Temporal change in etiology and clinical characteristics of hepatocellular carcinoma in a large cohort of patients with hepatocellular carcinoma in New South Wales, Australia

Abstract

AbstractBackgroundViral hepatitis and alcohol-related liver disease (ALRD) are the main risk factors for hepatocellular carcinoma (HCC) in many countries. In Australia, given the access to hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy since 2016, a temporal change in HCC etiology was hypothesized. This study evaluated the temporal change in the etiology and characteristics of HCC in New South Wales (NSW).MethodsPatients diagnosed with HCC, admitted to three public hospitals in NSW between 2008-21, were included in analyses. We assessed the annual frequency of each HCC etiology and the distribution of HCC characteristics in participants.ResultsAmong 1,370 patients, the most common HCC etiologies were HCV (n=483, 35%), ALRD (n=452, 33%), non-alcoholic fatty liver disease (n=347, 25%), and hepatitis B virus (n=301, 22%). The proportion of HCV-related HCC was the highest in 2011-16 (41%), and significantly declined to 30% in 2017-21 (OR: 0.53, 95%CI 0.35–0.79; p=0.002). The proportion of HCC with earlier diagnosis (BCLC stage O/A) increased from 41% in 2008-09 to 56% in 2020-21 (OR per annum: 1.05; 95%CI: 1.02–1.08; p=0.002), and proportion of patients receiving curative HCC management increased from 29% in 2008-09 to 41% in 2020-21 (OR per annum: 1.06; 95%CI: 1.03–1.10; p<0.001).ConclusionThe contribution of HCV to HCC burden has been decreasing in the DAA era, suggesting the role of HCV elimination in decreasing HCC risk. Increasing frequency of less advanced HCC at diagnosis over time suggests improved HCC surveillance.Lay SummaryIn New South Wales, the trend of liver cancer caused by hepatitis C increased during 2008-2016, and then significantly declined after 2016, most probably due to wide access to new hepatitis C treatment (direct-acting antiviral therapy). During 2008-2021, the proportion of patients with liver cancer whose cancer was diagnosed at early stage and proportion of those receiving curative liver cancer management increased.