Hepatocellular carcinoma in an Australian tertiary referral hospital 1975-2002: Change in epidemiology and clinical presentation

Aim: We compared the epidemiology and clinical features of hepatocellular carcinoma (HCC) cases diagnosed between 1975 and 2002. Methods: Retrospective and prospective analysis was performed of HCC cases diagnosed at The Alfred during the time periods 1975-1983 and 1995-2002. Demographic, epidemiological, clinical and laboratory data were recorded and compared between the two periods. Results: Comparing the 1995-2002 cohort to the 1975-1983 cohort, patients were older (64 years vs 60 years; P = 0.02), and were more likely to be non-Caucasian (25% vs 9%; P = 0.003) and born overseas (57% vs 40%; P = 0.03) particularly from Asia. In addition, hepatitis C virus (HCV) (35%), hepatitis B virus (HBV) (22%), and alcoholic liver disease (29%) were the major etiological factors for HCC with alcohol less likely the cause of underlying liver disease (33% vs 55%; P < 0.01). Among the 1995-2002 cohort, overseas-born patients were more likely to be infected with HBV (P < 0.001) and HCV (P = 0.01), while alcohol was more likely to be the etiological factor in Australian-born cases (P = 0.02), particularly among males. Detection of HCC by screening was the initial presentation in 38% of patients, and diagnosis of HCC was often by non-invasive means. Conclusions: The epidemiology of HCC has changed in Australia over the past 20 years with hepatitis C and hepatitis B now major etiological factors, and an increase in cases born overseas particularly from areas where HCV and HBV are endemic. This suggests the recent increase in incidence and death rates due to HCC in Australia relate to HCV and HBV infection.