Abstract

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide, but its current status is unclear. We aimed to investigate the evolution of etiology, presentation, management and prognostic tool in HCC over the past 12 years. A total of 3349 newly diagnosed HCC patients were enrolled and retrospectively analyzed. The comparison of survival was performed by the Kaplan-Meier method with the log-rank test. Hepatitis B and C virus infection in HCC were continuously declining over the three time periods (2004–2007, 2008–2011, 2012–2015; p < 0.001). At diagnosis, single tumor detection rate increased to 73% (p < 0.001), whereas vascular invasion gradually decreased to 20% in 2012–2015 (p < 0.001). Early stage HCC gradually increased from 2004–2007 to 2012–2015 (p < 0.001). The probability of patients receiving curative treatment and long-term survival increased from 2004–2007 to 2012–2015 (p < 0.001). The Cancer of Liver Italian Program (CLIP) and Taipei Integrated Scoring (TIS) system were two more accurate staging systems among all. In conclusion, the clinical presentations of HCC have significantly changed over the past 12 years. Hepatitis B and C virus-associated HCC became less common, and more patients were diagnosed at early cancer stage. Patient survival increased due to early cancer detection that results in increased probability to undergo curative therapies.

Highlights

  • Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide, but its current status is unclear

  • Our study shows that there was 13.1% reduction and 20.3% further reduction in the incident cases of HCC from 2004–2007 (n = 1308) to 2008–2011 (n = 1136), and from 2008–2011 to 2012–2015 (n = 905), respectively

  • Consistent with previous cohort studies[6,8,9], hepatitis B virus (HBV) infection significantly decreased after the implementation of the vaccination program[8,9]

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Summary

Introduction

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide, but its current status is unclear. We aimed to investigate the evolution of etiology, presentation, management and prognostic tool in HCC over the past 12 years. Hepatitis B and C virusassociated HCC became less common, and more patients were diagnosed at early cancer stage. HCC is the second most common reason for cancer-related mortality in Taiwan[5], an endemic area for hepatitis B virus (HBV). The risk for HCC development in patients with serologically confirmed HCV infection was estimated to be 17-fold[2]. For patients with early stage HCC, surgical resection, liver transplantation or local ablation therapy are usually indicated, with 5-year survival rate up to 75%14,16. We aimed to investigate the evolution of etiology, presentation, management, survival and prognostic tool in HCC patients from 2004 to 2015

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