This retrospective analysis included medical records from 368 patients diagnosed with late-stage/incurable HBV-related hepatocellular carcinoma (HCC) in New Zealand between 2003 and 2017. All were positive for hepatitis B surface antigen (HBsAg). The researchers sought to determine which factors contribute to the late presentation of HBV-related HCC. The patients were categorised into 1 of 4 groups, according to potential reasons for late presentation: no previous diagnosis of HBV infection (Group A; 40% of patients); known HBV diagnosis but not under HCC surveillance (Group B; 26%); known HBV diagnosis and under suboptimal HCC surveillance, defined as serum α-fetoprotein alone (without liver ultrasound) in patients with cirrhosis or who had a positive family history of HCC, or who were under surveillance outside the recommended timeframe (Group C; 12%); or known HBV diagnosis and under optimised HCC surveillance (Group D; 23%). The median age of death was 59 years. Ethnicity was most often Māori (39%), Pacific (34%), or Asian (20%). The incidence of patients presenting with HBV-related advanced HCC increased from 4.5 cases per million people between 2003 and 2007 (Era 1) to 6.0 cases per million people between 2008 and 2012 (Era 2), then to 6.3 cases per million people between 2013 and 2017 (Era 3). The overall median survival was 138 days and did not differ significantly from survival values calculated for Eras 1, 2 and 3, respectively. Mean survival time was significantly prolonged for patients under optimised surveillance (Group D) as compared with those in Groups A, B, or C (469 days vs 90, 145 and 152 days, respectively; p<0.05 for all comparisons). A significantly higher proportion of patients in Group D compared with those in Groups A, B or C received transarterial chemoembolisation (40% vs 11%, 22% and 18%; p<0.05 for all comparisons).
