The Mortality and Overall Survival Trends of Primary Liver Cancer in the United States

Abstract

Background Recent trends of hepatocellular carcinoma (HCC) mortality and outcome remain unknown in the United States (US). We investigated the recent trends of primary liver cancer (excluding intrahepatic cholangiocarcinoma) mortality and HCC stage, treatment, and overall survival (OS) in the US. Methods US Cancer Mortality database was analyzed to investigate the trend of primary liver cancer mortality. We analyzed the SEER 18 database to assess the temporal trend of tumor size, stage, treatment, and OS of HCC. Cox regression analysis investigated the association between HCC diagnosis year and OS. All statistical tests were 2-sided. Results During 2000-2018, liver cancer mortality rates increased until 2013, plateaued during 2013-2016 (annual percent change [APC] = 0.1%/yr, 95% confidence interval [CI] = -2.1% to 2.4%; P=0.92), and started to decline during 2016-2018 (APC = -1.5%/yr, 95% CI= -3.2% to 0.2%; P=0.08). However, mortality continues to increase in American Indians/Alaska Natives, individuals aged 65 or older, and in 33 states. There was a 0.61% (95% CI = 0.53% to 0.69%; P<0.001) increase in localized stage HCC and 0.86 mm (95% CI= -1.10 to -0.62; P<0.001) decrease in median tumor size per year. One-year OS rate increased from 36.3% (95% CI = 34.3% to 38.3%) to 58.1% (95% CI = 56.9% to 59.4%) during 2000-2015, and five-year OS rate almost doubled from 11.7% (95% CI = 10.4% to 13.1%) to 21.3% (95% CI = 20.2% to 22.4%) during 2000-2011. Diagnosis year (per year) (adjusted hazard ratio = 0.96; 95% CI = 0.96 to 0.97) was independently associated with OS in multivariable analysis. Conclusions Primary liver cancer mortality rates have started to decline in the US with demographic and state-level variation. With an increasing detection of localized HCC, the OS of HCC has improved over the past decades.

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“…Hepatocellular carcinoma (HCC), accounting for 80 % of the liver tumors, ranks the sixth most common malignancy with the leading mortality rate worldwide 1 . The high incidence of HCC is attributed to various risks factors, including hepatitis B or hepatitis C virus infection, aflatoxin, diabetes, obesity, alcohol abuse, and even smoking 2 , 3 .…”

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“…However, the risk of bleeding and tumor cell proliferation during biopsy is an ongoing problem during diagnosis [ 3 ]. Statistically, the 5-year survival rate of primary liver cancer in the United States is approximately 16% [ 4 ], which is close to that in Europe [ 5 ], whereas the survival rate of HCC in underdeveloped areas may be less than 5%. Thus, there is considerable research being undertaken currently on understanding the molecular genetic mechanism underlying HCC to provide a theoretical basis for the diagnosis and treatment of HCC.…”

Diagnostic Accuracy of Serum/Plasma Circular RNAs and the Combination of Circular RNAs and α-Fetoprotein for Detecting Hepatocellular Carcinoma: A Meta-Analysis

“…Furthermore, about 50% of all new cases and deaths worldwide occurred in China, and HCC is one of the five leading causes of cancer-related death in China (Chen et al, 2016 ). Patients detected in an early stage can achieve 5-year survival to 70% with suitable therapies (Llovet et al, 1999 ), when the 5-year overall survival (OS) rate has reached to 21.3% until 2011 and diagnosis year (per year) (adjusted hazard ratio = 0.96) was independently associated with OS in multivariable analysis (Lee et al, 2021 ). Imaging methods (such as computed tomography and ultrasonography) and blood biomarkers (such as α-fetoprotein [AFP]) are usually used to screen and diagnose HCC in the clinic (Luo et al, 2018 ).…”