Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study

Abstract

Background & aims: Hepatocellular carcinoma (HCC) is the second most common cause of cancer deaths worldwide. The global HCC BRIDGE study was a multiregional, large-scale, longitudinal cohort study undertaken to improve understanding of real-life management of patients with HCC, from diagnosis to death.

Methods: Data were collected retrospectively from January 2005 to September 2012 by chart reviews of eligible patients newly diagnosed with HCC at participating institutions.

Results: Forty-two sites in 14 countries contributed final data for 18 031 patients. Asia accounted for 67% of patients, Europe for 20% and North America for 13%. As expected, the most common risk factor was hepatitis C virus in North America, Europe and Japan, and hepatitis B virus in China, South Korea and Taiwan. The most common Barcelona Clinic Liver Cancer stage at diagnosis was C in North America, Europe, China and South Korea, and A in Taiwan and Japan. Across all stages, first HCC treatment was most frequently transarterial chemoembolization in North America, Europe, China and South Korea, percutaneous ethanol injection or radiofrequency ablation in Japan and resection in Taiwan. Survival from first HCC treatment varied significantly by region, with median overall survival not reached for Taiwan and 60, 33, 31, 24 and 23 months for Japan, North America, South Korea, Europe and China respectively (P < 0.0001).

Conclusions: Initial results from the BRIDGE study confirm previously reported regional trends in patient demographic characteristics and HCC risk factors, document the heterogeneity of treatment approaches across regions/countries and underscore the need for earlier HCC diagnosis worldwide.

Keywords: disease management; epidemiology; global trends; liver cancer; observational study; risk factors; treatment patterns.

Fig. 1

Distribution of sites participating in the HCC BRIDGE study by country.

Fig. 2

First recorded HCC treatment by country/region (A) and BCLC stage (B). *Percentages are based on percent of population with known values. ^†Any systemic therapy other than sorafenib, e.g., doxorubicin, gemcitabine, cisplatin, or other cytotoxic or biological agent. ^&ddagger;Any locoregional therapy not clearly PEI/RFA or TACE, e.g., transarterial radioembolization (TARE) or cryoablation. ^§Percentages are based on number of patients with data available; total may add up to >100% if more than one treatment was started concurrently. PEI, percutaneous ethanol injection; RFA, radiofrequency ablation; TACE, transarterial chemoembolization.

Fig. 3

Second recorded HCC treatment after first recorded resection, TACE, or PEI/RFA. *Combination therapy was not defined in the BRIDGE data; however, patients treated with either PEI or RFA were pooled together. ^†Percentages are based on percentage of population with known values. ^&ddagger;Includes grouped patients from Taiwan (n = 1587; 47%), South Korea (n = 1227; 37%), and Japan (n = 534; 16%). PEI, percutaneous ethanol injection; RFA, radiofrequency ablation; TACE, transarterial chemoembolization.

Fig. 4

Survival estimates from first HCC treatment by BCLC stage (A) and country/region (B), with number of subjects at risk and 95% Hall-Wellner bands (shaded colours). *Results shown are unadjusted and impacted to unknown degrees by lead-time and selection bias, as well as by censoring that decreases reliability with increasing time.