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Hepatocellular carcinoma in Australia's Northern Territory: high incidence and poor outcome
Author(s) -
Parker Christopher,
Tong Steven Y C,
Dempsey Karen,
Condon John,
Sharma Suresh K,
Chen John W C,
Sievert William,
Davis Joshua S
Publication year - 2014
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja13.11117
Subject(s) - medicine , incidence (geometry) , epidemiology , hepatocellular carcinoma , cancer registry , hazard ratio , population , liver cancer , demography , environmental health , confidence interval , physics , sociology , optics
Objective: To describe the epidemiology, clinical features, management and outcomes of hepatocellular carcinoma (HCC) in the Northern Territory over the past decade. Design, setting and patients : An NT‐wide epidemiology study covering the period 1991–2010 and a clinical cohort study including patients diagnosed during 2000–2011. HCC diagnoses were provided by the NT Cancer Registry and cross‐checked against clinical records. Main outcome measures: Age‐adjusted incidence of HCC; management; clinical features; and median and 1‐year survival. Results: There were 145 incident cases of HCC in the NT during 1991–2010, giving an age‐adjusted annual incidence of 22.7/100 000 (95% CI, 17.2–26.8) for Indigenous Australians and 4.0/100 000 (95% CI, 2.1–5.8) for non‐Indigenous Australians — an incidence rate ratio of 5.9 (95% CI, 4.7–7.4). There was no significant change in annual age‐adjusted incidence over this period. The most common causative factors were hepatitis B virus in Indigenous people and hepatitis C virus in non‐Indigenous people. Most people were diagnosed late, only 13/80 were diagnosed by screening, and outcomes were poor, with 28/80 overall surviving to 1 year. Outcomes were better among those managed through a centralised multidisciplinary service than among those who were not (adjusted hazard ratio for death at 1 year, 0.35 [95% CI, 0.16–0.81]). Conclusion: HCC incidence remains high in the Indigenous people of the NT. More resources are needed for HCC surveillance and management programs in this population.