California NanoSystems Institute, Crump Institute for Molecular Imaging, University of California, Los Angeles, Los Angeles, CA, USA.
Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA.
J Natl Cancer Inst. 2021 Nov 2;113(11):1531-1541. doi: 10.1093/jnci/djab079.
Recent trends of hepatocellular carcinoma (HCC) mortality and outcome remain unknown in the United States. We investigated the recent trends of primary liver cancer (excluding intrahepatic cholangiocarcinoma) mortality and HCC stage, treatment, and overall survival (OS) in the United States.
The National Center for Health Statistics Database was analyzed to investigate the trend of primary liver cancer mortality. We analyzed the Surveillance, Epidemiology, and End Results 18 Database to assess the temporal trend of tumor size, stage, treatment, and OS of HCC. We investigated the association between HCC diagnosis year and OS using Cox regression analysis. All statistical tests were 2-sided.
During 2000-2018, liver cancer mortality rates increased until 2013, plateaued during 2013-2016 (annual percent change = 0.1%/y, 95% confidence interval [CI] = -2.1%/y to 2.4%/y, P = .92), and started to decline during 2016-2018 (annual percent change = -1.5%/y, 95% CI = -3.2%/y to 0.2%/y, P = .08). However, mortality continues to increase in American Indian and Alaska Native, individuals aged 65 years or older, and in 33 states. There was a 0.61% (95% CI = 0.53% to 0.69%, P < .001) increase in localized stage HCC and a 0.86-mm (95% CI = -1.10 to -0.62 mm, P < .001) decrease in median tumor size per year. The 1-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 the 5-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.
Primary liver cancer mortality rates have started to decline in the United States with demographic and state-level variation. With an increasing detection of localized HCC, the OS of HCC has improved over the past decades.
美国原发性肝癌（不包括肝内胆管癌）死亡率和预后的近期趋势尚不清楚。我们调查了美国原发性肝癌（不包括肝内胆管癌）死亡率的近期趋势，以及肝癌的肿瘤大小、分期、治疗和总生存期（OS）的时空趋势。我们使用 Cox 回归分析调查了 HCC 诊断年份与 OS 之间的关系。所有统计检验均为双侧。
分析国家卫生统计中心数据库以调查原发性肝癌死亡率的趋势。我们分析了监测、流行病学和最终结果 18 数据库，以评估 HCC 的肿瘤大小、分期、治疗和 OS 的时间趋势。我们调查了 HCC 诊断年份与 OS 之间的关联，使用 Cox 回归分析。所有统计检验均为双侧。
2000-2018 年期间，肝癌死亡率持续上升，直至 2013 年达到峰值，然后在 2013-2016 年期间保持稳定（年变化率为 0.1%/y，95%置信区间[CI]为-2.1%/y 至 2.4%/y，P = .92），并于 2016-2018 年期间开始下降（年变化率为-1.5%/y，95%CI 为-3.2%/y 至 0.2%/y，P = .08）。然而，在美国印第安人和阿拉斯加原住民、65 岁及以上人群以及 33 个州，死亡率仍在继续上升。局部肝癌分期每年增加 0.61%（95%CI 为 0.53%至 0.69%，P < .001），肿瘤中位数每年缩小 0.86 毫米（95%CI 为-1.10 至-0.62 毫米，P < .001）。2000-2015 年间，1 年 OS 率从 36.3%（95%CI 为 34.3%至 38.3%）增加到 58.1%（95%CI 为 56.9%至 59.4%），而 5 年 OS 率几乎翻了一番，从 11.7%（95%CI 为 10.4%至 13.1%）增加到 21.3%（95%CI 为 20.2%至 22.4%）。2000-2011 年间。多变量分析显示，诊断年份（每年）（调整后的风险比=0.96，95%CI=0.96 至 0.97）与 OS 独立相关。
美国原发性肝癌死亡率开始下降，但存在人口统计学和州级差异。随着局部肝癌检出率的提高，肝癌的 OS 状况在过去几十年中有所改善。
