Liver cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study

Abstract

Background: Worldwide, liver cancer is a leading cause of death for both men and women. The number of Americans who are diagnosed with and die of liver cancer has been rising slowly each year. Using data from the CONCORD-2 study, this study examined population-based survival by state, race, and stage at diagnosis.

Methods: Data from 37 statewide registries, which covered 81% of the US population, for patients diagnosed during 2001-2009 were analyzed. Survival up to 5 years was adjusted for background mortality (net survival) with state- and race-specific life tables, and it was age-standardized with the International Cancer Survival Standard weights.

Results: Liver cancer was diagnosed overall more often at the localized stage, with blacks being more often diagnosed at distant and regional stages than whites. 5-year net survival was 12.2% in 2001-2003 and 14.8% in 2004-2009. Whites had higher survival than blacks in both calendar periods (11.7% vs 9.1% and 14.3% vs 11.4%, respectively). During 2004-2009, 5-year survival was 25.7% for localized-stage disease, 9.5% for regional-stage disease, and 3.5% for distant-stage disease.

Conclusions: Some progress has occurred in survival for patients with liver cancer, but 5-year survival remains low, even for those diagnosed at the localized stage. Efforts directed at controlling well-established risk factors such as hepatitis B may have the greatest impact on reducing the burden of liver cancer in the United States. Cancer 2017;123:5059-78. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Keywords: cancer registries; hepatitis; liver; population-based survival.

Figure 1

Liver cancer: 5-year age-standardized net survival for males and females (15–99 years old) diagnosed 2001–2003 and 2004–2009 and absolute changes (%). The states are grouped by US Census region. Data from 37 statewide cancer registries (covering 80.6% of the population) are ranked within US Census regions by decreasing survival estimate for 2004–2009. Dark colors denote states affiliated with the National Program of Cancer Registries; pale colors denote states affiliated with the Surveillance, Epidemiology, and End Results Program; and an asterisk denotes states affiliated with both federal surveillance programs. † Indicate changes were not plotted if a survival estimate was not available for 1 calendar period or if 1 or more estimates were not age-standardized.

Figure 2

Liver cancer: 5-year age-standardized net survival for males and females (15–99 years old) by state, race, and calendar period of diagnosis. The pooled (US) survival estimate for each calendar period is shown by the horizontal (solid) line with corresponding 95.0% and 99.8% control limits (dotted lines).