studies

432A AASLD ABSTRACTS HEPATOLOGY, October, 2015
442
Hepatocellular Carcinoma Surveillance Is Associated
With Improved Survival And Can Be Targeted To High
Risk Populations
Thai Hong 1 , Paul Gow 2,10 , Michael A. Fink 3,11 , Anouk T. Dev 4 ,
Stuart K. Roberts 5 , Amanda J. Nicoll 6,7 , John Lubel 6,12 , Ian Kronborg
8 , Niranjan J. Arachchi 8 , Marno C. Ryan 1,10 , William W.
Kemp 5 , Virginia H. Knight 4 , Helen Farrugia 9 , Vicky Thursfield 9 ,
Paul V. Desmond 1,10 , Alex J. Thompson 1,10 , Sally Bell 1 ; 1 Gastroenterology,
St Vincent’s Hospital, Melbourne, Melbourne, VIC,
Australia; 2 Gastroenterology, Austin Hospital, Melbourne, VIC,
Australia; 3 Surgery, Austin Hospital, Melbourne, VIC, Australia;
4 Gastroenterology & Hepatology, Monash Medical Centre, Melbourne,
VIC, Australia; 5 Gastroenterology & Hepatology, The
Alfred Hospital, Melbourne, VIC, Australia; 6 Gastroenterology &
Hepatology, Eastern Health, Melbourne, VIC, Australia; 7 Gastroenterology
& Hepatology, The Royal Melbourne Hospital, Melbourne,
VIC, Australia; 8 Gastroenterology & Hepatology, Western
Hospital, Melbourne, VIC, Australia; 9 Victorian Cancer Registry,
Cancer Council Victoria, Melbourne, VIC, Australia; 10 Medicine,
The University of Melbourne, Melbourne, VIC, Australia; 11 Surgery,
The University of Melbourne, Melbourne, VIC, Australia;
12 Eastern Health Clinical School, Monash University, Melbourne,
VIC, Australia
Background: Hepatocellular carcinoma (HCC) incidence is heterogeneously
distributed worldwide and is rising rapidly in
many developed countries where the complete range of therapeutic
options is available. Local epidemiology is important
to accurately characterise the disease and allow strategies to
effectively manage the problem. We performed the first population-based
study in Australia to capture a clinical cohort and
study the effect of aetiology, ethnicity and advanced therapeutic
options on survival outcomes. Method: Incident cases of
HCC (defined by AASLD diagnostic criteria or histology) were
prospectively identified over a 12-month period (1 July, 2012
to 30 June, 2013) from the population of Melbourne, Australia.
Cases were captured from multiple sources including admissions
and outpatient attendances to any of Melbourne’s seven
tertiary hospitals, gastroenterology department, radiology,
pathology and pharmacy databases as well as those registered
by the Victorian Cancer Registry. Patients were followed up
for at least 24 months with the primary endpoint being overall
survival. Results: There were 272 incident cases identified. The
major risk factors for liver disease were hepatitis C virus (HCV)
infection (41%), alcohol (39%), and hepatitis B virus (HBV)
infection (22%). Patients born overseas had up to 20 times the
incidence rate of Australian-born patients. Regional variations
of incidence within the study area correlated with percentage
of overseas-born patients and HBV seroprevalence in those
regions. Overall survival at 12 months was 57%. On multivariate
analysis, the independent predictors of survival were age,
the absence of cirrhosis, MELD score, AFP, tumour size, Barcelona
Clinic Liver Clinic (BCLC) stage and being involved in an
HCC surveillance program. Patients undergoing surveillance
had significantly smaller tumour size (p