HEPATOCELLULAR-CARCINOMA IN WESTERN SYDNEY - ETIOLOGY, CHANGES IN INCIDENCE, AND OPPORTUNITIES FOR BETTER OUTCOMES

Objectives: To examine the incidence of hepatocellular carcinoma (HCC) in western Sydney over the last 14 years, to assess risk factors for the disease among ethnic groups of Australian residents, and to consid er the opportunities for improving its usually poor outcome. Design an d subjects: Retrospective case-record review of clinical features in a ll (122) patients discharged from a 900-bed tertiary-referral teaching hospital with a diagnosis of HCC from January 1979 to March 1993. Mai n outcome measures: Annual number of new cases; risk factors according to birthplace; surgical resectability of tumours. Results: New cases admitted each year at least doubled between 1979-1985 and 1986-1992. T his apparent increase involved individuals born in Australia (50% of a ll patients) as well. as immigrants. Cirrhosis was found in 93% at liv er biopsy or autopsy. Excessive alcohol intake was an associated risk factor for 46% of Australian-born patients and for 13% of those born o verseas. Among the latter, HCC was associated with markers of hepatiti s B virus infection in 64%. Since hepatitis C virus (HCV) tests became available in 1990, five of nine patients tested were anti-HCV positiv e. Surveillance screening of patients known to have cirrhosis detected eight cases of early HCC. Seven of these had surgical resection and a ll are alive. Conclusions: New diagnoses of HCC have increased recentl y, irrespective of country of birth. In Australian-born patients alcoh olic liver disease remains a major aetiological factor but the role of HCV requires further evaluation. Among immigrants, cirrhosis from chr onic viral hepatitis accounts for most cases. We propose that preventi on of cirrhosis caused by chronic viral hepatitis should have the grea test long-term impact on prevention of HCC in Australia. The role of s urveillance of people with cirrhosis to detect small and potentially r esectable tumours should be explored.