Incidence and Survival Trends of Hepatocellular Carcinoma in Non-Cirrhotics With Ishak Fibrosis Score of 0-4 Between 2005-2014: A SEER Analysis

Abstract

Introduction: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and one of the leading causes of cancer related deaths. Although HCC occurs most commonly in cirrhotic livers, there is growing concern about HCC in non-cirrhotics, especially those with metabolic syndrome and NAFLD. However, there are limited data regarding HCC incidence and survival among non-cirrhotic patients in the United States. Methods: The Surveillance, Epidemiology, and End Results (SEER) registry was utilized to obtain data for HCC in non-cirrhotic patients with Ishak fibrosis scores of 0-4 from 2005-2014. Results: Overall incidence from 2005-2014 was 0.30 cases per 100,000 persons per year, with higher incidence in males (0.49, 95% CI: 0.47-0.51) compared to females (0.13, 95% CI: 0.12-0.14). For race, incidence was greatest among Asian or Pacific Islanders (APIs) (0.83, 95% CI: 0.77-0.90), but annual percent change (APC) was highest among whites (APC 3.29) and blacks (APC 6.53) (figure 1). APC in APIs has been stable (0.56)(table 1). Incidence analysis by HCC stage (localized, regional, and distant) shows that localized disease has the greatest incidence (0.18, 95% CI: 0.17-0.18) and localized and regional disease have the highest APC (3.24 and 6.51, respectively). Survival analysis showed that females had a higher five-year survival (42.8%, 95% CI: 37.2%-48.2%) than males (36.6%, 95%CI: 33.6%-39.5%). For race, APIs had the highest five-year survival (46.5%, 95% CI: 41.5%-51.2%) and blacks had the lowest (25.3%, 95% CI: 17.9%-33.3%) (figure 2). For stage and AFP levels, survival was highest for localized disease (51.7%, 95%CI: 48.2%- 55.1%) and negative/normal AFP levels (54.06%, 95%CI: 48.44%-59.34%), respectively. Conclusion: The incidence of HCC in non-cirrhotic patients in the US with Ishak fibrosis scores of 0-4 is increasing. Moreover, our findings correlate well with obesity trends in the US, where lower rates of obesity are observed among non-Hispanic Asians (11.7%) than among non-Hispanic white (34.5%), Hispanic (42.5%), and non-Hispanic black (48.1%)[1]. Survival is influenced by gender, race, AFP level, and stage of disease. These findings may help to identify at-risk populations as well as risk factors for improving surveillance for HCC in non-cirrhotics.832_A Figure 1. Incidence Rate, Race 2005-2014; decimal place indicates number of months in year832_B Figure 2. Count, Annual Percent Change and Hazard Ratios for HCC In Non-Cirrhotics with Ishak Fibrosis 0-4832_C Figure 3. Survival Based on Race