The Mortality and Overall Survival Trends of Primary Liver Cancer in the United States
The Mortality and Overall Survival Trends of Primary Liver Cancer in the United States
复制标题
美国原发性肝癌的死亡率和总生存率趋势
DOI：
10.1093/jnci/djab079
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发表时间：
2021-05-19
影响因子：
10.3
通讯作者：
Yang, Ju Dong
中科院分区：
文献类型：
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作者：
Lee, Yi-Te;Wang, Jasmine J.;Yang, Ju Dong
背景：在美国，肝细胞癌（HCC）死亡率和预后的最新趋势仍然未知。我们调查了美国原发性肝癌（不包括肝内胆管细胞癌）死亡率和HCC分期、治疗和总生存率（OS）的最新趋势。方法：分析全国卫生统计中心数据库原发性肝癌死亡率的变化趋势。我们分析了监测、流行病学和最终结果18数据库，以评估HCC的肿瘤大小、分期、治疗和OS的时间趋势。我们使用考克斯回归分析研究了HCC诊断年份与OS之间的关系。所有统计检验均为双侧检验。结果如下：在2000-2018年期间，肝癌死亡率一直上升到2013年，在2013-2016年期间达到稳定水平（年百分比变化= 0.1%/年，95%置信区间[CI] = -2.1%/y至2.4%/y，P = .92），并在2016-2018年期间开始下降（年百分比变化= -1.5%/年，95% CI = -3.2%/年至0.2%/年，P = 0.08）。然而，在33个州，65岁或以上的美洲印第安人和阿拉斯加原住民的死亡率继续上升。每年局限期HCC增加0.61%（95% CI = 0.53%至0.69%，P <0.001），肿瘤平均大小减少0.86 mm（95% CI = -1.10至-0.62 mm，P <0.001）。1年OS率从36.3%（95% CI = 34.3%至38.3%）至58.1%（95% CI = 56.9%至59.4%），2000-2011年期间，5年OS率几乎翻了一番，从11.7%（95% CI = 10.4%至13.1%）增至21.3%（95% CI = 20.2%至22.4%）。在多变量分析中，诊断年（每年）（校正的风险比= 0.96，95%CI = 0.96至0.97）与OS独立相关。结论：原发性肝癌死亡率在美国已经开始下降，人口统计学和州一级的变化。随着局限性HCC检测的增加，HCC的OS在过去几十年中有所改善。
Background: Recent trends of hepatocellular carcinoma (HCC) mortality and outcome remain unknown in the United States. We investigated the recent trends of primary liver cancer (excluding intrahepatic cholangiocarcinoma) mortality and HCC stage, treatment, and overall survival (OS) in the United States. Methods: The National Center for Health Statistics Database was analyzed to investigate the trend of primary liver cancer mortality. We analyzed the Surveillance, Epidemiology, and End Results 18 Database to assess the temporal trend of tumor size, stage, treatment, and OS of HCC. We investigated the association between HCC diagnosis year and OS using Cox regression analysis. All statistical tests were 2-sided. Results: During 2000-2018, liver cancer mortality rates increased until 2013, plateaued during 2013-2016 (annual percent change = 0.1%/y, 95% confidence interval [CI] = -2.1%/y to 2.4%/y, P = .92), and started to decline during 2016-2018 (annual percent change = -1.5%/y, 95% CI = -3.2%/y to 0.2%/y, P = .08). However, mortality continues to increase in American Indian and Alaska Native, individuals aged 65 years or older, and in 33 states. There was a 0.61% (95% CI = 0.53% to 0.69%, P < .001) increase in localized stage HCC and a 0.86-mm (95% CI = -1.10 to -0.62 mm, P < .001) decrease in median tumor size per year. The 1-year OS rate increased from 36.3% (95% CI = 34.3% to 38.3%) to 58.1% (95% CI = 56.9% to 59.4%) during 2000-2015, and the 5-year OS rate almost doubled from 11.7% (95% CI = 10.4% to 13.1%) to 21.3% (95% CI = 20.2% to 22.4%) during 2000-2011. Diagnosis year (per year) (adjusted hazard ratio = 0.96, 95% CI = 0.96 to 0.97) was independently associated with OS in multivariable analysis. Conclusions: Primary liver cancer mortality rates have started to decline in the United States with demographic and state-level variation. With an increasing detection of localized HCC, the OS of HCC has improved over the past decades.