Emerging trends in hepatocellular carcinoma incidence and mortality.
Emerging trends in hepatocellular carcinoma incidence and mortality.
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DOI：
10.1002/hep.27388
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发表时间：
2015-01
期刊：
影响因子：
--
通讯作者：
Lim JK
中科院分区：
文献类型：
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作者：
Njei B;Rotman Y;Ditah I;Lim JK
美国肝细胞癌 (HCC) 发病率的上升已有充分记录。该分析的目的是检查美国人口中 HCC 发病率、死亡率和生存率的时间趋势。监测、流行病学和最终结果数据用于检查 1973 年至 2011 年间 HCC 的发病率和基于发病率 (IB) 的死亡率。使用 Joinpoint 回归程序对按性别和癌症分期划分的年龄调整发病率和 IB 死亡率的长期趋势进行了表征。 1973年，HCC发病率为每10万人1.51例，而2011年，HCC发病率为每10万人6.20例。虽然 HCC 发病率持续上升，但 2006 年左右增速放缓。在敏感性分析中，2009 年至 2011 年间，发病率和 IB 死亡率没有显着增加。从 1970 年代到 2000 年代，总体中位生存期显着增加（2 个月与 8 个月；P < 0.001）。在多变量 Cox 回归分析中，年龄、性别、种族、肿瘤分级、诊断分期、淋巴/血管侵犯、原发肿瘤数量、肿瘤大小和肝移植与死亡率独立相关。我们的结果表明，2006 年左右 HCC 发病率有所下降。自 2009 年以来，美国人口中 IB 死亡率和 HCC 发病率首次没有增加，这是四十年来的首次。近年来发病率和 IB 死亡率的非显着增加表明 HCC 流行的高峰可能即将到来。从 1973 年到 2010 年，HCC 的生存率也显着提高，这似乎是由于在治疗阶段更早地发现 HCC 以及更多地利用治疗方式（尤其是移植）所致。
The rise in incidence of hepatocellular carcinoma (HCC) in the United States has been well documented. The purpose of this analysis was to examine temporal trends in HCC incidence, mortality, and survival within the U.S. population. The Surveillance, Epidemiology, and End Results data were used to examine incidence and incidence-based (IB) mortality in HCC from 1973 to 2011. Secular trends in age-adjusted incidence and IB mortality by sex and cancer stage were characterized using the Joinpoint Regression program. In 1973, HCC incidence was 1.51 cases per 100,000, whereas in 2011, HCC incidence was 6.20 cases per 100,000. Although HCC incidence continues to increase, a slowing of the rate of increase occurs around 2006. In a sensitivity analysis, there was no significant increase in incidence and IB mortality from 2009 to 2011. There was a significant increase in overall median survival from the 1970s to 2000s (2 vs. 8 months; P < 0.001). On multivariable Cox's regression analysis, age, sex, race, tumor grade, stage at diagnosis, lymph/vascular invasion, number of primary tumors, tumor size, and liver transplant were independently associated with mortality. Our results indicate a deceleration in the incidence of HCC around 2006. Since 2009 and for the first time in four decades, there is no increase in IB mortality and incidence rates for HCC in the U.S. population. The nonsignificant increase in incidence and IB mortality in recent years suggest that the peak of the HCC epidemic may be near. A significant survival improvement in HCC was also noted from 1973 to 2010, which seems to be driven by earlier detection of HCC at a curative stage and greater utilization of curative modalities (especially transplant).