Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Abstract

Hepatocellular carcinoma (HCC) is one of the most common and lethal cancers globally. With advances in therapy for chronic viral hepatitis, changing social circumstances, and increasing practice of HCC surveillance, the epidemiology of HCC is expected to change over time. We explored the temporal trends in HCC in Singapore, a multiethnic Asian country, over the last 3 decades. Patients with HCC were prospectively enrolled and stratified into two cohorts (C1, 1988‐2002; C2, 2003‐2016). Patient and tumor characteristics, management, and survival were compared between the two cohorts, and a survival census was performed on October 31, 2015. There were 1,401 patients, and the mean age at diagnosis of HCC for C1 and C2 was 60.1 and 63.5 years, respectively. Male patient preponderance decreased significantly, with the male to female ratio falling from 5.2:1 to 3.9:1 between C1 and C2. Hepatitis B, although still the predominant risk factor for HCC, showed a significant decline from C1 to C2 (76.5% to 68.2%), while the nonviral etiology increased significantly over the same period (14.4% versus 25.0%, respectively). Significantly more patients in C2 than C1 were diagnosed through surveillance (39.2% versus 11.3%, respectively) and had better physical performance (Eastern Cooperative Oncology Group 0, 62.1% versus 20.4%, respectively). While Child‐Pugh status was comparable, significantly more patients in C2 than C1 had early stage disease (Barcelona Clinic Liver Cancer 0‐A, 39.5% versus 7.4%, respectively), which translated into significantly higher median survival (18.6 months versus 3.8 months, respectively). Conclusion: Over the past 3 decades, hepatitis B‐related HCC has been decreasing while HCC due to nonviral etiology has been increasing significantly. Surveillance to diagnose early stage HCC is important in improving the outcome of HCC. (Hepatology Communications 2017;1:564–571)

Crucial role of the pentose phosphate pathway in malignant tumors (Review)

“…HCC is one of the most common cancers worldwide (71). Breast cancer is the second most common cancer in the world, with 1.7 million new cases diagnosed annually (72).…”

The Changing Epidemiology of Hepatocellular Carcinoma : Experience of a Single Center

“…e causes of this tumor coincide with those of liver cirrhosis, although there are epidemiological differences according to the geographical area considered. In detail, hepatitis B virus (HBV) etiology is prevalent in China, Southeast Asia, and sub-Saharan Africa [4,5], while chronic hepatitis C virus (HCV) is an important risk factor in western countries and Japan [6][7][8]. Chronic alcoholic liver diseases are reported worldwide, with the highest prevalence in Eastern and Central Europe (53 and 46%, respectively), sub-Saharan Africa (40%), and North America (37%) [9].…”

Management of Adverse Events Associated with Cabozantinib Treatment in Patients with Advanced Hepatocellular Carcinoma

“…The frequency, burden, and etiology of HCC vary across geographic regions and populations but are linked to prevalence of predisposing chronic hepatic conditions such as viral hepatitis and nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH), which generally develop in the setting of cirrhosis [ 3 , 4 ]. In recent years, the incidence of nonviral HCC has increased while the proportion of HCC cases related to viral hepatitis has declined [ 3 , 4 ]. Additional risk factors for HCC include alcohol consumption, smoking, obesity, and diabetes [ 2 ].…”