Hepatocellular carcinoma in Australia 1982 to 2014: increasing incidence and improving survival.

BACKGROUND AND AIMS: There is a paucity of accurate and current data on HCC trends in incidence and survival in developed countries. We performed an Australia-wide assessment of HCC epidemiology across a 33-year time span aiming to accurately describe changes in incidence and survival METHODS: Cases of HCC from 1982 to 2014 were identified via the Australian Cancer Database (ACD). Trends in incidence rates were explored using piecewise linear regression. Survival was compared by Kaplan-Meier survival curves and 1-, 3- and 5-year survival probabilities by year of diagnosis RESULTS: Age-adjusted HCC incidence rate increased from 1.38 per 100,000 (95%CI: 1.34-1.43) in 1982 to 4.96 per 100,000 (95%CI: 4.89-5.03, p<0.001) in 2014 with an average annual percentage increase of 4.46% (95%CI: 4.24%-4.69%). The highest incidence rate in 2014 was in those aged 75-79 (24.31 per 100,000; 95%CI: 19.50-29.12). Almost 80% of cases across the period were men who had significantly higher age-adjusted incidence rates in 2014 than women (8.55 per 100,000 {95%CI: 8.42-8.68} versus 1.65 per 100,000 {95%CI: 1.60-1.70}; p<0.001). A hepatitis C (HCV) birth cohort effect was identified and associated with rapid increases in HCC incidence when members of the cohort aged and entered into age groups 45-49, 50-54 and 55-59. Median survival increased from 2.10 months (95%CI: 1.57-2.62 months) in those diagnosed between 1982-1984 to 12.07 months (95%CI: 11.17-12.97 months) when diagnosed between 2010-2014 (p<0.001) CONCLUSIONS: An Australia-wide analysis of HCC epidemiological trends across three decades shows significant and consistent increases in both incidence and survival.