Hepatocellular Carcinoma Incidence, Mortality, and Survival Trends in the United States From 1975 to 2005

Altekruse, Sean F.; McGlynn, Katherine A.; Reichman, Marsha E.

doi:10.1200/jco.2008.20.7753

Cited by 1,526 publications

(1,180 citation statements)

References 36 publications

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“…(2) Despite improvement in overall survival over time, most patients continue to be diagnosed at advanced stages and 5-year survival rates remain below 20%. (3) Racial/ethnic minorities have higher rates of late-stage tumor detection as well as significantly lower stage-adjusted survival rates than non-Hispanic Caucasians. (4,5) Poor HCC clinical outcomes are, in part, attributed to underuse of surveillance among at-risk patients with cirrhosis.…”

Section: Conclusion-patientsmentioning

confidence: 99%

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Farvardin

Patel

Khambaty³

et al. 2016

Hepatology

148

130

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Over 20% of patients with cirrhosis are nonadherent with hepatocellular carcinoma (HCC) surveillance recommendations; however, few studies have evaluated the impact of patient-level factors on surveillance receipt. We characterized the association between HCC surveillance receipt and patient knowledge, attitudes, and perceived barriers in a racially diverse and socioeconomically disadvantaged cohort of patients with cirrhosis. Patients with cirrhosis followed at a large urban hospital were invited to complete a survey about HCC surveillance between August 2014 and December 2015. Multivariable logistic regression was performed to identify factors associated with HCC surveillance receipt during the 12-month period preceding and 6-month period after survey administration. We achieved a response rate of 71.8% (n = 541 of 753). Patients demonstrated high levels of HCC-related knowledge (summary score, 77.7%); however, 48.6% believed that eating a healthy diet precluded the need for HCC surveillance, and 34.0% believed that HCC surveillance was not necessary if they had a normal physical exam and/or lacked clinical symptoms. Patients expressed worry about developing and dying from HCC, but nearly half (49.9%) of patients reported barriers to receiving HCC surveillance, including difficulty with the scheduling process (30.5%), costs of surveillance testing (25.3%), and transportation difficulties (17.3%). HCC surveillance receipt was significantly higher in patients who knew cirrhosis is a risk factor for developing HCC (odds ratio [OR], 3.09; 95% confidence ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO: Amit G. Singal, M.D., M.S., Division of Digestive and Liver Diseases, UT Southwestern Medical Center, 5959 Harry Hines Boulevard, POB 1, Suite 420, amit.singal@utsouthwestern.edu,. * These authors contributed equally to this work and are co-first authors.Potential conflict of interest: Dr. Singal consults for and is on the speakers' bureau for Bayer. Dr. Yopp is on the speakers' bureau for Bayer and received grants from Novartis and Peregrine.Author names in bold designate shared co-first Although provider recommendation is reported to be a strong predictor for HCC surveillance, (9) patient-level factors may also play an important role in surveillance underuse. In prospective cohort studies, nearly 1 in 5 patients were nonadherent with provider recommendations for HCC surveillance. (10,11) The cancer-screening literature has applied theoretical models of behavior change and demonstrated that patients' poor knowledge, negative attitudes, or perceived barriers to cancer screening may be associated with lower screening rates. (12,13) However, most studies evaluating HCC surveillance correlates have primarily focused on patient sociodemographic and clinical characteristics. (7,14) The effect of theory-based, patient-reported psychosocial factors on HCC surveillance completion has not been quantified. A better understanding of patient knowledge, attitudes, and barriers, particularly among low-income minorities, i...

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Section: Conclusion-patientsmentioning

confidence: 99%

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Farvardin

Patel

Khambaty³

et al. 2016

Hepatology

148

130

View full text Add to dashboard Cite

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“…1,2 It is the fifth leading cause of cancer in men and the seventh leading cause of cancer in women in United States. 3,4 Although incidence rates for most cancers in United States are declining, incidence rates for HCC in both men and women continue to rise. 3 It is estimated that there will be 30,640 new HCC cases diagnosed in 2013 (22,720 in men and 7920 in women).…”

Section: Introductionmentioning

confidence: 99%

Approximately one‐half of patients with early‐stage hepatocellular carcinoma meeting Milan criteria did not receive local tumor destructive or curative surgery in the post‐MELD exception era

Devaki

Wong

Marupakula

et al. 2014

Cancer

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BACKGROUND: Since 2002, priority Model for End-stage Liver Disease (MELD) exception status has been given to patients with hepatocellular carcinoma (HCC) who meet the Milan criteria. Since then, the number of liver transplantations performed in patients with HCC has increased, but to the authors' knowledge, few studies to date have examined the effect of MELD exception recommendations on therapy use and survival rates in a nationwide sample. The current study examines therapy use and long-term survival rates among patients with HCC tumors meeting the Milan criteria in the post-MELD exception era. METHODS: The current study is a retrospective cohort study of 2179 patients with localized HCC meeting the Milan criteria who were registered between 2004 and 2007 in the Surveillance, Epidemiology, and End Results database. RESULTS: A total of 43% of patients did not receive any specific therapy. Overall, the 5-year relative survival rate for patients receiving only supportive care was dismal at 24% (95% confidence interval [95% CI], 21%-27%), whereas that for patients undergoing liver transplantation was 77% (95% CI, 71%-82%). Long-term survival was found to be dependent on age, race=ethnicity, and type of therapy received. A multivariate Cox proportional hazards model adjusted for age, race=ethnicity, and type of therapy received demonstrated that, compared with white patients, black patients had significantly poorer survival outcomes (hazards ratio, 1.23; 95% CI, 1.03-1.47 [P 5.02]), whereas Asian=Pacific Islander patients had significantly better survival rates when compared with white patients (HR, 0.66; 95% CI, 0.57-0.77 [P <.001]). CONCLUSIONS: Despite having localized disease that met transplantation criteria, nearly 50% of the large nationwide cohort of patients with HCC in the current study received only supportive care and had dismal 5-year relative survival rates, especially among black patients. Cancer 2014;120:1725-32. V C 2014 American Cancer Society.KEYWORDS: SEER, survival analysis, liver transplantation, localized hepatocellular carcinoma, Model for End-stage Liver Disease. INTRODUCTIONHepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. 1,2 It is the fifth leading cause of cancer in men and the seventh leading cause of cancer in women in United States. 3,4 Although incidence rates for most cancers in United States are declining, incidence rates for HCC in both men and women continue to rise. 3 It is estimated that there will be 30,640 new HCC cases diagnosed in 2013 (22,720 in men and 7920 in women). 3 Similarly, mortality rates for HCC have also increased over the past 2 decades and it is estimated that there will be 21,670 HCC-related deaths in 2013 (14,890 in men and 6780 in women). 3 Despite advances in screening and early detection, HCC still has a poor overall 5-year survival rate of 16% according to the data published by the Surveillance, Epidemiology, and End Results (SEER) program between 2002 and 2008. 3

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“…The HCC population in China contributes to about 55% of the total cases in the world , where the incidence of male is higher than female (Yang et al, 2005). In the United States of America, after adjusting by age, the incidence of HCC has grown from 1.6/100,000 in 1975 to 4.9/100,000 in 2005 (Altekruse et al, 2009). Compared with other cancers, the mortality of HCC is very high.…”

Section: Introductionmentioning

confidence: 99%

Exposure to organochlorine pesticides is an independent risk factor of hepatocellular carcinoma: A case–control study

Zhao

Shen

Liu

et al. 2011

J Expo Sci Environ Epidemiol

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Primary hepatocellular carcinoma (HCC) is highly prevalent in China. Although hepatitis B virus (HBV) and aflatoxin B1 (AFB1) are considered the major risk factors, among the high-risk cohorts only a small fraction develops liver cancer. Therefore, we investigated whether organochlorine pesticide exposure contributed to HCC risk in the Xiamen population. The questionnaire database was built from 346 HCC cases and 961 healthy controls during [2007][2008][2009]. The serum levels of a-, b-, g-, d-HCH, 1,1,1-trichloro-2,2-bis (p-chlorophenyl) ethane (p,p 0 -DDT), (1,1-dichloro-2,2-bis (p-chlorophenyl) ethylene (p,p 0 -DDE), 1,1,1-trichloro-2,2-bis (o-chlorophenyl) ethane and 1,1-dichloro-2,2-bis (p-chlorophenyl) ethane were measured by gas chromatography-tandem mass spectrometer, and statistical analysis was done using SPSS16. Significantly, we observed p,p 0 -DDT and p,p 0 -DDE, and at the first time b-HCH displayed quartile dose-dependent HCC risk trends; p,p 0 -DDT showed positive (i.e., synergistic) interactions with HBV, diabetes mellitus, AFB1 and polyaromatic hydrocarbon (PAH) exposure, but negative (i.e., antagonistic) interaction with heavy drinking; p,p 0 -DDE had positive interaction with PAH but negative interaction with HBV and p,p 0 -DDT; and b-HCH positively interacted with p,p 0 -DDT but negatively interacted with heavy drinking and diabetes. p,p 0 -DDT, p,p 0 -DDE and b-HCH were independent HCC risk factors. Because of their synergistic interactions with other factors, the high-level exposure combined with common AFB1 and HBV exposure in the investigated area may greatly enhance the risk of HCC.

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Hepatocellular Carcinoma Incidence, Mortality, and Survival Trends in the United States From 1975 to 2005

Cited by 1,526 publications

References 36 publications

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Approximately one‐half of patients with early‐stage hepatocellular carcinoma meeting Milan criteria did not receive local tumor destructive or curative surgery in the post‐MELD exception era

Exposure to organochlorine pesticides is an independent risk factor of hepatocellular carcinoma: A case–control study

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