Title: Hepatocellular carcinoma (HCC) in patients followed in two clinics in Toronto

Background: Hepatocellular carcinoma (HCC) is the dreaded complication of chronic HBV infection.

Purpose: Describe people with HCC attributed to HBV followed in two clinics in Toronto.

Method: SlicerDicer module of Epic was used to identify those with chronic HBV infection in two different clinics for HCC in those with hepatitis B.

Result(s): From June 4, 2022 to July 15, 2023, N=91 (7.3%) individuals with HCC were identified from 1,926 individuals (DW N=1,239; CY N=687) at risk for HCC. Most were Male 69 (75.8%); mean age 62.6 (range 30-88) at time of HCC diagnosis. Only 5 (5.5%) were born in Canada. The majority were born in Asia (78%) and Europe (11%). The majority 75 (82.4%) were Asian, Chinese being the biggest group 58 (63.7%).
Most who developed HCC while being followed in our clinics had smaller HCC at presentation (figure). Of those followed for over 2 years, HCC size at presentation was mean 2.9 cm (1-12.2 cm) vs those followed for less than 2 years mean 4.7 cm (1.5-18.6 cm). 43 (47%) had been on antiviral therapy for at least 2 years before HCC was diagnosed, most treated with Tenofovir 25 (58%) for 2-21 years and Entecavir 8 (19%) for 2-14 years. Three had HCC 5 to 14 years before functional cure, four had HCC 1 to 14 years after functional cure.

Conclusion(s): Antiviral therapy does not completely prevent HCC. Regular follow-up in our clinics led to detection of HCC at smaller sizes but large HCC at presentation was still possible despite regular surveillance imaging.