Epidemiology of cancer of the liver and intrahepatic bile ducts in an Australian population.

The incidence of liver and intrahepatic bile duct cancer in Australia is low at about one third the world average but increases are evident. South Australian registry data have been used to describe: age-standardized incidence and mortality trends; and disease-specific survivals, using Kaplan-Meier estimates and Cox proportional hazards regression. The study included 1,220 incident cancers (901 hepatocellular carcinomas; 201 cholangiocarcinomas; 118 other types) and 983 deaths. Incidence and mortality rates increased by 2-3 fold during 1977-2007. Incidence increases affected males, females and all ages. There was a strong: male predominance (3 to 1); and age gradient (70+ year old incidence >30 times under 50 year old incidence). Compared with hepatocellular carcinomas, cholangiocarcinomas and other histology types more often affected females and older ages and less often the Asian born. All histology types showed similar incidence increases. Apart from recognized risk factors (e.g., hepatitis B/C infection and aflatoxins for hepatocellular carcinoma; liver-fluke infection for cholangiocarcinomas, etc.), common risk factors may include excess alcohol consumption and possibly obesity and diabetes mellitus. Five-year disease-specific survival in 1998-2007 was 16%, with higher fatalities applying for earlier periods, older patients, males, lower socio-economic groups, and cholangiocarcinomas. Aboriginal patients tended to have higher case fatalities (p=0.054). Survival increases may be due to earlier diagnosis from alpha feta protein testing and diagnostic imaging, plus more aggressive treatment of localized disease. Mortality increases require a preventive response, including hepatitis B vaccination, prevention of viral infection though contaminated blood and other body fluids, early detection initiatives for high-risk patients, aggressive surgery for localized disease, and experimentation with new systemic therapies.