Hepatocellular carcinoma in a low-endemic area: rising incidence and improved survival

OBJECTIVETo examine recent trends in incidence and outcome among patients with hepatocellular carcinoma (HCC) in an unselected population in Western Europe. METHODSData from the nationwide Netherlands Cancer Registry were used to estimate trends in incidence for all 6514 patients newly diagnosed with primary liver cancer between 1989 and 2009. Trends in incidence, treatment, and relative survival according to sex and age were estimated in 5143 patients with HCC, also using the European Standardized Rates (ESR). RESULTSThe ESR for all primary liver cancers combined increased significantly between 1989 and 2009 as did the ESR for HCC among men (estimated annual percentage change2.2%, 95% confidence interval1.6–2.7) and for women aged below 60 years, suggesting etiological influences in these groups. Especially, the nonhistologically confirmed HCC incidence increased. More patients underwent surgery for HCC, from 9% in 1989–1994 to 23% in 2005–2009, as well as chemotherapy and/or irradiation, from 6 to 11% in the same period. At the end of the study period, only 66% of patients received noncancer-related HCC therapy, that is, best supportive care, compared with 85% in 1989–1994. The 1 and 5-year relative survival for patients with HCC increased significantly (P