Gaps in the Cascade of Care Contribute to Poor Liver Cancer Outcomes Among People Living With Hepatitis B: A Multicenter Observational Cohort Study

BACKGROUND: Chronic hepatitis B virus (HBV) remains a major cause of hepatocellular carcinoma (HCC) in Australia, despite the availability of effective, subsidized antiviral therapy. We aimed to describe the clinical characteristics, HBV care cascade, and outcomes among people with HBV-related HCC in Victoria, Australia. METHODS: We conducted a multicenter cohort study of all incident HCC cases across eight tertiary health networks in Victoria, Australia. Cases were identified retrospectively (January 1, 2018 to December 31, 2019) and prospectively (January 1, 2020 to October 17, 2022). The primary outcome was the proportion of incident HCC attributable to HBV. Secondary outcomes included uptake of guideline-based antiviral therapy and surveillance and overall survival from HCC diagnosis. Multivariable logistic regression was used to identify factors associated with treatment and surveillance uptake. RESULTS: Among 1203 incident HCC cases, 219 (18.2%) were HBV related. Most patients were male (89%) and of Asian ethnicity (60%). While 61% were aged 56-75 years, 25% were 36-55 years. Cirrhosis was present in 141 (64%), although 57 (26%) were newly diagnosed with cirrhosis at HCC presentation. The 121 (60%) patients were eligible for antiviral therapy. Linkage to specialist care was associated with treatment uptake (adjusted OR 8.4, 95% CI 4.3-16.1; p < 0.001). Surveillance enrolment at diagnosis was higher among HBV-related HCC compared with non-HBV HCC (48% vs. 40%). CONCLUSION: HBV remains a substantial contributor to HCC in Australia. Gaps in antiviral treatment and cirrhosis recognition persist, highlighting missed opportunities for prevention and early detection. Interventions to improve linkage to care and delivery of guideline-based HBV management are urgently needed.