The landscape of hepatocellular carcinoma in the UK in the past 20 years: the HCCUK/NCRAS partnership.


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Anya Burton1,Robert Driver2,Vinay Kumar3,Katherine Cullen4,Rhys Pockett4,Deborah Fitzsimmons4,Graeme Alexander5,Tim Cross6,Ian Rowe7,Aileen Marshall8
1Public Health England, London, UK,2University of Leeds, Leeds, UK,3University of Liverpool, Liverpool, UK,4Swansea Centre for Health Economics, Swansea, UK,5University College London, London, UK,6Royal Liverpool and Broadgreen Hospitals, Liverpool, UK,7St James University Hospital Leeds, Leeds, UK,8Royal Free Hospital, London, UK

Abstract

Background

The HCC-UK/NCRAS partnership was created in 2017 to facilitate a wide programme of research relating to hepatocellular carcinoma (HCC) using data available within the National Cancer Registration and Analysis Service (NCRAS). NCRAS data includes tumour- and patient-specific variables, diagnosis and treatment information. These individual-level data are linked to multiple datasets including Hospital Episodes Statistics (HES).

Aim: The partnership programme is examining the epidemiology of HCC in England, including regional variation in incidence, routes to diagnosis, treatment and survival, as well as the economic burden.

Method

HCC cases were identified using ICD10-O-2 code C22.0 and morphology code M8170.  Demographic characteristics were explored and European age-standardised incidence and mortality rates per 100,000 person years calculated. Linked HES codes were used to identify the presence and severity of cirrhosis.

Results

62,135 primary liver cancer cases were diagnosed in England between 1997 and 2016. 29,906 of these were HCC.  For HCC the mean age at diagnosis was 68.4 years and the male to female ratio was 3.4. Overall 25% of all HCC cases were from the most deprived population quintile.  58% of HCC cases were identified as having cirrhosis and, of these, 42% had decompensated cirrhosis, through linked HES data.  The majority of HCC patients did not receive specific anticancer treatment. The two most common Routes to Diagnosis were emergency presentation (35%) and GP referral (30%).

Conclusion

HCC incidence and mortality have tripled over the last 20 years; the most deprived individuals are most at risk. HCC is often associated with cirrhosis and more than one in five individuals diagnosed with HCC has advanced cirrhosis such that treatment options for HCC are severely limited. These trends highlight the urgent need to address prevention strategies for both liver disease and hepatocellular carcinoma specifically at regional and population level.