The recent increase in the incidence of hepatocellular cancer in the United States is thought to underlie the rising mortality of this malignancy. However, it remains unknown whether survival of patients with hepatocellular carcinoma (HCC) has changed during the same time period. Using the SEER database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute, we examined the temporal changes and determinants of survival among patients with histologically proven HCC over a 20-year period. Between 1977 and 1996, 7,389 patients diagnosed with HCC were followed in the survival database of SEER. The overall 1-year relative survival rate increased from 14% (95% confidence intervals ( Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. 1 A recent increase in the ageadjusted mortality rates of HCC was reported in the United States. 2 Marked ethnic and gender-related differences in mortality were noted; men were 3 times more affected than women and minority ethnic groups were affected several times more than white patients. 2 Mortality rates of HCC are affected by its incidence as well as by survival after diagnosis. Although the age-adjusted incidence rates of HCC have been increasing during the same time period of rising mortality, the temporal and demographic features of survival in patients with HCC in the United States are unknown. In the last 2 decades, management of patients with HCC has included variable application of screening and treatment modalities such as ultrasound, computed tomography scan, ␣-fetoprotein, hepatic resection, chemoembolization, or alcohol injection. 3 The effectiveness of the current overall management of patients with HCC in reducing mortality remains unknown.In the United States, the Surveillance, Epidemiology, and End Results (SEER) Program is an ongoing contract-supported program of the National Cancer Institute to collect population-based cancer incidence and survival data in a uniform cancer registry. Using the SEER database, we examined the temporal changes as well as determinants of survival in patients with HCC over a 20-year period. PATIENTS AND METHODSDatabase. The National Cancer Institute's SEER Program consists of 9 population-based cancer registries. The study population was selected from the 9 population-based cancer registries that constitute the National Cancer Institute's SEER Program. The registries account for 10% to 14% of the US population and include the states of Connecticut, Hawaii, New Mexico, and Utah and the metropolitan areas: San Francisco/Oakland, Detroit, Seattle, and Atlanta. Information pertaining to the incidence and survival of all types of cancer between 1974 to 1996 are available on a CD-ROM issued by the National Cancer Institute. 4 The ninth revision of the Clinical Modification of the International Classification of Diseases (ICD-9-CM) and International Classification of Diseases for Oncology (ICD-O) 5 are used to encode for malignancies in SEER incidence data. The SEER Program collects informati...

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Death rates from primary liver cancer (hepatocellular carcinoma, HCC), have continued to rise in the U.S. over recent decades despite the availability of an increasing range of treatment modalities, including new systemic therapies. Prognosis is strongly associated with tumor stage at diagnosis; however, most cases of HCC are diagnosed beyond an early stage. This lack of early detection has contributed to low survival rates. Professional society guidelines recommend semi-annual ultrasound-based HCC screening for at-risk populations, yet HCC surveillance continues to be underutilized in clinical practice. On April 28, 2022, the Hepatitis B Foundation convened a workshop to discuss the most pressing challenges and barriers to early HCC detection and the need to better leverage existing and emerging tools and technologies that could improve HCC screening and early detection. In this commentary we summarize technical, patient-, provider-, and system-level challenges, and opportunities to improve processes and outcomes across the HCC screening continuum. We highlight promising approaches to HCC risk stratification and screening, including new biomarkers, advanced imaging incorporating AI, and algorithms for risk stratification. Workshop participants emphasized that action to improve early detection and reduce HCC mortality is urgently needed, noting concern that many of the challenges we are facing today are the same or similar to those faced a decade ago, and that HCC mortality rates have not meaningfully improved. Increasing the uptake of HCC screening was identified as a short-term priority, while simultaneously developing and validating better screening tests and risk-appropriate surveillance strategies.

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Methods: A retrospective cohort study of adult patients with H. pylori infection treated with clarithromycin triple therapy or bismuth quadruple therapy at a tertiary care county hospital on the US-Mexico border from January 2009 to March 2022 was conducted. Patients with unknown treatment regimens or an absence of an eradication test were excluded from the analysis. A logistic regression model adjusting for propensity scores using the inverse probability treatment weighting method was used to determine the relationship between eradication status and the treatment regimen. The analyses were adjusted for, age, gender, ethnicity, insurance, diabetes, smoking, illicit drug use, and PPI use. Results: A total of 938 patients were included, 201 patients (21.4%) in the quadruple regimen group and 737 patients (78.6%) in the triple regimen group. Mean age was 51 years, female (70.8%), Hispanic (90.4%), and non-insured patients (29.4%). The H. pylori eradication rate with quadruple therapy was significantly higher compared with triple therapy (91.5% vs 83.2% P50.004) in unadjusted analysis and after adjusting for propensity scores (OR 2.43;.27], P50.002). Following the 2017 ACG guidelines, the rate of using quadruple as the first line therapy increased from 11.1% to 24.6% (P, .0001). Furthermore, quadruple regimen therapy was more likely to be prescribed for insured (79.1%) compared with non-insured (20.9%) patients (P, 0.001) (Table ). Conclusion: In a predominantly Hispanic population, bismuth quadruple therapy is more effective in H. pylori eradication compared with clarithromycin triple regimen. However, insurance status seems to influence the choice of recommended regimen in this high-risk population.