- 1Faculty of Medicine University of Queensland Brisbane Queensland Australia.
- 2Cancer and Chronic Disease Epidemiology Group QIMR Berghofer Medical Research Institute Brisbane Queensland Australia.
- 3Mater Research Institute University of Queensland Brisbane Queensland Australia.
- 4Department of Gastroenterology and Hepatology Mater Hospitals Brisbane Brisbane Queensland Australia.
- 5Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia.
Background and aim: Surveillance and early detection and curative treatment of hepatocellular carcinoma (HCC) are the mainstay of improving survival for patients, but there are several barriers to achieving this goal. We reported the impact of remoteness of residence on receipt of treatment, tumor stage, and survival in patients with HCC in Queensland.
Methods: We conducted a retrospective cohort study of 1651 HCC patients (147 migrants) from 1 January 2007 to 31 December 2016. We used Wilcoxon rank-sum test to compare the median age at the time of diagnosis and Bayesian Weibull accelerated failure time regression to identify independent predictors of time to death.
Results: The median survival time after HCC diagnosis was 9.0 months (interquartile range 2.0-24.0). Metropolitan residence (P = 0.02), non-English language (P < 0.001), foreign country of origin (P < 0.001), and HBV etiology (P < 0.001) were significantly associated with receiving surgical resection for HCC treatment. The strongest predictors of time to death were undifferentiated tumor at presentation (time ratio [TR] = 0.30, 95% credible interval (CrI) 0.23-0.39), age ≥70 years (TR = 0.42, 95% CrI 0.34-0.53), living in remote areas (TR = 0.67, 95% CrI 0.55-0.80), and presence of ≥1 comorbidity (TR = 0.69 95% CrI 0.54-0.90). All the other covariates adjusted, including country of birth (TR = 0.76, 95% CrI 0.49-1.06), did not predict survival time.
Conclusions: Patients living in rural and remote areas had late stage clinical presentation and poor survival. Remoteness of residence may limit access to HCC surveillance in at-risk patients such as those with cirrhosis, and timely curative treatment to improve survival in these patients.