Epidemiology, clinical treatment patterns, and survival of hepatocellular carcinoma in Manitoba

Nikesh Hanumanthappa; Byung Heon Cho; Andrew McKay; David Peretz; Gerald Y Minuk; Pascal Lambert; Maged Nashed

doi:10.3138/canlivj.2019-0015

Epidemiology, clinical treatment patterns, and survival of hepatocellular carcinoma in Manitoba

Can Liver J. 2020 Jun 4;3(2):194-202. doi: 10.3138/canlivj.2019-0015. eCollection 2020 Spring.

Authors

Nikesh Hanumanthappa¹, Byung Heon Cho², Andrew McKay³, David Peretz³, Gerald Y Minuk⁴, Pascal Lambert⁵, Maged Nashed¹

Affiliations

¹ Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
² Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Section of Hepatology, Department of Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Section of Hepatology, Department of Internal Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
⁵ Department of Epidemiology and Statistics, CancerCare Manitoba, Winnipeg, Manitoba, Canada.

Abstract

Background: Hepatocellular carcinoma (HCC) has a very poor survival rate, especially for those who do not receive a potentially curative therapy.

Methods: Treatment details were collected for 320 HCC patients diagnosed in Manitoba between January 2011 and December 2015. Patients had a mean age of 67.3 years, and 71.6% were men. Of these patients, 67 (20.9%) received curative treatment, 36 (11.3%) received non-curative treatment, and 217 (67.8%) received supportive care only; 71.3% of patients had liver cirrhosis. Alcoholic cirrhosis was the most common etiology of chronic liver disease (22.2%).

Results: Those who received curative treatment had a significantly lower incidence of portal vein thrombosis and multinodular disease than those in other groups. Patients who received supportive care only had a higher incidence of ascites. We found no difference in the distribution of cirrhosis or portal hypertension among the treatment groups. The 2- and 5-year overall survival rates for the whole cohort were 27% and 14%, respectively. No significant change was found in 2-year survival for patients diagnosed in each year from 2011 to 2015 (p = 0.250). Also, we found no significant change in proportion of treatment given to patients over the same period (p = 0.432).

Conclusion: The poor survival rate of HCC patients in Manitoba could potentially be improved by maximizing the use of local therapy and by implementing multidisciplinary-based case discussion. Efforts should also be directed toward early management of infective, alcoholic, and non-alcoholic steatohepatitis, which will, we hope, lead to a reduction in the incidence of HCC.

Keywords: Manitoba; epidemiology; hepatocellular carcinoma; local therapy; survival Author Affiliation.