The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States.
The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States.
复制标题
肝移植对美国肝癌死亡率的影响。
DOI：
10.1158/1055-9965.epi-20-1188
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Engels EA
中科院分区：
文献类型：
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作者：
Mahale P;Shiels MS;Lynch CF;Chinnakotla S;Wong LL;Hernandez BY;Pawlish KS;Li J;Alverson G;Schymura MJ;Engels EA
Hepatocellular carcinoma (HCC) carries a poor prognosis. Liver transplantation (LT) is potentially curative for localized HCC. We evaluated the impact of LT on US general population HCC-specific mortality rates. The Transplant Cancer Match Study links the US transplant registry with 17 cancer registries. We calculated age-standardized incidence (1987–2017) and incidence-based mortality (IBM) rates (1991–2017) for adult HCCs. We partitioned population-level IBM rates by cancer stage and calculated counterfactual IBM rates assuming transplanted cases had not received a transplant. Among 129,487 HCC cases, 45.9% had localized cancer. HCC incidence increased on average 4.0% annually (95%CI=3.6%−4.5%). IBM also increased for HCC overall (2.9% annually; 95%CI=1.7%−4.2%) and specifically for localized stage HCC (4.8% annually; 95%CI=4.0%−5.5%). The proportion of HCC-related transplants jumped sharply from 6.7% (2001) to 18.0% (2002), and further increased to 40.0% (2017). HCC-specific mortality declined among both non-transplanted and transplanted cases over time. In the absence of transplants, IBM for localized HCC would have increased at 5.3% instead of 4.8% annually. LT has provided survival benefit to patients with localized HCC. However, diagnosis of many cases at advanced stages, limited availability of donor livers, and improved mortality for non-transplanted patients have limited the impact of transplantation on general population HCC-specific mortality rates. Though LT rates continue to rise, better screening and treatment modalities are needed to halt the rising HCC mortality rates in the US.
