Original Article Dig Dis 2014;32:664–669 DOI: 10.1159/000367983

Epidemiological Trends of Hepatocellular Carcinoma in Austria Matthias Pinter a Florian Hucke a Nadine Zielonke b Michael Trauner a Wolfgang Sieghart a Markus Peck-Radosavljevic a a

Division of Gastroenterology and Hepatology and Comprehensive Cancer Center, AKH and Medical University of Vienna, and b Austrian National Cancer Registry, Statistics Austria, Vienna, Austria

Abstract Background/Aims: The heterogeneous epidemiology of hepatocellular carcinoma (HCC) with the highest incidence rates in East Asia, sub-Saharan Africa and Melanesia results from variations in the main risk factors. We investigated epidemiological trends, including incidence and mortality, of patients diagnosed with HCC over a 20-year period in Austria. Methods: Data on age-adjusted incidence rates of HCC were obtained from the Austrian National Cancer Registry, which compiles nationwide data on all newly diagnosed cancers. Data on age-adjusted mortality were obtained from the national death registry (Statistics Austria). Results: Of 24,939 patients diagnosed with hepatobiliary tumors between 1990 and 2009, 8,561 subjects had HCC (m/f ratio 75/25%; mean age 69 years). Lymph node and distant metastases were present in 7.5 and 12.2%, respectively. The age-adjusted incidence rate was significantly higher in men than women (m/f ratio 4.5/1) and markedly increased in men (4.68/5.10) but remained stable in women (1.18/1.11). Similarly, the age-adjusted mortality rate was significantly higher

© 2014 S. Karger AG, Basel 0257–2753/14/0326–0664$39.50/0 E-Mail [email protected] www.karger.com/ddi

in men than women (m/f ratio 4.5/1), increased in men (4.02/4.98) and remained stable in women (0.92/1.0). The median overall survival was 4.5 months for men and 3.2 months for women with 1-/5-year survival rates of 33/11% and 28/10%, respectively. Conclusion: HCC is the most common hepatobiliary neoplasia in Austria and has a very poor prognosis. The age-adjusted incidence and mortality rates were higher in males, increased over time in men and remained stable in women. Extrahepatic metastases were rarely diagnosed and associated with dismal survival. © 2014 S. Karger AG, Basel

Introduction

Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the third most common cause of cancer-related mortality [1]. HCC usually develops in patients with underlying liver cirrhosis [2, 3], who have an annual HCC incidence rate of approximately 1–8% [4]. Men are more often affected by HCC with a m/f ratio of approximately 2.4 [5]. M. Pinter, F. Hucke, W. Sieghart and M. Peck-Radosavljevic are members of the Vienna Liver Cancer Study Group.

Markus Peck-Radosavljevic, MD Abteilung Gastroenterologie und Hepatologie, Klinik Innere Medizin III AKH and Medizinische Universität Wien Währinger Gürtel 18–20, AT–1090 Wien 8 (Austria) E-Mail markus.peck @ meduniwien.ac.at

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Key Words Hepatocellular carcinoma · Epidemiology · Incidence · Mortality

Patients and Methods Data Retrieval National databases were used to analyze epidemiological trends of Austrian patients diagnosed with HCC between January 1990 and December 2009. Data on cancer incidence were obtained from the Austrian National Cancer Registry, which compiles data on all newly diagnosed cancers in Austria, a country of approximately 8.4 million (2011) inhabitants. All patients with HCC in Austria are registered in the Austrian National Cancer Registry. It is located in Vienna and operated by Statistics Austria since 1969. The collected information included general demographic characteristics of the patients (age, sex, province of residence), histological type and stage of the tumor according to the International Classification of Diseases for Oncology, Third Edition (ICD-O-3), and the date of diagnosis confirmation. The date of death was primarily obtained from cancer notification forms reporting the death of a person. If no such form was available but the date of death of a person was reported by the official mortality statistics, the date of death reported on the death certificate was used. To obtain this date, the cancer incidence database is regularly matched with official death certificates. The current study includes incidence data from the Austrian National Cancer Registry on patients diagnosed from 1990 to 2009 with vital status up to December 31, 2010. For the analysis, only HCC cases according to the four-digit International Classification of Diseases version 9 (ICD9, 1990– 2001: 155.0) and version 10 (ICD10, 2002–2009: C22.0) codes were included.

HCC in Austria

Table 1. Patient characteristics

All HCC patients Fibrolamellar HCC Age, years Mean ± SD Range Sex Male Female Metastases Lymph node1 Distant2 1

8,561 (100%) 7 (0.1%) 69 ± 11.1 10 – 99 6,400 (75%) 2,161 (25%) 636 (7%) 1,042 (12%)

Not evaluable, n = 1,457 (17%). 2 Not evaluable, n = 967 (11%).

Statistics Baseline characteristics were summarized using descriptive statistics. χ2 test was used to compare categorical data. Parametric data were compared by Student’s t test. Age-standardized incidence and mortality rates (per 100,000 WHO standard population in 2001) were calculated by year of diagnosis and sex. Time trends in incidence and mortality were assessed by bivariate Spearman correlation; sex differences were calculated by the unpaired MannWhitney U test. Survival was defined as time from date of diagnosis to date of death or last follow-up (December 31, 2010). Death-certificateonly or autopsy-only cases were excluded from survival analyses. OS was calculated by the Kaplan-Meier method and compared by means of the log rank test. A p value