Call for applications for a fully financed PhD fellowship
Hepatocellular carcinoma (HCC) is a primary liver cancer that develops in patients with liver cirrhosis. "HCC surveillance" aims to reduce mortality from HCC through early detection. It is defined as an ultrasound examination of the liver with or without measurement of serum alpha-fetoprotein every 6 months. It is a standard treatment offered to patients with cirrhosis everywhere except in Denmark. This discrepancy is due to the combination of weak evidence in favor of HCC surveillance and studies showing that Danish patients with cirrhosis have a lower risk of HCC than patients in other countries. It is widely recognized that it is impossible to conduct a randomized trial of HCC surveillance due to the sample size required and patients’ unwillingness to be randomized.
This PhD project consists of 3 studies aiming to to strengthen the evidence for or against HCC surveillance offered to patients with cirrhosis.
Study 1: This clinical study introduces HCC surveillance among patients with cirrhosis in the Central Denmark Region. The effects of HCC surveillance will be determined by comparing time-trends in HCC incidence and mortality between the Central Denmark Region and the other Danish regions. The PhD student will play a key role in informing clinicians, in the practical implementation of HCC surveillance, and in collecting data on patients offered HCC surveillance. Moreover, the PhD student will be responsible for assessing the effects of HCC surveillance based on clinical data and data from nationwide healthcare registers.
Study 2: This study examines time-trends in the incidence of HCC (early-stage and late-stage), mortality from HCC, and survival with HCC in the Danish general population. It will be based on data from Denmark's nationwide healthcare registers, and it will provide an update - and more! - of our study describing time-trends through 2016 (Jepsen P, et al. Liver Int 2017;37:871-878).
Study 3: This study examines the risk of HCC and the risk of death from HCC among patients with cirrhosis in Denmark and England. It will be based on data from Denmark's nationwide healthcare registers and more detailed clinical data from the Central Denmark Region. The English data will be extracted from the Clinical Practice Research Datalink, e.g., as done here: West J, et al. Aliment Pharmacol Ther 2017;45:983-990. The key question for the study is this: What proportion of patients with cirrhosis (of different etiologies) die from HCC? The point is that this proportion is the maximum proportion of patients with cirrhosis who can be helped by HCC surveillance. We have previously provided an estimate for Danish patients with cirrhosis (Jepsen P, et al. J Hepatol 2020;73:1030-1036), but that study was limited to patients with alcohol-related cirrhosis and had follow-up through 2018, only.
Thus, this PhD project will require someone with clinical experience who wants to do clinical research and also knows or wants to know how to conduct registry-based research.
This PhD project is about cirrhosis and hepatocellular carcinoma. Therefore, the candidate must have clinical experience with cirrhosis and, ideally, hepatocellular carcinoma. Because of the practical difficulties of introducing a new clinical routine (HCC surveillance) across the Central Denmark Region, it is preferred that the candidate has clinical experience with cirrhosis from the Central Denmark Region.
Please submit your application via this link. Application deadline is 31 March 2025 23:59 CET. Preferred starting date is 1 September 2025.
For information about application requirements and mandatory attachments, please see our application guide.
Please contact Clinical Professor Peter Jepsen, pj@clin.au.dk for more information.
All interested candidates are encouraged to apply, regardless of their personal background. Salary and terms of employment are in accordance with applicable collective agreement.
