Shift in Patterns of Care and Survival Outcomes of Hepatocellular Carcinoma in a Canadian Provincial Cancer Program

Purpose Hepatocellular carcinoma (HCC) is the most common and highly morbid primary liver malignancy. In this retrospective study, we describe the clinical characteristics of patients with HCC, identify factors determining the type of delivered treatment, and evaluate the overall survival (OS).  Materials and methods Demographic and treatment details were collected for HCC patients diagnosed in Manitoba between January 2011 and December 2021. The cohort was divided according to the treatment that was delivered: curative, non-curative, and supportive care-only groups.  Results A total of 800 patients were identified. Complete staging information was not available for all patients. The mean age was 67 years, and men represented 72.5% of the cohort. One hundred ninety-five (24.4%) patients received curative treatment, 188 (23.5%) received non-curative treatment, and 417 (52.1%) received supportive care only. Alcoholic cirrhosis was the most common etiology of chronic liver disease (20.3%). Patients were less likely to receive curative treatment if they had portal hypertension or multifocal disease. Patients with ascites or distant metastasis were more likely to receive supportive care only. The one- and five-year OS rates for the full cohort were 50% and 23%, respectively. Between 2011 and 2021, the prevalence of non-curative therapies has increased. Trans-arterial chemoembolization (TACE) was the most common non-curative treatment with one- and three-year OS rates of 88% and 41%, respectively.  Conclusion The OS of patients with HCC in Manitoba improved between 2011 and 2021 and was temporally associated with increased utilization of non-curative local therapies, including TACE. However, given the retrospective nature of the study, these findings demonstrate association rather than causal effect.