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. Crown Copyright (C) 2021 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).
Bibliographical noteFunding Information:
HCC-UK BASL/NCRAS Partnership Steering Group: Anya Burton, Aileen Marshall, Graeme Alexander, Ian Rowe, Robert J. Driver, Vinay Kumar, Tim Cross, Katherine Cullen, Rhys Pockett, Tom Bird, Dyfed W. Huws, Anna Gavin, Daniela Tataru, Lizz Paley, David Wallace, and Guruprasad Aithal, BASL president. NCRAS advisor: Sean McPhail. Cancer data sources: Data for this study are based on patient-level information collected by the NHS, as part of the care and support of cancer patients. The data is collated, maintained, and quality assured by the: National Cancer Registration and Analysis Service, which is part of Public Health England (PHE); Welsh Cancer Intelligence and Surveillance Unit, Health Intelligence Division, Public Health Wales: Scottish Cancer Registry, Information Services Division; and NI Cancer Registry, funded by The Public Health Agency for Northern Ireland.
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.
This work was supported by the British Association for the Study of the Liver, which received an unrestricted and unconditional award from BTG International Ltd (grant number 52733 1 0). BTG did not have any input into the study design, data collection, analysis or interpretation of the data, writing of the manuscript, review of the manuscript, the decision to submit the manuscript, or the writing of this statement.
- Hepatocellular carcinoma
- Intrahepatic cholangiocarcinoma
- Primary liver cancer