Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Hubei, Wuhan, 430071, China.
Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Jiangxi, Nanchang, 330006, China.
BMC Cancer. 2021 Oct 29;21(1):1157. doi: 10.1186/s12885-021-08904-3.
Hepatocellular carcinoma (HCC) incidences have been increasing in the United States. This study aimed to examine temporal trend of HCC survival and determine prognostic factors influencing HCC survival within the U.S.
The Surveillance Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with primary HCC from 1988 to 2015. Overall survival (OS) and disease-specific survival (DSS) were calculated by the Kaplan-Meier method. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for prognostic factors and comparing survival between patients diagnosed at different periods (per 5-year interval). Results A total of 80,347 patients were included. The proportions of both young patients (< 45 years) and old patients (≥75 years) decreased over time (P < 0.001) and the male-to-female ratio increased over time (P < 0.001). Significant decreasing temporal trends were observed for HCC severity at diagnosis, including SEER stage, tumor size, tumor extent, and lymph node involvement (P < 0.001 for all). OS and DSS of patients with HCC improved over time (P < 0.001). After adjusting for patient and tumor characteristics and treatment difference, period of diagnosis retained an independent factor for improved DSS and its prognostic significance was evident for localized and regional HCC (P < 0.001), but not for distant HCC. On multivariate analyses, young age, female gender, Hispanic ethnicity, and married status were predictors favoring DSS, whereas a worse DSS was observed for patients with tumor > 5 cm, with vascular invasion, and with lymph node involvement. Patients treated with liver-directed therapy (HR = 0.54, 95% CI: 0.35-0.56), hepatic resection (HR = 0.35, 95% CI: 0.33-0.37), and transplantation (HR = 0.14, 95% CI: 0.13-0.15) had significantly longer DSS compared with those who received no surgery. In stratified analyses, the beneficial effects of surgical approach, regardless therapy type, were significant across all stages.
Our results indicate a significant improvement in survival for HCC patients from 1988 to 2015, which may be attributable to advances in early diagnosis and therapeutic approaches.
肝癌（HCC）在美国的发病率一直在上升。本研究旨在探讨 HCC 生存的时间趋势，并确定影响美国 HCC 生存的预后因素。
利用监测、流行病学和最终结果（SEER）数据库，从 1988 年至 2015 年，确定诊断为原发性 HCC 的患者。采用 Kaplan-Meier 法计算总生存率（OS）和疾病特异性生存率（DSS）。采用单因素和多因素 Cox 回归模型，估计预后因素的风险比（HR）和 95%置信区间（CI），并比较不同时期（每 5 年间隔）诊断的患者之间的生存情况。
共纳入 80347 例患者。年轻患者（<45 岁）和老年患者（≥75 岁）的比例随时间推移而下降（P<0.001），男性与女性比例随时间推移而上升（P<0.001）。诊断时 HCC 严重程度的时间趋势明显降低，包括 SEER 分期、肿瘤大小、肿瘤范围和淋巴结受累情况（均 P<0.001）。随着时间的推移，HCC 患者的 OS 和 DSS 均得到改善（P<0.001）。在调整患者和肿瘤特征以及治疗差异后，诊断时期仍然是 DSS 改善的独立因素，并且其预后意义在局限性和区域性 HCC 中明显（P<0.001），但在远处 HCC 中不明显。多因素分析显示，年龄较轻、女性、西班牙裔和已婚是 DSS 的预测因素，而肿瘤>5cm、血管侵犯和淋巴结受累与较差的 DSS 相关。接受肝定向治疗（HR=0.54，95%CI：0.35-0.56）、肝切除术（HR=0.35，95%CI：0.33-0.37）和移植（HR=0.14，95%CI：0.13-0.15）的患者 DSS 明显长于未手术患者。分层分析显示，无论治疗类型如何，手术方法的有益效果在所有阶段均显著。
我们的研究结果表明，1988 年至 2015 年 HCC 患者的生存率显著提高，这可能归因于早期诊断和治疗方法的进步。
