Article Text

Download PDFPDF
Original research
Major variation in hepatocellular carcinoma treatment and outcomes in England: a retrospective cohort study
  1. Sue Beecroft1,
  2. Matthew O’Connell1,
  3. Ayman Nassar2,
  4. Katie Noon2,
  5. Kevin G Pollock2,
  6. Dan Palmer3,
  7. Timothy J S Cross4
  1. 1 Harvey Walsh Limited, Runcorn, UK
  2. 2 Bristol Myers Squibb Pharmaceuticals, Uxbridge, UK
  3. 3 Department of Medical Oncology, University of Liverpool Institute of Translational Medicine, Liverpool, UK
  4. 4 Department of Translational Medicine, University of Liverpool, Liverpool, UK
  1. Correspondence to Ayman Nassar, Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK; ayman.nassar{at}


Objective Hepatocellular carcinoma (HCC) is increasingly incident in England, while survival remains poor with regional disparities. We aimed to explore the differences in HCC treatment across different geographical regions and to examine the impact on cancer survival.

Methods Incident HCC cases and treatment were identified from the English Hospital Episode Statistics (2016–2017) and then a subset by National Health Service (NHS) regions. Treatment was grouped into curative, palliative and untreated. Median survival was estimated to date of death in the national statistics.

Results The median observed survival was 8.6 months (95% CI 7.5 to 9.9) across all 2160 HCC cases, 52.1 months (CI 50.5, not reached) in 449 (20.8%) treated with curative intent, 21.0 months (CI 18.5 to 24.5) after other cancer-specific treatment in 449 (20.8%), and 2.3 months (CI 2.1 to 2.6) in 1262 (58.4%) untreated. Across NHS regions, <50% of cases received treatment (30.4%–49.6%), while between 14.2% and 27.7% had curative treatment. The 3-year survival was similar (23.5%–29.7%), except in the London region (40.0%).

Conclusion Majority of HCC cases in England are untreated and survival remains low, with variation in outcomes in regions with similar incident rates. A deeper exploration of regional treatments and screening practice is required to improve early detection and survival.

  • hepatocellular carcinoma

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Contributors AN, TJSC and DP originated the concept. SB and MO'C performed the data analysis and initial drafting of the manuscript. All authors contributed to iterative drafting of the manuscript. AN is the guarantor of the manuscript.

  • Funding The study was funded by Bristol Myers Squibb.

  • Competing interests KN, KP and AN are employees of Bristol Myers Squibb.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.