Status
Completed
Title
Development and validation of personalised risk prediction models for early detection and diagnosis of hepatocellular carcinoma (HCC) among the English population from primary care
What were the objectives of the study?
Our aim is to describe the basic patient characteristics and epidemiologic indicators of people diagnosed with HCC in England – the incidence (overall and by age groups, sex, ethnicity, socioeconomic status, etc.), route to diagnosis, stage at diagnosis, treatments, and survival duration of patients diagnosed with HCC, and the trend over the last 15 years (2005-2020);
Chief Investigator
Professor Ellie Barnes
Lead Applicant Organisation Name
Sponsor
University of Oxford
Location of research
University of Oxford
Date on which research approved
08-Jul-2021
Project reference ID
OX30
Generic ethics approval reference
18/EM/0400
Are all data accessed are in anonymised form?
Yes
Brief summary of the dataset to be released (including any sensitive data)
Linked electronic health records from primary care (EMIS), secondary care (Hospital Episode Statistics, HES), Office for National Statistics (ONS) mortality data, and cancer registry, will be needed for this study. These four data sources are linked in the QResearch database.
What were the main findings?
7331 patients were diagnosed with primary liver cancer during follow-up. The age-standardised incidence rates increased over the study period, particularly for HCC in men (increased by 60%). Age, sex, socioeconomic deprivation, ethnicity, and geographical regions were all significantly associated with liver cancer incidence in the English primary care population. People aged ≥80 years were more likely to be diagnosed through emergency presentation and in late stages, less likely to receive treatments and had poorer survival than those aged <60 years. Men had a higher risk of being diagnosed with liver cancer than women, with a hazard ratio (HR) of 3.9 (95% confidence interval 3.6–4.2) for HCC, 1.2 (1.1–1.3) for CCA, and 1.7 (1.5–2.0) for other specified/unspecified liver cancer. Compared with white British, Asians and Black Africans were more likely to be diagnosed with HCC. Patients with higher socioeconomic deprivation were more likely to be diagnosed through the emergency route. Survival rates were poor overall. Patients diagnosed with HCC had better survival rates (14.5% at 10-year survival, 13.1%–16.0%) compared to CCA (4.4%, 3.4%–5.6%) and other specified/unspecified liver cancer (12.5%, 10.1%–15.2%). For 62.7% of patients with missing/unknown stage in liver cancer, their survival outcomes were between those diagnosed in Stages III and IV.
This study provides an overview of the current epidemiology and the disparities in clinical pathways of primary liver cancer in England between 2008 and 2018. A complex public health approach is needed to tackle the rapid increase in incidence and the poor survival of liver cancer. Further studies are urgently needed to address the gaps in early detection and diagnosis of liver cancer in England.
Funding Source
Cancer Research UK
Public Benefit Statement
Research Team
Prof Julia Hippisley-Cox (WP6 lead)
Dr Weiqi Liao
Prof Ellie Barnes (DeLIVER project CI)
Prof Carol Coupland
Prof Peter Jepsen (Aarhus University, Denmark)
Dr Philippa Matthews
Dr Hamish Innes (Glasgow Caledonian University)
Ms Cori Campbell
Approval Letter
Publications
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Development and validation of personalised risk prediction models for early detection and diagnosis of primary liver cancer among the English primary care population using the QResearch® database: research protocol and statistical analysis plan
Authors: Weiqi Liao, Peter Jepsen, Carol Coupland, Hamish Innes, Philippa C. Matthews, Cori Campbell, Eleanor Barnes & Julia Hippisley-Cox
Ref:
https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-022-00133-x -
Disparities in care and outcomes for primary liver cancer in England during 2008–2018: a cohort study of 8.52 million primary care population using the QResearch database
Authors: Liao W, Coupland CAC, Innes H, Jepsen P, Matthews PC, Campbell C, The DeLIVER consortium
Ref:
https://www.sciencedirect.com/science/article/pii/S2589537023001463
Access Type
Trusted Research Environment (TRE)