Introduction Hepatocellular cancer (HCC) is a recognised complication of liver cirrhosis.1 The cause of liver cirrhosis is varied, but the prevalence of certain conditions like non-alcoholic fatty liver disease (NAFLD) is rising.2 This study aimed to identify the time trends of HCC over the last 10 years focusing on the aetiopathology of cirrhosis and modality of diagnosis. Hepatoma surveillance clinics have been established within the last 10 years, wherein cirrhotic patients are screened 6 monthly with ultrasound and alpha fetoprotein. We also aimed to compare the clinical characteristics of patients identified by this surveillance programme with those diagnosed when they presented with symptoms.
Methods Symptomatic HCC cases were identified by review of medical records coding with “Hepatocellular carcinoma” and the HPB multidisciplinary team meeting lists between 1/1/04 and 31/12/13. The hepatoma screening programme records were accessed to identify cases detected on routine screening. Electronic patient records were used to identify the underlying pathology, date of diagnosis, date of death and other baseline data.
Results During this ten year period 146 individuals were diagnosed with HCC of which 25 cases were detected by the surveillance programme. The mean incidence of HCC rose from 11.6/year during the period 2003–08 to 17.6/year in the years 2009–13. NAFLD was the most prevalent pathology in all years, but showed no significant change in incidence between these two time periods (42.1 vs. 36.6%). The mean age at diagnosis in the screened group was significantly lower (57.1 ± 8.3) than symptomatic (69 ± 9.7; p < 0.001). The rate of curative therapy (Resection, OLT) was higher in the screening group as opposed to the symptomatic (24 vs. 7.2%) as also palliative therapy (TACE, RFA) (20 vs. 13.5%). Transplant free survival was greater at 1 and 3 years in the screened group (35 vs. 25.5%; 20 vs. 8.2%), but no significant difference was noted at 5 years (0 vs. 2%).
Conclusion We demonstrated a significant increase in incidence of HCC within our population in the last five years in keeping with other published studies,2 but no increase in NAFLD-related hepatoma. Within our population we have been able to show a positive effect of the hepatoma screening programme in terms of early age of diagnosis, suitability for a therapeutic option and better short and medium term survival rates.
Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 2004;127(1):S35-S50
Davila JA, El-Serag HB. The rising incidence of hepatocellular carcinoma in the United States: an update. Gastroenterology 2012;142(1):S914
Disclosure of Interest None Declared.
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