Hepatocellular carcinoma confirmation, treatment, and survival in surveillance, epidemiology, and end results registries, 1992-2008

Abstract

Approaches to the diagnosis and management of hepatocellular carcinoma (HCC) are improving survival. In the Surveillance, Epidemiology, and End Results-13 registries, HCC stage, histological confirmation, and first-course surgery were examined. Among 21,390 HCC cases diagnosed with follow-up of vital status during 1998-2008, there were 4,727 (22%) with reported first-course invasive liver surgery, local tumor destruction, or both. The proportion with reported liver surgery or ablation was 39% among localized stage cases and only 4% among distant/unstaged cases. Though 70% of cases had histologically confirmed diagnoses, the proportion with confirmed diagnoses was higher among cases with reported invasive surgery (99%), compared to cases receiving ablation (81%) or no reported therapy (65%). Incidence rates of histologically unconfirmed HCC increased faster than those of confirmed HCC from 1992 to 2008 (8% versus 3% per year). Two encouraging findings were that incidence rates of localized-stage HCC increased faster than rates of regional- and distant-stage HCC combined (8% versus 4% per year), and that incidence rates of reported first-course surgery or tumor destruction increased faster than incidence rates of HCC without such therapy (11% versus 7%). Between 1975-1977 and 1998-2007, 5-year cause-specific HCC survival increased from just 3% to 18%. Survival was 84% among transplant recipients, 53% among cases receiving radiofrequency ablation at early stage, 47% among cases undergoing resection, and 35% among cases receiving local tumor destruction. Asian or Pacific Islander cases had significantly better 5-year survival (23%) than white (18%), Hispanic (15%), or black cases (12%).

Conclusion: HCC survival is improving, because more cases are diagnosed and treated at early stages. Additional progress may be possible with continued use of clinical surveillance to follow individuals at risk for HCC, enabling early intervention.

Fig. 1

Incidence trends, all HCC cases, histologically confirmed cases, and unconfirmed cases, SEER-13, 1992-2008*† * APC: Annual percent change; Asterix: slope differs from zero, P<0.05 †Database: Incidence in SEER-13 Registries, Research Data, Nov 2010 Submission (1992-2008)

Fig. 2

Incidence trends, all HCC cases, cases diagnosed at localized stage, regional or distant stage, and unstaged cases, SEER-13, 1992-2008† * APC: Annual percent change; Asterix: slope differs from zero, P<0.05 †Database: Incidence in SEER-13 Registries, Research Data, Nov 2010 Submission (1992-2008)

Fig. 3

Incidence trends, HCC cases by reported first course primary surgery/local tumor destruction, stage and histologic confirmation status. † * APC: Annual percent change (non-cumulative). Asterix indicates APC slope differs from zero, P<0.05. †Database: Incidence in SEER-13 Registries, Research Data, Nov 2010 Submission (1992-2008)

Fig. 4

HCC stage distribution and histologic confirmation status by reported first course surgery, diagnosis years 1998-2007*† * Transplant, resection, and local tumor destruction groups exclude 31 cases with unspecified surgery and 451 cases with equivocal data regarding surgery. †Database: Incidence in SEER-13 Registries, Research Data, Nov 2010 Submission (1998-2008)

Fig. 5

HCC five-year cause-specific survival by reported first course surgery including by non-Hispanic race/ Hispanic ethnicity, diagnosis years 1998-2007.*† *Abbreviations: AI/AN=American Indian or Alaska Native, API=Asian or Pacific Islander. Note: Transplant, resection, and local tumor destruction groups exclude 24 cases with unspecified surgery and 121 cases with equivocal data regarding surgery. Data suppressed if fewer than 12 cases iden fied. †Database: Incidence in SEER-13 Registries, Research Data, Nov 2010 Submission (1998-2008)