Improving survival in patients with hepatocellular carcinoma related to chronic hepatitis C and B but not in those related to non‐alcoholic steatohepatitis or alcoholic liver disease: a 20‐year experience from a national programme
| Autor: | Edward Gane, Ibrahim M Hassan |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Alcoholic liver disease medicine.medical_specialty Carcinoma Hepatocellular 030204 cardiovascular system & hematology medicine.disease_cause Gastroenterology 03 medical and health sciences Liver disease Hepatitis B Chronic 0302 clinical medicine Non-alcoholic Fatty Liver Disease Internal medicine Internal Medicine medicine Humans Registries 030212 general & internal medicine Liver Diseases Alcoholic Hepatitis B virus business.industry Liver Neoplasms Fatty liver Hepatitis C Hepatitis C Chronic Hepatitis B medicine.disease digestive system diseases Liver Transplantation Survival Rate Hepatocellular carcinoma Female Steatohepatitis business New Zealand |
| Zdroj: | Internal Medicine Journal. 49:1405-1411 |
| ISSN: | 1445-5994 1444-0903 |
| DOI: | 10.1111/imj.14304 |
| Popis: | BACKGROUND Hepatocellular carcinoma (HCC) is the most rapidly increasing cause of cancer mortality in New Zealand due to endemic hepatitis B virus (HBV) infection and recent hepatitis C virus (HCV) and obesity epidemics. AIM To describe the changing landscape of HCC referred to a national HCC service over a 20-year period, including trends in underlying liver disease, screening uptake and access to curative treatments, and to determine the impact of screening on outcomes with a comparison between screened detected and non-screened detected cases. METHODS All newly diagnosed cases of HCC referred to New Zealand Liver Transplant Unit between 1998 and 2017 were included. Data on patient demographics, liver disease aetiology, screening status and treatment modalities were collected. RESULTS HCC diagnosis rates have increased from 24 cases in 1998 to 250 in 2017, an increase of 20% per annum. The total of 1985 HCC cases was divided into three cohorts (Era 1: 1998-2009; Era 2: 2009-2014; Era 3: 2014-2017), each comprising 661-662 patients. During the study period, overall survival improved (P = 0.005). The proportion with screen-detected HCC was similar across the three cohorts (44% in Era 1, 42% in Era 2 and 47% in Era 3). Five- and 10-year survival was higher in screen-detected cases (49 and 43%) than in non-screen detected cases (14 and 10%), P < 0.0001. Survival was higher in patients with HCV and HBV than in those with non-alcoholic steatohepatitis (NASH) or alcoholic liver disease (ALD) - 5 and 10-year survival was 40 and 34% in HCV-HCC, 30 and 26% in HBV-HCC, 15 and 14% in NASH-HCC, 13 and 10% in ALD-HCC, P < 0.0001. CONCLUSION Better outcomes in patients with HBV- or HCV-related HCC than in those with NASH-related or ALD-related HCV may reflect better screening uptake and better access to curative therapies. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text