The Geography of Primary Hepatic Neoplasms Treatments in Canada: Changes in Latitudes and Changes in Attitudes

BACKGROUND Studies on treatment modalities for primary hepatic neoplasms (PHN) in Canada are lacking. Our primary aim was to analyze the age-standardized incidence of hepatic resection, ablation, transplantation, and embolization for PHN between 2002 and 2013. Secondary aim was to evaluate temporal trends for these treatment modalities. STUDY DESIGN National Canadian Cancer Registries were accessed for relevant epidemiological data. Age-standardized incidence of treatment ratios (SIRs) was calculated and comparisons were performed for Atlantic Canada, Ontario, the Prairies, and British Columbia. RESULTS British Columbia recorded the highest SIRs for ablation (1.9; 95% CI 1.8-2.0), hepatic resection (1.2; 95% CI 1.1-1.3), and transarterial locoregional therapies (2.8; 95% CI 2.4-3.2). For hepatic resection, the lowest SIR was found in Atlantic Canada (0.7; 95% CI 0.6-0.9), while the Prairies recorded the lowest estimate for transarterial therapies (0.2; 95% CI 0.1-0.4). Liver transplantation had the highest SIR in Ontario (1.5; 95% CI 1.3-1.6) and the lowest SIR in British Columbia. No significant temporal changes in SIRs were observed for any of the treatments except for transarterial therapies. CONCLUSIONS Treatment of PHN in Canada differs by geography. Variations might be due to differences in expertise or access to therapeutic modalities.