Diagnostics and treatment of hepatocellular carcinoma: Trends in the Netherlands in the period 2003-2011

Objective: Hepatocellular carcinoma (HCC) is rare in the Netherlands. Nevertheless, incidence has increased in the past decade. New treatment strategies for HCC -most in palliative setting- have recently been introduced. However, prognosis remains poor. Our aim was to evaluate trends in distribution of diagnostic testing and treatment for HCC in the past decade. Design: Retrospective study. Method: Trends in diagnostic testing and initial treatment of patients with HCC diagnosis in the period 2003-2011 were evaluated based on data of the Dutch Cancer Registry. The following treatments were evaluated: resection, radiofrequency ablation (RFA), transarterial chemoembolization (TACE), targeted systemic therapy (mainly sorafenib) and other systemic chemotherapy. Hospitals were classified as academic and non-academic centers. In this report, the study period was divided into three periods: 2003-2005, 2006-2008 and 2009-2011. Results: In the period 2003-2011, 2915 patients were diagnosed with HCC. Diagnostic testing including biopsies was performed in virtually all hospitals. Despite a significant decrease in later years, tumour biopsy was still performed in approximately 50% of all cases. Also, there was a significant increase of the number of hospitals where active treatment was performed (from 33% to 62% of all hospitals). Proportion of patients treated with RFA, TACE or sorafenib increased significantly, whereas proportion of patients treated curatively by resection remained stable (approximately 10%). Proportion of patients treated with other systemic chemotherapy decreased. During the period 2003-2011, the majority of patients with HCC were treated in academic centers. Nevertheless, proportion of treatments in academic centers decreased significantly (from 83% to 75% of all treatments). TACE, RFA and resections were mainly performed in academic centers (respectively 99%, 95% and 79%), whereas 52% of sorafenib treatments were given in non-academic centers. In the period 2003-2011, 321 resections were performed of which 60% in high-volume academic centers (≥5 resections/year), 18% in low-volume academic centers (<5 resections/year), 0% in high-volume non-academic centers and 22% in low-volume non-academic centers. Median survival after resection was 47 months. Initial sorafenib treatment was given to 227 patients in the period 2003-2011 of which 25% in high-volume academic centers (≥5 initial sorafenib treatments annually started), 23% in low-volume academic centers (<5 initial sorafenib treatments annually started), and 52% in low-volume non-academic centers. Significant differences existed between regions in use of RFA or TACE (both p<0.001, after casemix correction). Conclusion: No trends towards centralization in diagnostic testing and initial treatment for HCC were observed in the period 2003- 2011.

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