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.
- 1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74-108.
- 2. International Agency for Research on Cancer, World Health Organization. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. Liver cancer. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx (accessed Jan 2014).
- 3. Australian Institute of Health and Welfare. Cancer in Australia 2010: an overview. Canberra: AIHW, 2010. (AIHW Cat. No. CAN 56; Cancer Series No. 60.) https://www.aihw.gov.au/publication-detail/?id=6442472459 (accessed Feb 2014).
- 4. MacLachlan JH, Cowie BC. Liver cancer is the fastest increasing cause of cancer death in Australians. Med J Aust 2012; 197: 492-493. <MJA full text>
- 5. Wan X, Mathews JD. Primary hepatocellular carcinoma in Aboriginal Australians. Aust J Public Health 1994; 18: 286-290.
- 6. Condon JR, Barnes T, Cunningham J, Armstrong BK. Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory. Med J Aust 2004; 180: 504-507. <MJA full text>
- 7. Liu B, Guthridge S, Li SQ, et al. The end of the Australia antigen? An ecological study of the impact of universal newborn hepatitis B vaccination two decades on. Vaccine 2012; 30: 7309-7314.
- 8. Carroll E, Page W, Davis JS. Screening for hepatitis B in East Arnhem Land: a high prevalence of chronic infection despite incomplete screening. Intern Med J 2010; 40: 784-787.
- 9. Dent E, Selvey CE, Bell A, et al. Incomplete protection against hepatitis B among remote Aboriginal adolescents despite full vaccination in infancy. Commun Dis Intell Q Rep 2010; 34: 435-439.
- 10. Wood N, Backhouse J, Gidding HF, et al. Estimates of chronic hepatitis B virus infection in the Northern Territory. Commun Dis Intell Q Rep 2005; 29: 289-290.
- 11. Graham S, Guy RJ, Cowie B, et al. Chronic hepatitis B prevalence among Aboriginal and Torres Strait Islander Australians since universal vaccination: a systematic review and meta-analysis. BMC Infect Dis 2013; 13: 403.
- 12. MacLachlan JH, Allard N, Towell V, Cowie BC. The burden of chronic hepatitis B virus infection in Australia, 2011. Aust N Z J Public Health 2013; 37: 416-422.
- 13. Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005; 42: 1208-1236.
- 14. Chondur R, Guthridge S. Population data in the Northern Territory. Darwin: Department of Health and Community Services, 2006. http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/113/1/population_info_paper_formatted_aug06.pdf (accessed Jan 2014).
- 15. Australian Bureau of Statistics. Australian demographic statistics, September quarter 2002. Canberra: ABS, 2003. (ABS Cat. No. 3101.0.) http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&31010_sep%202002.pdf&3101.0&Publication&104DE27A798E5A37CA256CEE008139E4&24&Sep%202002&20.03.2003&Previous (accessed Feb 2014).
- 16. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334: 693-699.
- 17. Bruix J, Sherman M; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53: 1020-1022.
- 18. European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-943.
- 19. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004; 130: 417-422.
- 20. McMahon BJ, Bulkow LR, Singleton RJ, et al. Elimination of hepatocellular carcinoma and acute hepatitis B in children 25 years after a hepatitis B newborn and catch-up immunization program. Hepatology 2011; 54: 801-807.
- 21. Sun Z, Chen T, Thorgeirsson SS, et al. Dramatic reduction of liver cancer incidence in young adults: 28 year follow-up of etiological interventions in an endemic area of China. Carcinogenesis 2013; 34: 1800-1805.
- 22. Robotin MC, Kansil M, Howard K, et al. Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening. J Hepatol 2009; 50: 990-998.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.