Early-Stage Australian HCC Patients Treated at Tertiary Centres Show Comparable Survival Across Metropolitan and Non-Metropolitan Residency

Background: Hepatocellular carcinoma (HCC) poses a significant public health challenge in Australia, with poorer survival observed in non-metropolitan populations. This study investigated whether survival disparities persist between non-metropolitan and metropolitan patients if only those with early-stage HCC treated at metropolitan tertiary referral centres are considered. Methods: We performed a retrospective cohort study across ten Australian tertiary centres involving patients with a new diagnosis of Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, recorded from 1 January 2016 to 31 December 2020. Residential postcodes were entered using the Modified Monash (MM) model to define metropolitan versus non-metropolitan residence. The primary endpoint was adjusted for all-cause mortality. Results: Our study included 854 patients (metropolitan n = 612, and non-metropolitan n = 242) with a median follow-up of 42.6 months. We found no significant survival or mortality differences between the two groups with the unadjusted Kaplan–Meier survival analysis (log-rank test p = 0.612) and with the Cox proportional hazards regression analysis (adjusted HR 0.93, 95% CI 0.64–1.34, p = 0.690). As expected, tumour burden, Child–Pugh Score, and Charlson Comorbidity Index (CCI) were significant predictors of mortality. Conclusions: Our findings suggest that previously observed survival disparities may stem from delayed diagnosis and reduced access to tertiary care in non-metropolitan regions and highlight the need for improved HCC surveillance and referral pathways, particularly for rural and Indigenous communities, to mitigate geographic inequities.

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Publication Details

Journal
Livers
Published
2026-01-04
DOI
https://doi.org/10.3390/livers6010002
Primary Topic
Hepatocellular Carcinoma Treatment and Prognosis
Type
article
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article

Early-Stage Australian HCC Patients Treated at Tertiary Centres Show Comparable Survival Across Metropolitan and Non-Metropolitan Residency

Kathryn Gazelakis, Elysia Greenhill, Daniel Saitta, Zina Valaydon et al.
Livers
Hepatocellular Carcinoma Treatment and Prognosis
article

Early-Stage Australian HCC Patients Treated at Tertiary Centres Show Comparable Survival Across Metropolitan and Non-Metropolitan Residency

Kathryn Gazelakis, Elysia Greenhill, Daniel Saitta, Zina Valaydon, Stuart Keith Roberts, Nicholas Batt, Merlyn Joseph, Amanda Nicoll, Kate Collins, Nicholas Hannah, Steven J. Bollipo, Rohit Sawhney, Jessica Howell, Jonathan Abdelmalak, Joshua Haron Abasszade, John Lubel, Myo J. Tang, Marie J. Sinclair, Anouk Dev, Stephen M. Riordan, John R. Zalcberg, Claude V. Dennis, James Haridy, Simone Irene Strasser, Dhivya Pandiaraja, Eileen Lam, Suresh Sharma, Katherine Bateman, Susan Byers, Ammar Majeed, Alexander J. Thompson, Avik Majumdar, Natalie L. Ngu, Daniel Clayton-Chubb, Siddharth Sood, William Kemp, Jacinta Holmes
article en

Abstract

Background: Hepatocellular carcinoma (HCC) poses a significant public health challenge in Australia, with poorer survival observed in non-metropolitan populations. This study investigated whether survival disparities persist between non-metropolitan and metropolitan patients if only those with early-stage HCC treated at metropolitan tertiary referral centres are considered. Methods: We performed a retrospective cohort study across ten Australian tertiary centres involving patients with a new diagnosis of Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, recorded from 1 January 2016 to 31 December 2020. Residential postcodes were entered using the Modified Monash (MM) model to define metropolitan versus non-metropolitan residence. The primary endpoint was adjusted for all-cause mortality. Results: Our study included 854 patients (metropolitan n = 612, and non-metropolitan n = 242) with a median follow-up of 42.6 months. We found no significant survival or mortality differences between the two groups with the unadjusted Kaplan–Meier survival analysis (log-rank test p = 0.612) and with the Cox proportional hazards regression analysis (adjusted HR 0.93, 95% CI 0.64–1.34, p = 0.690). As expected, tumour burden, Child–Pugh Score, and Charlson Comorbidity Index (CCI) were significant predictors of mortality. Conclusions: Our findings suggest that previously observed survival disparities may stem from delayed diagnosis and reduced access to tertiary care in non-metropolitan regions and highlight the need for improved HCC surveillance and referral pathways, particularly for rural and Indigenous communities, to mitigate geographic inequities.

LiversVol. 6(1)
The Royal Melbourne Hospital (AU), The University of Melbourne (AU), Royal Prince Alfred Hospital (AU), Austin Hospital (AU), John Hunter Hospital (AU), St Vincent's Hospital Melbourne (AU), Eastern Health (AU), Prince of Wales Hospital (AU), Footscray Hospital (AU), Western Health (AU), Monash Health (AU), Alfred Health (AU), Monash University (AU)
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Openalex Percentile: Top 98%
Hepatocellular Carcinoma Treatment and Prognosis
DOIOpen Access PDFOpenAlex
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