Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer deaths both globally and in Australia. Although survival rate for HCC is low, early detection offers a chance for curative treatment. Individuals with liver cirrhosis (severe scarring of the liver) and chronic hepatitis B infection from high-risk regions have increased HCC risks and are recommended to undergo surveillance with six-monthly ultrasounds.
Methods: Using data from the 45 and Up Study cohort, linked with the NSW Cancer Registry, we identified 302 patients with incident HCC diagnosed over 2006-2019. Possible aetiologies of liver disease and patterns of abdominal imaging utilisation were determined through linkage with routinely collected data, including hospital records, medical and pharmaceutical claims data from Services Australia. Abdominal imaging was categorised as 0-6, 6-12, or 12-24 months before HCC diagnosis.
Results: The median age of the patients was 69 years. Most patients were male (78%) and born in Australia & Oceania (69%). 64% of the patients were overweight with a body mass index (BMI) greater than 25. Ex-smokers accounted for 47% of the patients, and 48% had a documented diagnosis of diabetes. Aetiologies of liver disease were determined from hospital and pharmaceutical claims records, with 14% attributed to alcohol-related liver disease, 7% to fatty liver, 11% to a combination of viral hepatitis and alcohol, and 21% to viral hepatitis alone. Linked records did not reveal a cause in 48% of cases. Only 5% of patients had a prior admission for cirrhosis before HCC diagnosis, while 59% were diagnosed with cirrhosis at or after the time of HCC diagnosis.
In the 6 months preceding HCC diagnosis, 69% of patients underwent one or more form of abdominal imaging (ultrasound, CT or MRI). During the 6-12 months and 12-24 months before diagnosis, 23% and 33% of patients, respectively, had a record of abdominal imaging. Only 16% underwent abdominal imaging tests in both periods, indicating probable liver surveillance. Uptake of abdominal imaging was not significantly associated with age, BMI, alcohol intake, smoking history, or liver disease aetiology.
Conclusion: This study describes the clinical characteristics and surveillance patterns in patients with HCC in Australia. The findings reveal suboptimal surveillance practices, with a significant proportion of patients lacking regular abdominal imaging in the years leading up to HCC diagnosis. Efforts should be directed towards increasing awareness among clinicians and patients to identify at-risk individuals and improving surveillance strategies to facilitate early detection.