Division of Digestive and Liver Diseases.
Comprehensive Transplant Center.
J Natl Compr Canc Netw. 2020 Sep;18(9):1210-1220. doi: 10.6004/jnccn.2020.7564.
It remains unknown to what extent hepatocellular carcinomas (HCCs) are detected very early (T1 stage; ie, unifocal <2 cm) in the United States. The aim of this study was to investigate the trends and factors associated with very early detection of HCC and resultant outcomes.
Patients with HCC diagnosed from 2004 through 2014 were identified from the National Cancer Database. Logistic regression was used to identify factors associated with T1 HCC detection, and Cox proportional hazard analyses identified factors associated with overall survival among patients with T1 HCC.
Of 110,182 eligible patients, the proportion with T1 HCC increased from 2.6% in 2004 to 6.8% in 2014 (P<.01). The strongest correlate of T1 HCC detection was receipt of care at an academic institution (odds ratio, 3.51; 95% CI, 2.31-5.34). Older age, lack of insurance, high Model for End-Stage Liver Disease (MELD) score, high alpha-fetoprotein, increased Charlson-Deyo comorbidity score, and nonsurgical treatment were associated with increased mortality, and care at an academic center (hazard ratio [HR], 0.27; 95% CI, 0.15-0.48) was associated with reduced mortality in patients with T1 HCC. Liver transplantation (HR, 0.27; 95% CI, 0.20-0.37) and surgical resection (HR, 0.67; 95% CI, 0.48-0.93) were independently associated with improved survival compared with ablation. This is the first study to examine the trend of T1 HCC using the National Cancer Database, which covers approximately 70% of all cancer diagnoses in the United States, using robust statistical analyses. Limitations of the study include a retrospective study design using administrative data and some pertinent data that were not available.
Despite increases over time, <10% of HCCs are detected at T1 stage. The strongest correlates of survival among patients with T1 HCC are receiving care at an academic institution and surgical treatment.
在美国，肝癌（HCC）在多早（T1 期；即单发<2cm）被发现尚不清楚。本研究旨在调查与 HCC 早期发现相关的趋势和因素及其结果。
从国家癌症数据库中确定了 2004 年至 2014 年期间诊断为 HCC 的患者。使用逻辑回归来确定与 T1 HCC 检测相关的因素，使用 Cox 比例风险分析确定 T1 HCC 患者总生存相关的因素。
在 110182 名合格患者中，T1 HCC 的比例从 2004 年的 2.6%增加到 2014 年的 6.8%（P<.01）。T1 HCC 检测的最强相关因素是在学术机构接受治疗（优势比，3.51；95%CI，2.31-5.34）。年龄较大、无保险、较高的终末期肝病模型（MELD）评分、较高的甲胎蛋白、增加的 Charlson-Deyo 合并症评分和非手术治疗与死亡率增加相关，而在学术中心接受治疗（风险比[HR]，0.27；95%CI，0.15-0.48）与 T1 HCC 患者的死亡率降低相关。肝移植（HR，0.27；95%CI，0.20-0.37）和手术切除（HR，0.67；95%CI，0.48-0.93）与消融相比，均与生存改善独立相关。这是第一项使用国家癌症数据库检查 T1 HCC 趋势的研究，该数据库涵盖了美国约 70%的所有癌症诊断，使用了强大的统计分析。研究的局限性包括使用行政数据进行回顾性研究设计以及一些未获得的相关数据。
尽管随着时间的推移有所增加，但仍有<10%的 HCC 被发现处于 T1 期。T1 HCC 患者生存的最强相关因素是在学术机构接受治疗和接受手术治疗。
