BACKGROUND: Hepatocellular carcinoma (HCC) is one of the fastest rising causes of cancer-related deaths in the United States, with disparities observed in cancer incidence and survival between ethnic groups. This report provides updated analyses on race-specific disparities in US HCC trends. METHODS: This large, population-based cohort study was conducted using Surveillance, Epidemiology, and End Results cancer registry data from 2003 to 2011 to investigate race-specific disparities in HCC incidence and survival. Survival was analyzed using Kaplan-Meier methods and multivariate Cox proportional-hazards models. RESULTS: From 2003 to 2011, Asians had the highest HCC incidence, followed by blacks, Hispanics, and non-Hispanic whites. During the same period, Hispanics had the greatest increase in HCC incidence (135.8%), whereas Asians experienced a 5.5% decrease. Although patients aged 65 years had the highest HCC incidence among all racial/ethnic groups, the higher HCC incidence in Asians was observed only for patients ages <50 and 65 years, whereas HCC incidence among patients ages 50 to 64 years was similar among Asians, blacks, and Hispanics. The overall 5-year HCC survival rate was highest among Asians (26.1%; 95% confidence interval [CI], 24.5%-27.6%) and lowest among blacks (21.3%; 95% CI, 19.5%-23.1%). On multivariate regression, Asians (hazard ratio, 0.83; 95% CI, 0.79-0.87; P < .001) and blacks (hazard ratio, 0.94; 95% CI, 0.89-0.99; P 5 .01) had significantly higher survival compared with non-Hispanic whites. CONCLUSIONS: Asians were the only group to demonstrate a declining HCC incidence in the form of a shift from advanced HCC to more localized HCC. These findings most likely reflect improved screening and surveillance efforts for this group. Cancer 2016;122:2512-23. V C 2016 American Cancer Society.KEYWORDS: incidence, liver cancer, racial differences, screening, Surveillance, Epidemiology, and End Results (SEER). INTRODUCTIONHepatocellular carcinoma (HCC) is a leading cause of cancer-related morbidity and mortality worldwide. [1][2][3] In the United States, the incidence of HCC has more than quadrupled, becoming the fastest rising cause of cancer-related deaths. 4,5 Although Asians have the highest overall HCC incidence, when stratified by race/ethnicity, the largest proportional increase in HCC incidence has been observed among Hispanics and blacks. 6,7 These observed differences in HCC trends may reflect race/ethnicity-specific differences in the underlying etiology of HCC, including chronic hepatitis C virus (HCV), chronic hepatitis B virus (HBV), nonalcoholic steatohepatitis, and alcoholic liver disease. 8 For example, the predominant etiology of HCC among Asians is HBV, and improved treatment of HBV over time may contribute to decreased incidence of HCC. In addition, race/ethnicity-specific differences in disease progression and HCC risk may occur even when the underlying liver disease etiology is the same. Disparities in disease progression and HCC risk may warrant more aggressive disease managem...

Among US adults with HCC, blacks consistently had more advanced stage at diagnosis and lower rates of receiving treatment. After correcting for cancer stage and evaluating the subset of patients eligible for curative therapies, blacks and Hispanics had significantly lower rates of curative HCC treatment.