The recent increase in the incidence of hepatocellular cancer in the United States is thought to underlie the rising mortality of this malignancy. However, it remains unknown whether survival of patients with hepatocellular carcinoma (HCC) has changed during the same time period. Using the SEER database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute, we examined the temporal changes and determinants of survival among patients with histologically proven HCC over a 20-year period. Between 1977 and 1996, 7,389 patients diagnosed with HCC were followed in the survival database of SEER. The overall 1-year relative survival rate increased from 14% (95% confidence intervals ( Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. 1 A recent increase in the ageadjusted mortality rates of HCC was reported in the United States. 2 Marked ethnic and gender-related differences in mortality were noted; men were 3 times more affected than women and minority ethnic groups were affected several times more than white patients. 2 Mortality rates of HCC are affected by its incidence as well as by survival after diagnosis. Although the age-adjusted incidence rates of HCC have been increasing during the same time period of rising mortality, the temporal and demographic features of survival in patients with HCC in the United States are unknown. In the last 2 decades, management of patients with HCC has included variable application of screening and treatment modalities such as ultrasound, computed tomography scan, ␣-fetoprotein, hepatic resection, chemoembolization, or alcohol injection. 3 The effectiveness of the current overall management of patients with HCC in reducing mortality remains unknown.In the United States, the Surveillance, Epidemiology, and End Results (SEER) Program is an ongoing contract-supported program of the National Cancer Institute to collect population-based cancer incidence and survival data in a uniform cancer registry. Using the SEER database, we examined the temporal changes as well as determinants of survival in patients with HCC over a 20-year period.
PATIENTS AND METHODSDatabase. The National Cancer Institute's SEER Program consists of 9 population-based cancer registries. The study population was selected from the 9 population-based cancer registries that constitute the National Cancer Institute's SEER Program. The registries account for 10% to 14% of the US population and include the states of Connecticut, Hawaii, New Mexico, and Utah and the metropolitan areas: San Francisco/Oakland, Detroit, Seattle, and Atlanta. Information pertaining to the incidence and survival of all types of cancer between 1974 to 1996 are available on a CD-ROM issued by the National Cancer Institute. 4 The ninth revision of the Clinical Modification of the International Classification of Diseases (ICD-9-CM) and International Classification of Diseases for Oncology (ICD-O) 5 are used to encode for malignancies in SEER incidence data. The SEER Program collects informati...