Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Jan;156(2):477-491.e1.
doi: 10.1053/j.gastro.2018.08.065. Epub 2018 Oct 24.

Epidemiology and Management of Hepatocellular Carcinoma

Laura Kulik  1 , Hashem B El-Serag  2
Affiliations
Review

Epidemiology and Management of Hepatocellular Carcinoma

Laura Kulik et al. Gastroenterology. 2019 Jan.

Abstract

The major risk factors for hepatocellular carcinoma (HCC) in contemporary clinical practice are becoming increasingly related to sustained virological response after hepatitis C, suppressed hepatitis B virus during treatment, and alcoholic and nonalcoholic fatty liver disease. We review the emerging data on the risk and determinants of HCC in these conditions and the implications of HCC surveillance. However, from a public health perspective, active hepatitis C and B continue to drive most of the global burden of HCC. In United States, the age-adjusted incidence rates of HCC in Hispanics have surpassed those of HCC in Asians. Prognosis in HCC is complex because of the competing risk imposed by underlying cirrhosis and presence of malignancy. In addition to tumor burden, liver function and performance status; additional parameters including tumor biopsy, serum markers, and subclassification of current staging systems; and taking into account patterns of tumor progression may improve patient selection for therapy. Advancements in the treatment of HCC have included identification of patients who are most likely to derive a clinically significant benefit from the available therapeutic options. Additionally, the combination strategies of locoregional therapies and/or systemic therapy are being investigated.

Keywords: Epidemiology; Hepatitis C; Hepatocellular Carcinoma.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST: Research grant funding for investigator initiated research from Gilead, Wako, and Merck to H El-Serag. Research grant funding for investigator initiated research from BMS to L Kulik.

Figures

FIGURE 1
FIGURE 1
Yearly age adjusted incidence rates of HCC in United States between 2000 and 2012 broken by race and ethnicity. Adopted from ref #
FIGURE 2
FIGURE 2
The cumulative incidence and determinates of HCC following DAA-related SVR among VA patients with HCV. The incidence rates are shown according to several demographic and clinical features for patients with and without cirrhosis at baseline. Adopted from ref #
FIGURE 3
FIGURE 3
The risk of HCC among patients with hepatitis B receiving continuous antiviral treatment. Adopted from ref #.
See this image and copyright information in PMC

References

    1. Singal AG, El-Serag HB. Hepatocellular carcinoma from epidemiology to prevention: translating knowledge into practice. Clinical gastroenterology and hepatology. 2015;13(12):2140–51. - PMC - PubMed
    1. White DL, Thrift AP, Kanwal F, Davila J, El-Serag HB. Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through 2012. Gastroenterology. 2017;152(4):812–20. e5. - PMC - PubMed
    1. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Annals of internal medicine. 2006;144(10):705–14. - PubMed
    1. Kallwitz ER, Daviglus ML, Allison MA, Emory KT, Zhao L, Kuniholm MH, et al. Prevalence of suspected nonalcoholic fatty liver disease in Hispanic/Latino individuals differs by heritage. Clinical Gastroenterology and Hepatology. 2015;13(3):569–76. - PMC - PubMed
    1. Mittal S, Sada YH, El-Serag HB, Kanwal F, Duan Z, Temple S, et al. Temporal trends of nonalcoholic fatty liver disease-related hepatocellular carcinoma in the veteran affairs population. Clinical Gastroenterology and Hepatology. 2015;13(3):594–601. e1. - PMC - PubMed

Publication types