Primary liver cancer in the UK: Incidence, incidence-based mortality and survival by subtype, sex and nation

Abstract Background & Aims 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 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-, two- and five-year age-standardised net survival was estimated. Results 82,024 PLCs were diagnosed. Both hepatocellular carcinoma (HCC) incidence and mortality rates trebled (ASR 1.8 to 5.5 per 100,000, ASMR 1.3 to 4.0). The rate of increase appeared to plateau around 2014/15. 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 HCC survival (change in one-year survival 24% to 47%) . Intrahepatic cholangiocarcinoma one-year survival improved from 22.6% to 30.5% and was the most common PLC in women 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 recently years, possibly due 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 one year, therefore further progress in prevention, early detection, and treatment innovation are needed.