Early-Stage Australian HCC Patients Treated at Tertiary Centres Show Comparable Survival Across Metropolitan and Non-Metropolitan Residency
Year: 2026
Type: article
Study design: Observational Study
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.
Source: Livers
Authors: Jonathan Abdelmalak, Simone I. Strasser, Natalie L. Ngu, Claude Dennis, Marie Sinclair, Avik Majumdar, Kate Collins, Katherine Bateman, Anouk Dev, Joshua H. Abasszade, Zina Valaydon, Daniel Saitta, Kathryn Gazelakis, Susan Byers, Jacinta Holmes, Alexander J. Thompson, Jessica Howell, Dhivya Pandiaraja, Steven Bollipo, Suresh Sharma, Merlyn Joseph, Rohit Sawhney, Amanda Nicoll, Nicholas Batt, Myo J. Tang, Stephen Riordan, Nicholas Hannah, James Haridy, Siddharth Sood, Eileen Lam, Elysia Greenhill, Daniel Clayton-Chubb, John Lubel, William Kemp, Ammar Majeed, John Zalcberg, Stuart K. Roberts
Institutions: Austin Hospital, The Alfred Hospital, Alfred Health, Austin Health, Monash University, Royal Prince Alfred Hospital, Monash Medical Centre, Monash Health, Footscray Hospital, Western Health, The University of Melbourne, St Vincent's Hospital Melbourne, John Hunter Hospital, Eastern Health, Prince of Wales Hospital, The Royal Melbourne Hospital
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,207
OpenAlex ID: W7118199551