Carville Kylie S, MacLachlan Jennifer H, Thursfield Vicky, Cowie Benjamin C
Epidemiology Unit, The Doherty Institute, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2018 Jul;48(7):835-844. doi: 10.1111/imj.13823.
Liver cancer continues to be a health priority in Australia, with the majority attributable to preventable causes, and certain populations at higher risk.
Epidemiological assessment of incidence, trends and distribution to inform prevention, and reassessment of data in light of recent changes to registry case definitions.
Reported cases of hepatocellular carcinoma (HCC) in Victoria, Australia, 1984-2013, were obtained from the Victorian Cancer Registry. Demographic characteristics were examined, incidence and survival assessed using Poisson and Cox regression, and geographic distribution mapped. Incidence was compared before and after inclusion of non-histologically confirmed cases in Registry data to assess impacts on incidence trends.
Diagnoses of HCC rose substantially between 1984 and 2013, increasing sixfold from 0.9 to 5.9 per 100 000. The rate of increase per year accelerated from 5.3% between 1984 and 2003 to 9.5% between 2004 and 2013. Cases were disproportionately male (80%), median age at diagnosis was 66 years and 53% were born overseas. Even during 2004-2013, 5-year survival was only 16%, although higher among younger people, metropolitan residents and people born overseas. Incidence showed strong geographic clustering. The proportion of cases diagnosed clinically increased from 1% during 1984-2004 to 43% in 2009-2013. The revised case definition added 993 cases (27.3% of total).
Cases of HCC are becoming increasingly common, and revised incidence estimates highlight the impact of case definitions in the context of changing diagnostic approaches. The ongoing burden, disproportionate population distribution and low survival emphasise the importance of prevention and early detection as a public health imperative.
肝癌仍是澳大利亚的一项重要健康问题，大多数肝癌可归因于可预防的病因，且某些人群风险更高。
对发病率、趋势及分布进行流行病学评估，为预防工作提供信息，并根据登记病例定义的近期变化重新评估数据。
从维多利亚癌症登记处获取1984年至2013年澳大利亚维多利亚州报告的肝细胞癌（HCC）病例。检查人口统计学特征，使用泊松回归和Cox回归评估发病率和生存率，并绘制地理分布图。比较登记数据中纳入非组织学确诊病例前后的发病率，以评估对发病率趋势的影响。
1984年至2013年期间，HCC诊断病例大幅增加，从每10万人0.9例增至5.9例，增长了六倍。每年的增长率从1984年至2003年期间的5.3%加速至2004年至2013年期间的9.5%。病例中男性占比过高（80%），诊断时的中位年龄为66岁，53%出生于海外。即使在2004年至2013年期间，5年生存率也仅为16%，不过在年轻人、大城市居民和海外出生的人群中生存率更高。发病率呈现出强烈的地理聚集性。临床诊断病例的比例从1984年至2004年期间的1%增至2009年至2013年期间的43%。修订后的病例定义增加了993例（占总数的27.3%）。
HCC病例越来越常见，修订后的发病率估计凸显了病例定义在诊断方法不断变化背景下的影响。持续的负担、不均衡的人群分布和低生存率强调了预防和早期检测作为公共卫生要务的重要性。
