Rising Incidence of Hepatitis C-related Hepatocellular Carcinoma and Impact of Surveillance

Abstract

Background and AimsTo determine rates of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (HCV) and impact of regular surveillance on treatment outcomes and overall survival.MethodsA retrospective analysis of all HCC patients referred to NZLTU from January 1999 to June 2014.Results1300 new HCCs were diagnosed, of whom 288 were HCV-related. Number of HCV-HCCs increased from 1/27 (3.7%) in 1999 to 54/173 (31.2%) in 2013. 128 (44.44%) HCV-related HCCs were detected by surveillance whilst remaining 160 (55.56%) were diagnosed incidentally or following onset of symptoms. Of 160 symptomatic or incidentally picked up cases, 31 were not known to have prior diagnosis of HCV, 76 were diagnosed with HCV and known to have cirrhosis but lost to follow-up and 53 were diagnosed with HCV but thought to be non-cirrhotic. Of the 53 non-cirrhotic patients, 35 never underwent staging with either biopsy or a fibroscan. At most recent staging of remaining patients 6/18 had severe fibrosis (F3 or LSM>9.5 kPa), 8/18 had moderate fibrosis (F2 or LSM>7.1 kPa) and 4/18 had mild fibrosis (F0/F1 or LSM<7.1 kPa).At time of detection, 103/126 (80.5%) screen-detected HCCs were suitable for curative interventions compared to 63/160 (39.3%) not detected through screening.Conclusions Background and AimsTo determine rates of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (HCV) and impact of regular surveillance on treatment outcomes and overall survival. To determine rates of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (HCV) and impact of regular surveillance on treatment outcomes and overall survival. MethodsA retrospective analysis of all HCC patients referred to NZLTU from January 1999 to June 2014. A retrospective analysis of all HCC patients referred to NZLTU from January 1999 to June 2014. Results1300 new HCCs were diagnosed, of whom 288 were HCV-related. Number of HCV-HCCs increased from 1/27 (3.7%) in 1999 to 54/173 (31.2%) in 2013. 128 (44.44%) HCV-related HCCs were detected by surveillance whilst remaining 160 (55.56%) were diagnosed incidentally or following onset of symptoms. Of 160 symptomatic or incidentally picked up cases, 31 were not known to have prior diagnosis of HCV, 76 were diagnosed with HCV and known to have cirrhosis but lost to follow-up and 53 were diagnosed with HCV but thought to be non-cirrhotic. Of the 53 non-cirrhotic patients, 35 never underwent staging with either biopsy or a fibroscan. At most recent staging of remaining patients 6/18 had severe fibrosis (F3 or LSM>9.5 kPa), 8/18 had moderate fibrosis (F2 or LSM>7.1 kPa) and 4/18 had mild fibrosis (F0/F1 or LSM<7.1 kPa).At time of detection, 103/126 (80.5%) screen-detected HCCs were suitable for curative interventions compared to 63/160 (39.3%) not detected through screening. 1300 new HCCs were diagnosed, of whom 288 were HCV-related. Number of HCV-HCCs increased from 1/27 (3.7%) in 1999 to 54/173 (31.2%) in 2013. 128 (44.44%) HCV-related HCCs were detected by surveillance whilst remaining 160 (55.56%) were diagnosed incidentally or following onset of symptoms. Of 160 symptomatic or incidentally picked up cases, 31 were not known to have prior diagnosis of HCV, 76 were diagnosed with HCV and known to have cirrhosis but lost to follow-up and 53 were diagnosed with HCV but thought to be non-cirrhotic. Of the 53 non-cirrhotic patients, 35 never underwent staging with either biopsy or a fibroscan. At most recent staging of remaining patients 6/18 had severe fibrosis (F3 or LSM>9.5 kPa), 8/18 had moderate fibrosis (F2 or LSM>7.1 kPa) and 4/18 had mild fibrosis (F0/F1 or LSM<7.1 kPa). At time of detection, 103/126 (80.5%) screen-detected HCCs were suitable for curative interventions compared to 63/160 (39.3%) not detected through screening. Conclusions