Epidemiology of hepatitis B-associated hepatocellular carcinoma in Victoria

M. Sinclair, S. Roberts, W. Kemp, V. Knight, A. Dev, P. Gow, H. Philpott, I. Kronborg, N. J. Arachchi, S. Bell, L. Lim, A. Gorelik, A. Nicoll

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Abstract

Background: Chronic hepatitis B (HBV) and cirrhosis are major risk factors for hepatocellular carcinoma (HCC). The proportion and characteristics of cases with cirrhosis are not well documented. Aim: Our aim was to compare demographic, viral and tumour characteristics of HBV-associated HCC in an Australian cohort, in patients with and without cirrhosis. Methods: Existing HCC databases at six Melbourne teaching hospitals were reviewed for cases associated with HBV. Patient demographics, HBV viral characteristics, presence of cirrhosis, serum alpha-fetoprotein and tumour size were assessed. Mode of diagnosis was recorded through surveillance or symptoms, and treatment was either palliative, percutaneous or surgical. Results: We identified 197 cases of HBV-related HCC. The mean age was 57.9 ± 12.9 years; 83% were male, and 55.3% and 35.3% were of Asian and European descent respectively. Of 168 patient with available data, 146 (87%) had cirrhosis versus 22 (13%) without. Patients with cirrhosis tended to be older (median 60 vs 52 years, P = 0.078). Asian patients were more likely to have HCC without cirrhosis than Europeans (17% vs 6%, P = 0.04). There were no other differences identified between cirrhotic and non-cirrhotic patients. Thirty-four per cent of patients had tumours greater than 5cm at diagnosis, and 47% were diagnosed after presenting with symptoms. Twelve patients with HBV-HCC were outside current screening guidelines. Conclusion: Most patients in Melbourne with HBV-associated HCC have cirrhosis. HCC characteristics in non-cirrhotic and cirrhotic patients were similar. The large number of patients detected through symptoms and with large tumours reinforces the need for vigilance in screening.

Original languageEnglish
Pages (from-to)501-506
Number of pages6
JournalInternal Medicine Journal
Volume43
Issue number5
DOIs
Publication statusPublished - 1 May 2013

Keywords

  • Cirrhosis
  • Epidemiology
  • Hepatitis B
  • Hepatocellular carcinoma

Cite this

Sinclair, M. ; Roberts, S. ; Kemp, W. ; Knight, V. ; Dev, A. ; Gow, P. ; Philpott, H. ; Kronborg, I. ; Arachchi, N. J. ; Bell, S. ; Lim, L. ; Gorelik, A. ; Nicoll, A. / Epidemiology of hepatitis B-associated hepatocellular carcinoma in Victoria. In: Internal Medicine Journal. 2013 ; Vol. 43, No. 5. pp. 501-506.
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Sinclair, M, Roberts, S, Kemp, W, Knight, V, Dev, A, Gow, P, Philpott, H, Kronborg, I, Arachchi, NJ, Bell, S, Lim, L, Gorelik, A & Nicoll, A 2013, 'Epidemiology of hepatitis B-associated hepatocellular carcinoma in Victoria', Internal Medicine Journal, vol. 43, no. 5, pp. 501-506. https://doi.org/10.1111/imj.12068

Epidemiology of hepatitis B-associated hepatocellular carcinoma in Victoria. / Sinclair, M.; Roberts, S.; Kemp, W.; Knight, V.; Dev, A.; Gow, P.; Philpott, H.; Kronborg, I.; Arachchi, N. J.; Bell, S.; Lim, L.; Gorelik, A.; Nicoll, A.

In: Internal Medicine Journal, Vol. 43, No. 5, 01.05.2013, p. 501-506.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Epidemiology of hepatitis B-associated hepatocellular carcinoma in Victoria

AU - Sinclair, M.

AU - Roberts, S.

AU - Kemp, W.

AU - Knight, V.

AU - Dev, A.

AU - Gow, P.

AU - Philpott, H.

AU - Kronborg, I.

AU - Arachchi, N. J.

AU - Bell, S.

AU - Lim, L.

AU - Gorelik, A.

AU - Nicoll, A.

PY - 2013/5/1

Y1 - 2013/5/1

N2 - Background: Chronic hepatitis B (HBV) and cirrhosis are major risk factors for hepatocellular carcinoma (HCC). The proportion and characteristics of cases with cirrhosis are not well documented. Aim: Our aim was to compare demographic, viral and tumour characteristics of HBV-associated HCC in an Australian cohort, in patients with and without cirrhosis. Methods: Existing HCC databases at six Melbourne teaching hospitals were reviewed for cases associated with HBV. Patient demographics, HBV viral characteristics, presence of cirrhosis, serum alpha-fetoprotein and tumour size were assessed. Mode of diagnosis was recorded through surveillance or symptoms, and treatment was either palliative, percutaneous or surgical. Results: We identified 197 cases of HBV-related HCC. The mean age was 57.9 ± 12.9 years; 83% were male, and 55.3% and 35.3% were of Asian and European descent respectively. Of 168 patient with available data, 146 (87%) had cirrhosis versus 22 (13%) without. Patients with cirrhosis tended to be older (median 60 vs 52 years, P = 0.078). Asian patients were more likely to have HCC without cirrhosis than Europeans (17% vs 6%, P = 0.04). There were no other differences identified between cirrhotic and non-cirrhotic patients. Thirty-four per cent of patients had tumours greater than 5cm at diagnosis, and 47% were diagnosed after presenting with symptoms. Twelve patients with HBV-HCC were outside current screening guidelines. Conclusion: Most patients in Melbourne with HBV-associated HCC have cirrhosis. HCC characteristics in non-cirrhotic and cirrhotic patients were similar. The large number of patients detected through symptoms and with large tumours reinforces the need for vigilance in screening.

AB - Background: Chronic hepatitis B (HBV) and cirrhosis are major risk factors for hepatocellular carcinoma (HCC). The proportion and characteristics of cases with cirrhosis are not well documented. Aim: Our aim was to compare demographic, viral and tumour characteristics of HBV-associated HCC in an Australian cohort, in patients with and without cirrhosis. Methods: Existing HCC databases at six Melbourne teaching hospitals were reviewed for cases associated with HBV. Patient demographics, HBV viral characteristics, presence of cirrhosis, serum alpha-fetoprotein and tumour size were assessed. Mode of diagnosis was recorded through surveillance or symptoms, and treatment was either palliative, percutaneous or surgical. Results: We identified 197 cases of HBV-related HCC. The mean age was 57.9 ± 12.9 years; 83% were male, and 55.3% and 35.3% were of Asian and European descent respectively. Of 168 patient with available data, 146 (87%) had cirrhosis versus 22 (13%) without. Patients with cirrhosis tended to be older (median 60 vs 52 years, P = 0.078). Asian patients were more likely to have HCC without cirrhosis than Europeans (17% vs 6%, P = 0.04). There were no other differences identified between cirrhotic and non-cirrhotic patients. Thirty-four per cent of patients had tumours greater than 5cm at diagnosis, and 47% were diagnosed after presenting with symptoms. Twelve patients with HBV-HCC were outside current screening guidelines. Conclusion: Most patients in Melbourne with HBV-associated HCC have cirrhosis. HCC characteristics in non-cirrhotic and cirrhotic patients were similar. The large number of patients detected through symptoms and with large tumours reinforces the need for vigilance in screening.

KW - Cirrhosis

KW - Epidemiology

KW - Hepatitis B

KW - Hepatocellular carcinoma

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