Improved survival of patients with hepatocellular carcinoma and disparities by age, race, and socioeconomic status by decade, 1983-2012

Abstract

Hepatocellular carcinoma (HCC), accounting for the majority of liver cancer, is a highly aggressive malignancy with poor prognosis and therefore adds up the financial burden. Incidence data of HCC in three decades during 1983-2012 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database with incidence rates of 1.9, 3.1 and 4.9 per 100,000 respectively. In addition, to evaluate the survival changes in the same period, a total of 63,640 HCC cancer cases were accessed from SEER database. The six-month relative survival rates improved each decade from 31.0% to 42.9% to 57.2% and the higher increase can be seen in the last two decades. More importantly, the disparities of survival among different racial groups and socioeconomic status (SES) were confirmed by the inferiority of survival in Black race and high-poverty group respectively. This research analyzed the incidence and survival data of HCC in the past three decades and may help predict the future trends of incidence and survival. Furthermore, this study may help better design healthcare policies and clinical management programs to balance the disparities of survival between SES groups, races, ages and sexes confirmed in this study and thereby improve the clinical management of HCC.

Global trends in the burden of liver cancer

“…For example, although the global burden of LC is rising, in a study specific to China, Xiao et al noted a decrease in mortality from 1999 to 2011. Similarly in a study specific to the United States, Wang et al documented a decreasing incidence and mortality rates of hepatocellular carcinoma among Asians/Pacific Islanders and men aged 35‐49 years. It is important to note that the central goal of the study is to exclusively describe the trends in global incidence, mortality and prevalence of LC based on geographic regions, socio‐economic standing, and demographics.…”

“…While the incidence and mortality was highest in the MHD region, the prevalence was highest in the VHHD region. It is likely that the rising incidence combined with easier access to care and availability of the newer expensive treatment options contributing to improved survival are responsible for the higher prevalence noted in the VHHD region. The higher prevalence in the VHHD region calls for the development of support systems to address the needs of the increasing number of survivors from LC.…”

“…In Europe, the findings are variable depending on the country although some favorable trends were noted. Whereas in the United States some studies have documented a rising burden albeit associated with an improved survival, particularly in some ethnic groups. In contrast, the international study by Zhang et al noted a decrease in the age‐standardized rates for LC in Asia and an increase in European, American, and Oceanian populations.…”

Biomarker MicroRNAs for Diagnosis, Prognosis and Treatment of Hepatocellular Carcinoma: A Functional Survey and Comparison

“…. In terms of prognosis, the overall survival rate was also disparate among different ethnic groups124. Here we reorganized HCC miRNA biomarkers based on the ethnicity of patients described in each citation.…”

Factors associated with ethnical disparity in overall survival for patients with hepatocellular carcinoma

“…Ethnicity has been demonstrated to be related to the prognosis of HCC patients in the United States (U.S.) [2–5]. In general, African American ethnicity is associated with the poorest overall survival rate; whereas Asian ethnicity is associated with the best overall survival [3–5].…”