In contrast to current reports that show liver cancer rates increasing on the global scale, the incidence of hepatocellular carcinoma remained stable for 18 years in a large German cohort study.
Additionally, researchers found that HCC was increasingly diagnosed earlier, likely related to better screening programs and employment of therapeutic options.
“Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death worldwide, and its incidence is expected to rise further,” Enrico N. De Toni, PD, Dr.med, from the University of Munich in Germany, and colleagues wrote. “However, this trend might not reflect the reality of single states or regions, due to the different prevalence of risk factors, which account for a wide variability of incidence.”
De Toni and colleagues analyzed data on 4,078 patients from the Southern German region who had been diagnosed with HCC between 1998 and 2016. The incidence of HCC per year was 6.4 per 100,000 in men and 1.5 per 100,000 in women after adjusting for age and world standard.
While HCC rates remained largely stable during this period, the average patient age increased from 67.1 years between 1998 and 2002 to 69.1 years between 2013 and 2016.
The researchers wrote that increasing age at diagnosis seemed to contradict the prediction that decreasing tumor sizes would be accompanied with decreasing age but may reflect the aging of the general population related to improved treatment of chronic viral hepatitis.
“We expectedly observed a clear decline of the frequency of biopsies,” De Toni and colleagues wrote, referring to a decrease from 56% in 2004 to 30.4% in 2016. “However, the overall percentage of diagnostic biopsies (45%) shows that many physicians still rely on histology for diagnosis of HCC.”
Surgical and local-ablative treatment rates increased from 33.4% between 1998 and 2002 to 47.2% between 2013 and 2016. Palliative locoregional treatments such as transarterial chemoembolization also increased from 17% in the early period to 34.5% in the late period.
Overall survival rates were 45.5% at 1 year, 24.5% at 3 years, 16.2% at 5 years, and 8.2% at 10 years, increasing from an average of 6 months between 1998 and 2002 to 12 months between 2008 and 2016.
“Both implementation of screening programs and the advances in the therapeutic stratification are likely to have contributed to improve survival of HCC patients in the general population,” the researchers concluded. “The fact that the prognosis of patients with metastatic disease remained unchanged highlights the unmet need for effective systemic treatment in patients with advanced HCC.” – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.