S1243 Epidemiology of Hepatocellular Carcinoma (HCC) in a Canadian University Centre

Abstract

Introduction: Nearly 85% of HCC cases are reported in Asia and Saharan Africa. This explains why data on risk factors often concerns Asian populations. In fact, hepatitis B and C are among the major risk factors leading to HCC in current literature. We believe our predominant Caucasian population might not be the same given the different incidence of Non-Alcoholic Steatohepatitis (NASH) or alcoholic cirrhosis compared to these countries. In this study, we evaluated the prevalence of risk factors of HCC in our Canadian population in order to prevent and identify the best treatments for our population. Since the cause leading to HCC might modify management in the future, it becomes interesting to describe the epidemiology of our population. Methods: We retrospectively reviewed 196 files of patients 18 years of age and older diagnosed with HCC by radiological or pathological criteria between 2010 and 2020 from two of our university databases (Registre Local du Cancer and Ned-Écho). The prevalence of cirrhosis, hepatitis B, hepatitis C, alcoholic cirrhosis and NASH were presented using proportion with the Wilson method using 95% confidence interval. Z tests were used to compare the prevalence of our population’s HCC risk factors with the literature values. Finally, a Cox model was used to assess the risks factors contributing most to mortality. Results: 178 patients were included in our study. 94.9% of our population was Caucasian. 83.1% were male.19.6% did not have an underlying cirrhosis. Only 59.6% had a CHILD A cirrhosis limiting accessibility to treatment. Furthermore, the prevalence of hepatitis B was 4.7% compared to 33% in current literature (p< 0.001), hepatitis C was 25.1% compared to 21% (p =0.183), alcoholism was 45.0% compared to 30% (p< 0.001), NASH was 37.8% compared to less than 16% (p=0.002). There was no statistical difference in mortality by cancer risk factor. Conclusion: New evidence suggest that HCC related to NASH may be a favourable prognostic factor in patients treated with lenvatinib. Hence, the choice of a tyrosine kinase treatment might be better for the management of a Caucasian population. Promoting good lifestyle habits might also reduce the incidence of HCC in our Canadian population given the high prevalence of HCC related to NASH and alcoholic cirrhosis. Finally, approximatively half of our population had a CHILD A cirrhosis which emphasizes how crucial it is to adequately screen for HCC before cirrhosis progression as this will have an effect on management and prognostic.