By Liz Highleyman

Over the course of years or decades, chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) can progress to advanced liver disease, including cirrhosis and hepatocellular carcinoma (HCC), a form of primary liver cancer. HCC is the third leading cause of cancer-related mortality worldwide.

As people who were infected years ago have progressed to advanced stages of disease, the incidence of liver cancer has risen in the U.S. But survival is improving, likely due to more widespread screening, early treatment, and improvements in therapy, according to a study published in the February 17, 2009 advance online edition of the Journal of Clinical Oncology.

Sean Altekruse and colleagues from the National Cancer Institute analyzed age-adjusted trends in HCC incidence using U.S. Surveillance, Epidemiology, and End Results (SEER) cancer registries from 1975 through 2005. Age-specific rates were examined for birth cohorts born between 1900 and 1959. Age-adjusted incidence and cause-specific survival rates from 1992 through 2005 were analyzed according to race/ethnicity, disease stage, and treatment. Liver cancer mortality rates were also examined.

Results

Age-adjusted HCC incidence rates tripled between 1975 and 2005, increasing from 1.6 to 4.9 cases per 100,000 persons.

On an annual basis, the HCC incidence rate rose by 4.3% per year.

In all racial/ethnic groups combined, the HCC rate was about 3 times higher in men compared with women.

HCC incidence rates increased in each 10-year birth cohort from 1900 through the 1950s.

HCC incidence rates increased in all racial/ethnic groups.

Between 1992 and 2005, HCC among Asians and Pacific Islanders -- a group with a high prevalence of chronic hepatitis B -- increased by 17%.

Asians/Pacific Islanders continued to have the highest HCC incidence rate, but their annual increase was smaller (1.0%) compared with other racial/ethnic groups (5.0% for American Indians/Alaska natives, 4.9% for blacks, 4.6% for whites, 4.0% for Hispanics).

Between 2000 and 2005, the HCC rate increased markedly among black, Hispanic, and white middle-aged men (aged 50-59), likely reflecting an increase in HCV infections in the 1960s and 1970s.

The overall annual change in the HCC mortality rate was 1.6% per year.

Asians/Pacific Islanders had the highest HCC mortality rate, but experienced an annual decrease of 0.9% over time, while annual mortality rates rose for other racial/ethnic groups (1.3% for blacks, 1.7% for Hispanics and whites).

Between 1992 and 2004, 2-year to 4-year HCC survival rates doubled, coinciding with more patients being diagnosed with early-stage, localized HCC.

Prognosis especially improved among patients with localized HCC who received treatment, with the 1-year survival rate increasing from 65% in 1992 to 83% in 2004.

However, recent overall 1-year survival rates remained below 50%.

"HCC incidence and mortality rates continue to increase, particularly among middle-aged black, Hispanic, and white men," the investigators concluded.

They stated that "Screening of at-risk groups and treatment of localized-stage tumors may contribute to increasing HCC survival rates in the United States," but added that, "More progress is needed."

3/13/09

Reference
SF Altekruse, KA McGlynn, and ME Reichman. Hepatocellular Carcinoma Incidence, Mortality, and Survival Trends in the United States From 1975 to 2005. Journal of Clinical Oncology. February 17, 2009 [Epub ahead of print]. (Abstract).