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. 2021 Jan 19;3(2):100232.
doi: 10.1016/j.jhepr.2021.100232. eCollection 2021 Apr.

Primary liver cancer in the UK: Incidence, incidence-based mortality, and survival by subtype, sex, and nation

Anya Burton  1   2 , Daniela Tataru  2 , Robert J Driver  3 , Thomas G Bird  4   5   6 , Dyfed Huws  7 , David Wallace  8 , Timothy J S Cross  9 , Ian A Rowe  10   11 , Graeme Alexander  12 , Aileen Marshall  13 ; HCC-UK/BASL/NCRAS Partnership Steering Group
Collaborators, Affiliations

Primary liver cancer in the UK: Incidence, incidence-based mortality, and survival by subtype, sex, and nation

Anya Burton et al. JHEP Rep. .

Abstract

Background & aims: The incidence of primary liver cancer (PLC) is increasing in Western Europe. To understand trends over time and the current burden in the UK, a detailed analysis of the epidemiology of PLC and its subtypes was conducted.

Methods: Data on PLCs diagnosed during 1997-2017 were obtained from population-based, nationwide registries in the UK. European age-standardised incidence (ASR) and incidence-based mortality rates (ASMR) per 100,000 person-years were calculated overall and by sex and UK-nation. Annual percentage change in rates was estimated using Joinpoint regression. One-, 2-, and 5-year age-standardised net survival was estimated.

Results: A total of 82,024 PLCs were diagnosed. Both hepatocellular carcinoma (HCC) incidence and mortality rates trebled (ASR 1.8-5.5 per 100,000, ASMR 1.3-4.0). The rate of increase appeared to plateau around 2014/2015. Scottish men consistently had the highest HCC incidence rates. PLC survival increased, driven by a substantial increase in the proportion that are HCC (as prognosis is better than other PLCs) and in HCC survival (change in 1-year survival 24-47%). Intrahepatic cholangiocarcinoma was the most common PLC in women and 1-year survival improved from 22.6% to 30.5%.

Conclusions: PLC incidence has been increasing rapidly but, as most risk factors are modifiable, it is largely a preventable cancer. This rate of increase has slowed in recent years, possibly attributable to effective treatment for hepatitis C. As other risk factors such as obesity and diabetes remain prevalent in the UK, it is unlikely the considerable burden of this disease will abate. While improvements in survival have been made, over half of patients are not alive after 1 year, therefore further progress in prevention, early detection, and treatment innovation are needed.

Lay summary: Many more people are getting liver cancer, particularly the subtype hepatocellular carcinoma, than 20 years ago. Men in Scotland are most likely to get liver cancer and to die from it. Survival after liver cancer diagnosis is getting longer but still less than half are alive after 1 year.

Keywords: AAPC, average annual percentage change; APC, annual percentage change; ASMR, age-standardised mortality rate; ASR, age-standardised incidence rate; BASL, British Association for the Study of the Liver; DAA, direct-acting antivirals; DCO, death certificate only; HCC, hepatocellular carcinoma HCV, hepatitis C virus; Hepatocellular carcinoma; ICCA, intrahepatic cholangiocarcinoma; ICD-10, International Classification of Diseases 10th Edition; ICD-O, International Classification of Diseases for Oncology; Incidence; Intrahepatic cholangiocarcinoma; Mortality; NAFLD, non-alcoholic fatty liver disease; NCRAS, National Cancer Registration and Analysis Service; NI, Northern Ireland; PLC, primary liver cancer; Primary liver cancer; Survival.

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Conflict of interest statement

All of the authors completed the ICMJE uniform disclosure form; GA, AM, DT, DH, DW, TGB, and RJD have nothing to disclose. During the conduct of the study, AB reports grants from BTG International Ltd. Outside of the submitted work TJSC reports grants from Sirtex, Bristol-Myers-Squibb, and Bayer and personal fees from Eisai pharmaceuticals, Bayer, AstraZeneca, and Roche. IAR reports personal fees from Roche and Abbvie, outside the submitted work. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Age-standardised incidence and incidence-based mortality. (A) Primary liver cancer; (B) hepatocellular carcinoma; (C) intrahepatic cholangiocarcinoma; (D) other and unspecified liver tumours. Estimates from 3-year rolling cohorts. ASR, age-standardised incidence rate per 100,000.
Fig. 2
Fig. 2
Age-standardised net-survival in all persons by nation and subtype. (A) Primary liver cancer; (B) hepatocellular carcinoma; (C) intrahepatic cholangiocarcinoma; (D) other and unspecified liver tumours. Estimates from 5-year rolling cohorts.
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