Arnett Azlann, Siegel David A, Dai Shifan, Thompson Trevor D, Foster Jennifer, di Pierro Erika J, Momin Behnoosh, Lupo Philip J, Heczey Andras
Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.
Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
medRxiv. 2024 Apr 5:2024.03.25.24304564. doi: 10.1101/2024.03.25.24304564.
Hepatocellular carcinoma accounts for approximately 80% of liver neoplasms. Globally, hepatocellular carcinoma ranks as the third most lethal cancer, with the number of deaths expected to further increase by 2040. In adults, disparities in incidence and survival are well described while pediatric epidemiology is not well characterized.
To describe incidence and survival for pediatric (ages 0-19 years) hepatocellular carcinoma cases and compare these measures to adults (ages ≥20 years) diagnosed with hepatocellular carcinoma. We evaluated demographic factors and clinical characteristics that influence incidence and outcomes.
Population-based cohort study.
Incidence data from the US Cancer Statistics database from 2003 to 2020 and 5-year relative survival from the National Program of Cancer Registries from 2001 to 2019, covering 97% and 83% of the US population, respectively.
355,349 US Cancer Statistics and 257,406 the National Program of Cancer Registries patients were identified using ICD-O-3 C22.0 and 8170-5 codes.
Incidence annual percent change (APC) and average APC (AAPC) using joinpoint regression. Five-year relative survival. All-cause survival estimated using multivariate Cox modeling. Corresponding 95% confidence intervals (CI) were calculated.
Incidence rate per 100,000 persons was 0.056 (95%CI:0.052-0.060) for pediatric cases and 7.793 (7.767-7.819) for adults. Incidence was stable in the pediatric population (0.3 AAPC, -1.1-1.7). In contrast, after periods of increase, incidence declined in adults after 2015 (-1.5 APC). Relative survival increased over time for both pediatric and adult ages and was higher for children and adolescents (46.4%, 95%CI:42.4-50.3) than adults (20.7%, 95%CI:20.5-20.9) overall and when stratified by stage. Regression modeling showed that non-Hispanic Black race and ethnicity was associated with higher risk of death in children and adolescents (1.48, 95%CI:1.07-2.05) and adults (1.11, 95%CI:1.09-1.12) compared to non-Hispanic white race and ethnicity.
Between 2003 and 2020 in the United States, pediatric incidence was stable while incidence in adults began to decline after 2015. Survival was higher across all stages for children and adolescents compared to adults. Non-Hispanic Black race and ethnicity showed a higher risk of death for both age groups. Further studies could explore the factors that influence these outcome disparities.
肝细胞癌约占肝脏肿瘤的80%。在全球范围内，肝细胞癌是第三大致命癌症，预计到2040年死亡人数将进一步增加。在成年人中，发病率和生存率的差异已有充分描述，而儿童流行病学特征尚不明确。
描述儿童（0至19岁）肝细胞癌病例的发病率和生存率，并将这些指标与诊断为肝细胞癌的成年人（≥20岁）进行比较。我们评估了影响发病率和预后的人口统计学因素和临床特征。
基于人群的队列研究。
来自2003年至2020年美国癌症统计数据库的发病率数据，以及来自2001年至2019年国家癌症登记计划的5年相对生存率数据，分别覆盖美国97%和83%的人口。
使用ICD-O-3 C22.0和8170-5代码识别出355,349例美国癌症统计患者和257,406例国家癌症登记计划患者。
使用连接点回归分析发病率年度百分比变化（APC）和平均APC（AAPC）。5年相对生存率。使用多变量Cox模型估计全因生存率。计算相应的95%置信区间（CI）。
儿童病例每10万人的发病率为0.056（95%CI：0.052 - 0.060），成人为7.793（7.767 - 7.819）。儿童人群的发病率稳定（AAPC为0.3，-1.1至1.7）。相比之下，在经历了一段时间的上升后，2015年后成人发病率下降（APC为-1.5）。儿童和成人的相对生存率均随时间增加，总体上以及按阶段分层时，儿童和青少年的生存率（46.4%，95%CI：42.4 - 50.3）高于成人（20.7%，95%CI：20.5 - 20.9）。回归模型显示，与非西班牙裔白人种族和族裔相比，非西班牙裔黑人种族和族裔在儿童和青少年（1.48，95%CI：1.07 - 2.05）和成人（1.11，95%CI：1.09 - 1.12）中死亡风险更高。
2003年至2020年在美国，儿童发病率稳定，而成人发病率在2015年后开始下降。儿童和青少年在所有阶段的生存率均高于成人。非西班牙裔黑人种族和族裔在两个年龄组中均显示出较高的死亡风险。进一步研究可探索影响这些预后差异的因素。
