Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar;126(5):804-814.
doi: 10.1038/s41416-021-01509-4. Epub 2021 Nov 26.

Regional variations in hepatocellular carcinoma incidence, routes to diagnosis, treatment and survival in England

Anya Burton #  1   2 , Vinay K Balachandrakumar #  2   3 , Robert J Driver  4 , Daniela Tataru  2 , Lizz Paley  2 , Aileen Marshall  5 , Graeme Alexander  6 , Ian A Rowe  4 ; HCC-UK/BASL/NCRAS Partnership; Daniel H Palmer  7 , Tim J S Cross  8
Affiliations

Regional variations in hepatocellular carcinoma incidence, routes to diagnosis, treatment and survival in England

Anya Burton et al. Br J Cancer. 2022 Mar.

Abstract

Background: Hepatocellular carcinoma (HCC) incidence, management and survival across England were examined to determine if geographical inequalities exist.

Method: 15,468 HCC cases diagnosed 2010-2016 were included. Age-standardised incidence rates, net survival and proportions receiving potentially curative treatment and presenting through each route to diagnosis adjusted for age at diagnosis, sex and area-based deprivation quintile, were calculated overall and by Cancer Alliance.

Results: HCC incidence rates increased in men from 6.2 per 100,000 in 2010 to 8.8 in 2016, and in women from 1.5 to 2.2. The highest incidence rates, found in parts of the North of England and London, were nearly double the lowest. The adjusted proportion presenting as an emergency ranged 27-41% across Cancer Alliances. Odds increased with increasing deprivation quintile and age. Only one in five patients received potentially curative treatment (range 15-28%) and odds decreased with increasing deprivation and age. One-year survival in 2013-2016 ranged 38-53%.

Conclusion: This population-based, nationwide analysis demonstrates clear differences in HCC incidence, management and survival across England. It highlights socioeconomic-associated variation and the need for improvement in early diagnosis and curative treatment of HCC. This research should assist policymakers, service providers and clinicians to identify regions where additional training, services and resources would be best directed.

PubMed Disclaimer

Conflict of interest statement

All of the authors completed the ICMJE uniform disclosure form; Professor Alexander, Dr. Tataru, Ms. Paley, Dr. Marshall and Dr. Driver have nothing to disclose. During the conduct of the study, Dr. Burton reports grants from BTG International Ltd and Dr. Balachandrakumar, Dr. Cross and Professor Palmer report grants from Sirtex, Bristol-Myers-Squibb and Bayer. Dr Cross reports personal fees from Bayer. Outside the submitted work, Dr. Cross reports personal fees from Eisai pharmaceuticals, Bayer, AstraZeneca and Roche and Professor Palmer reports grants and personal fees from Bristol-Myers-Squibb, AstraZeneca, MSD and Nucana Inc, and personal fees from Eisai, Bayer, and Roche. Dr. Rowe reports personal fees from Roche, non-financial support from Abbvie, outside the submitted work.

Figures

Fig. 1
Fig. 1. HCC incidence by Cancer Alliance.
By year: 2010 on the left and 2016 on the right. By Sex: Men on the first row, women on the second row.
Fig. 2
Fig. 2. Proportion of patients presenting as an emergency, by Cancer Alliance.
Proportions unadjusted and adjusted for age, sex and deprivation quintile shown in the forest plot (left) and adjusted proportions displayed in the choropleth map (right).
Fig. 3
Fig. 3. Proportion of patients receiving potentially curative treatments, by Cancer Alliance.
Proportions unadjusted and adjusted for age, sex and deprivation quintile shown in the forest plot (left) and adjusted proportions displayed in the choropleth map (right).
Fig. 4
Fig. 4
One-year net survival by Cancer Alliance and cohort.
See this image and copyright information in PMC

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. doi: 10.3322/caac.21492. - DOI - PubMed
    1. Liu Z, Jiang Y, Yuan H, Fang Q, Cai N, Suo C, et al. The trends in incidence of primary liver cancer caused by specific etiologies: results from the Global Burden of Disease Study 2016 and implications for liver cancer prevention. J Hepatol. 2019;70:674–83. doi: 10.1016/j.jhep.2018.12.001. - DOI - PubMed
    1. Ioannou GN, Green P, Lowy E, Mun EJ, Berry K. Differences in hepatocellular carcinoma risk, predictors and trends over time according to etiology of cirrhosis. PLoS ONE. 2018;13:e0204412. doi: 10.1371/journal.pone.0204412. - DOI - PMC - PubMed
    1. Ratib S, West J, Crooks CJ, Fleming KM. Diagnosis of liver cirrhosis in England, a cohort study, 1998–2009: a comparison with cancer. Am J Gastroenterol. 2014;109:190–8. doi: 10.1038/ajg.2013.405. - DOI - PubMed
    1. The 2nd Atlas of variation in risk factors and healthcare for liver disease in England. (Public Health England, Wellington House, London SE1 8UG, 2017).

Publication types