Recent Trends in the Epidemiology of Hepatocellular Carcinoma in Olmsted County, Minnesota

Abstract

Background/Aim The epidemiology of hepatocellular carcinoma (HCC) has changed in the United States (US) recently. The aim of this study is to evaluate the recent trends of HCC epidemiology in the Olmsted County, Minnesota, US. Method Residents aged over 20 with newly diagnosed HCC were identified using the Rochester Epidemiology Project database. Clinical information was compared among patients diagnosed between 2000 and 2009 (era 1) and 2010–2014 (era 2). Result Over 1.6 million person years of follow up, 93 residents were diagnosed with HCC. The mean age was 67 and 71% were male. The age- and sex-adjusted incidence rates were 6.3 and 7.0 per 100,000 person-years in the first and second eras (P=0.64). The proportion with HBV etiology increased from 4% to 21% between the two eras (P<0.01) while there was a trend toward a decreasing proportion of HCV etiology from 42% to 29% (P=0.20). Only 39% of HCC surveillance candidates had HCCs detected under surveillance and 41% of cirrhotic patients had unrecognized cirrhosis at the time of HCC diagnosis. NAFLD was associated with unrecognized cirrhosis and absence of cirrhosis at HCC diagnosis. More than half (56%) of patients presented at BCLC stage C or D and the median survival was 9.7 months. The overall survival had not changed over time. Conclusion The incidence of HCC remained stable after 2010 in Olmsted County. The proportion of HBV-induced HCC increased while there was a trend of decreasing proportion of HCV-induced HCC. The overall survival in community residents with HCC remains poor.

Diabetes Is Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Cirrhosis From Nonalcoholic Fatty Liver Disease

“…Diagnosis of NAFLD as an underlying cause of cirrhosis was based on clinical (documented history of fatty liver disease), radiological (steatosis noted on radiographic test), or histological (steatosis noted on liver histology) evidence of fatty liver disease or the presence of cryptogenic liver disease with metabolic syndrome at the time of or preceding initial evaluation in the absence of other causes of CLD (chronic viral hepatitis B or C, metabolic, autoimmune, genetic, or biliary liver disease) or significant alcohol consumption (history of alcohol abuse or dependence or documented alcohol consumption of >20 g daily for men and 10 g daily for women) as described …”

“…Incidence and mortality rates of hepatocellular carcinoma (HCC) have been increasing in the United States . Whereas chronic hepatitis C virus (HCV) infection has been the leading cause of HCC in the United States for the past several decades, successful treatment of chronic hepatitis C with highly potent direct antiviral treatment is decreasing the disease burden of HCV and thus decreasing the number of HCV‐associated HCC . In contrast to the rapid reduction in HCV‐related complications, global prevalence and economic burden of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) are increasing .…”

“…I ncidence and mortality rates of hepatocellular carcinoma (HCC) have been increasing in the United States. (1)(2)(3) Whereas chronic hepatitis C virus (HCV) infection has been the leading cause of HCC in the United States for the past several decades, successful treatment of chronic hepatitis C with highly potent direct antiviral treatment is decreasing the disease burden of HCV and thus decreasing the number of HCV-associated HCC. (2) In contrast to the rapid reduction in HCV-related complications, global prevalence and economic burden of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis Abbreviations: BMI, body mass index; CI, confidence interval; CLD, chronic liver disease; CTP, Child-Turcotte-Pugh; HbA1c, glycated hemoglobin; HCC, hepatocellular carcinoma; HCV, hepatitis B virus; HE, hepatic encephalopathy; HR, hazard ratio; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; OPTN, Organ Procurement and Transplantation; UNOS, United Network for Organ Sharing.…”

Impact of surveillance for hepatocellular carcinoma on survival in patients with compensated cirrhosis

“…Key transition probabilities in the model included annual incidence of HCC (3%; range, 1%‐5%) and median annual mortality of incurable HCC (50%; range, 45%‐55%) . The mean interval of tumor progression between early, detectable lesions to advanced stage was set to be 1 year, based on the reported doubling time of HCC of approximately 6 months .…”

Value of MRI in medicine: More than just another test?

“…) . While patients with suspicious hepatic nodules may require additional imaging, given the very low (93 HCC in 1.6 million person years of follow‐up; <7 per 100,000 person years) incidence of new HCC in cirrhotic patients undergoing screening, the majority of patients require no additional imaging until their next screening visits . This confers substantial potential cost savings, and an improved patient experience …”