Disparities Still Exist for HCC Incidence, Survival in United States

A new study has identified several interesting trends by race and ethnicity among patients with hepatocellular carcinoma (HCC) in the United States.

The study, published in Cancer, found that Asians were the only group that has a decreasing incidence of HCC, a trend likely due to a shift from advanced disease to more localized disease. In contrast, blacks, Hispanics, and non-Hispanic whites all had increasing rates of HCC.

“Although the overall incidence of total HCC seems to have peaked and plateaued beginning in 2009, the prevalence of total HCC has continued rising since 2003,” wrote researchers led by John Ha, MD, of Alameda Health System-Highland Hospital in Oakland, California. “The disparate trends in HCC incidence and prevalence in the most recent era reflect 2 major improvements in the management of HCC: 1) improved identification and treatment of underlying liver disease etiologies that can lead to HCC, and 2) improved HCC screening and surveillance programs that contribute to early detection and thereby improved treatment and long-term survival outcomes.”

Using data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry, the researchers investigated race-specific disparities in HCC incidence and survival from 51,741 patients with HCC from 2003 to 2011. The median follow-up was 8 months.

During this time, they found that Asians had the highest incidence of HCC (18.6 per 100,000 persons per year). This was followed by blacks (15.7 per 100,000), Hispanics (11.8 per 100,000), and non-Hispanic whites (7.0 per 100,000). Asian men had the highest incidence overall of any group (28.9 per 100,000).

Although Asians had the highest incidence, Hispanics saw the greatest increase in rates during this time period (35.8%). In contrast, the rates among Asians decreased by 5.5%. According to the researchers, “This observation likely reflects improvements in the management of chronic hepatitis B virus, which translate into a reduced incidence of hepatitis B virus–related HCC.”

Looking at 5-year HCC survival, the researchers found the highest survival rate among Asians (26.1%) and the lowest among blacks (21.3%). A multivariable regression analysis showed that Asians had a 17% higher rate of survival (hazard ratio [HR], 0.83 [95% CI, 0.79–0.87]; P < .001), and blacks had a 6% higher rate of survival (HR, 0.94 [95% CI, 0.89–0.99]; P = .01) compared with non-Hispanic whites.

“Greater research is needed to better understand these race/ethnicity-specific disparities and how to ensure equitable implementation of HCC screening, surveillance, and treatment programs across all groups to improve long-term HCC outcomes,” the researchers wrote.