Ethnic disparities and liver transplantation rates in hepatocellular carcinoma patients in the recent era: Results from the surveillance, epidemiology, and end results registry

Abstract

Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality. After the implementation of the Model for End-Stage Liver Disease system, rates of liver transplantation (LT) for HCC patients increased. However, it is not clear whether this trend has continued into recent times. Using the Surveillance, Epidemiology, and End Results registry (1998-2010), we retrospectively analyzed trends for LT among HCC patients in 3 time periods: 1998-2003, 2004-2008, and 2009-2010. A total of 60,772 HCC patients were identified. In the more recent time periods, the proportion of localized-stage HCC increased (45.0% in 1998-2003, 50.4% in 2004-2008, and 51.7% in 2009-2010; P < 0.001). Although the proportion of HCC patients within the Milan criteria also increased with time (22.8% in 1998-2003, 31.8% in 2004-2008, and 37.1% in 2009-2010; P < 0.001), the proportion of those patients undergoing LT increased from 1998-2003 to 2004-2008 but decreased from 2004-2008 to 2009-2010. However, the actual frequencies of LT were similar in 2004-2008 (208.2 per year) and 2009-2010 (201.5 per year). A multivariate logistic regression, including sex, age, ethnicity, Milan criteria, tumor stage, tumor size and number, and time periods, demonstrated a lower likelihood of LT in 2009-2010 versus 1998-2003 [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.57-0.71]. Blacks (OR = 0.48, 95% CI = 0.41-0.56), Asians (OR = 0.65, 95% CI = 0.57-0.73), and Hispanics (OR = 0.76, 95% CI = 0.68-0.85) were all less likely to undergo LT in comparison with non-Hispanic whites. Despite the increasing proportion of patients with HCC diagnosed at an earlier stage, LT rates declined in the most recent era. In addition, ethnic minorities were significantly less likely to undergo LT. The growing imbalance between the number of transplant-eligible HCC patients and the shortage of donor livers emphasizes the need to improve donor availability and curative alternatives to LT.

Surgical Resection Versus Radiofrequency Ablation for Single Hepatocellular Carcinoma ≤ 2 cm in a Propensity Score Model

“…8,9 Because of limited availability of liver transplantation, SR and RFA are frequently employed in patients with very early-stage HCC. 10,11 However, whether SR or RFA should be the choice of treatment in terms of OS and recurrencefree survival (RFS) is still under intense debate without universally accepted treatment algorithm. 12 In this study, we aimed to investigate the impact of treatment selection on HCC recurrence and long-term survival in a prospectively followed-up cohort of patients with very early-stage HCC receiving SR or RFA as the primary treatment.…”

SESN2 correlates with advantageous prognosis in hepatocellular carcinoma

“…The etiology of HCC is diverse and complicated; hepatitis B (HBV) and hepatitis C (HCV) viral infections as well as liver cirrhosis often contribute to HCC development [6, 7]. Despite substantial improvements in HCC management, including surgical resection, microwave ablation, liver transplantation, radiofrequency and chemotherapy, over the last 10 years, the prognosis of HCC remains unsatisfactory; moreover, the 5-year overall survival rate is less than 30% [8, 9]. For now, alpha-fetoprotein (AFP) is still the most widely acknowledged marker in early detection and follow-up surveillance for HCC [10].…”

“…Moreover, SESN2 acts as an important contributor in autophagy induction and tumor suppression [16, 17]. For example, SESN2 expression could be increased via the c-Jun N-terminal kinase (JNK) pathway to influence autophagy induction in cancer cells [9, 18]. Several gene expression analyses have also shown down-regulated SESN2 expression in different types of lung cancers [19, 20].…”

TIMP-3 Expression Associates with Malignant Behaviors and Predicts Favorable Survival in HCC

“…HCC tumorigenesis is a multistep process, and various factors are associated with HCC development, including hepatitis B (HBV) and hepatitis C (HCV) viral infections, chronic alcohol consumption and nonalcoholic fatty liver disease [5], [6]. Despite various therapeutic strategies for HCC treatment that have improved in the last two decades, such as surgical resection, radiofrequency, microwave ablation, chemotherapy, and transplantation, HCC remains a highly fatal disease because of the high recurrence and metastasis rates [7]; the overall 5-year survival rate of HCC patients has recently been reported to be only 16% [8]. Given the poor prognosis for patients with HCC and the complexity of outcome prediction, it is vital to identify useful prognostic factors for HCC in order to optimize the therapeutic approach for each case.…”