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Hepatocellular carcinoma in Australia's Northern Territory: high incidence and poor outcome

Christopher Parker, Steven Y C Tong, Karen Dempsey, John Condon, Suresh K Sharma, John W C Chen, William Sievert and Joshua S Davis
Med J Aust 2014; 201 (8): 470-474. || doi: 10.5694/mja13.11117

Summary

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.

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  • Christopher Parker1
  • Steven Y C Tong1
  • Karen Dempsey2
  • John Condon1
  • Suresh K Sharma3
  • John W C Chen4
  • William Sievert5
  • Joshua S Davis1

  • 1 Menzies School of Health Research, Darwin, NT.
  • 2 Health Gains Planning Unit, Northern Territory Government, Darwin, NT.
  • 3 Royal Darwin Hospital, Darwin, NT.
  • 4 South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, SA.
  • 5 Monash Medical Centre, Melbourne, VIC.


Acknowledgements: 

We thank Libby John, Darren Mounkley, Ramon Pathi and Mark Brooke-Smith from Flinders Medical Centre; and Krispin Hajkowicz, Jane Davies and all the registrars from the Royal Darwin Hospital liver clinic for helping with clinical management of the patients in this study. We thank Mark Loewenthal for statistical advice. National Health and Medical Research Council early career fellowships provided salary support for Joshua Davis and Steven Tong.

Competing interests:

No relevant disclosures.

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