Staging and therapy for patients with hepatocellular cancer in a defined population from 2000 to 2011 – active palliative treatment improved overall survival

Abstract

Background: Sweden’s western region has successively introduced the use of validated non-invasive diagnostic algorithms and treatment allocation for hepatocellular cancer (HCC). The aim was to analyse whether between 2000 and 2011 these changes in strategy had an impact on survival.

Methods: Data concerning diagnosis, survival and treatment for 687 individuals with HCC were retrieved from the regional cancer centre’s register and hospital charts. The 12-year period was divided into three four-year cohorts (A-B-C).

Results: There was an increase in the crude incidence rate of HCC from 2.7 to 4.2 per 100 000 inhabitants (p < 0.0001) over the period studied. Imaging was increasingly used for diagnosis over the three time periods (1.4%, 7.9% and 29%; p < 0.0001). Alcohol abuse was the most common aetiology for underlying liver disease (42%). The median survival time for all HCC patients improved over time – period A: 3.8 months, period B: 5.1 months and period C: 7.0 months (p = 0.0007). The 209 patients without any underlying liver disease had a worse survival than the 377 with a reported underlying liver disease (p = 0.0001). Active palliative treatment (APT) increased from 17% to 35% during period C (p < 0.0001). For these patients, median survival increased from 8.8 months to 14.2 months. Best supportive care was used less over time.

Discussion: Overall survival improved when more patients had APT, mainly trans arterial chemoembolisation (TACE).