Incidence and survival of pediatric and adult hepatocellular carcinoma, United States, 2001-2020

Abstract

Importance Hepatocellular carcinoma (HCC) accounts for approximately 80% of liver neoplasms. Globally, HCC ranks as the third most lethal cancer, with the number of HCC-related deaths expected to further increase by 2040. In adults, disparities in incidence and survival are well described while the epidemiology of pediatric HCC is not well characterized. Objective To describe incidence and survival for pediatric (ages 0-19 years) HCC cases and compare these measures to adults (ages ≥20 years) diagnosed with HCC. We evaluated demographic factors and clinical characteristics that influence incidence and outcomes. Design Population-based cohort study Setting Incidence data from the US Cancer Statistics (USCS) database from 2003 to 2020 and 5-year relative survival from the National Program of Cancer Registries (NPCR) from 2001 to 2019, covering 97% and 83% of the US population, respectively. Participants 355,349 (USCS) and 257,406 (NPCR) patients were identified using ICD-O-3 C22.0 and 8170-5 codes. Main Outcomes and Measures Incidence annual percent change (APC) and average APC (AAPC) using joinpoint regression. Five-year relative survival. All-cause survival estimated using multivariate Cox modeling. Corresponding 95% confidence intervals (CI) were calculated. Results HCC incidence rate per 100,000 persons was 0.056 (95%CI:0.052-0.060) for pediatric cases and 7.793 (7.767-7.819) for adults. Incidence was stable in the pediatric population (0.3 AAPC, -1.1-1.7). In contrast, after periods of increase, incidence declined in adults after 2015 (-1.5 APC). Relative survival increased over time for both pediatric and adult ages and was higher for children and adolescents (46.4%, 95%CI:42.4-50.3) than adults (20.7%, 95%CI:20.5-20.9) overall and when stratified by stage. Regression modeling showed that non-Hispanic Black race and ethnicity was associated with higher risk of death in children and adolescents (1.48, 95%CI:1.07-2.05) and adults (1.11, 95%CI:1.09-1.12) compared to non-Hispanic white race and ethnicity. Conclusions and Relevance Between 2003 and 2020 in the United States, pediatric HCC incidence was stable while incidence in adults began to decline after 2015. Survival was higher across all stages for children and adolescents compared to adults. Non-Hispanic Black race and ethnicity showed a higher risk of death for both age groups. Further studies could explore the factors that influence these outcome disparities.