of HCC would be expected to decline, given the potential impact of well–tolerated and effective DAA treatments. In addition, enhanced HCC screening could enable early diagnosis and better management options. The use of administrative databases for surveillance, particularly with the addition of individual–level antiviral treatment data, will be a valuable tool for evaluation and monitoring trends of HCV and HCC burden in relation to public health intervention strategies across the three settings.

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