Age-adjusted Hepatocellular Carcinoma Incidence Rates Research Articles

Abstract C110: The role of generation on hepatocellular carcinoma risk among US Mexicans in Los Angeles

Abstract Background. Incidence of hepatocellular carcinoma (HCC) is nearly twice as likely to occur among Hispanics/Latinos compared to their Non-Hispanic White counterparts. Studies show that birthplace may play a role specifically where US-born Hispanic/Latinos are at a greater risk of developing HCC compared to foreign-born Hispanic/Latinos, which may be due to acculturation. Given this information, we looked at how generations in the US impact HCC risk among US Mexicans. Methods. The Multiethnic Cohort (MEC), a prospective study with over 215,000 participants in Los Angeles, CA and Hawaii. The MEC regularly performs linkages with the Surveillance, Epidemiology, End Results (SEER) Program. International Classification of Diseases for Oncology, Third Edition (ICD-O-3) codes C.22 and histology codes 8170-8175 to identify HCC cases up until December 31st, 2017. We subset our sample to self-identified Mexicans with information on parental birthplace (n=32,239). Generation status was categorized by 1st generation as born in the Mexico with both parents born in Mexico; 2nd generation as US-born with at least one parent born in Mexico; and 3rd generation as US-born with both parents also born in the US. To assess HCC risk, we performed multivariable Cox models adjusting for age, sex, body mass index (BMI), smoking status, alcohol intake, history of diabetes, and daily coffee consumption. Results. After an average follow-up time of 23.4 years there were a total of 220 HCC incident cases. With successive generation, US-Mexicans were more likely to be current smokers, have a greater intake of alcohol, consume more coffee, and have an elevated BMI. In addition, there was an increase in age-adjusted HCC incidence rates (per 100,000) with each increasing generation (1st generation: 20.9, 2nd generation: 27.5, 3rd generation: 34.7). In the multivariable model, 2nd and 3rd generation US Mexicans had a 35% (95% CI: 1.00-1.84) and 61% (95% CI: 1.10-2.36) increased risk of HCC compared to 1st generation US Mexicans, respectively (Ptrend=0.009). While we did not observe significant heterogeneity by diabetes status (Pheterogeneity=0.41); those who did not have diabetes and were 3rd generation had an 82% (95% CI: 1.17-2.84) increased risk of HCC compared to a 1st generation US Mexicans who also did not have diabetes. There was also no heterogeneity by BMI status (Pheterogeneity=0.92) and alcohol intake (Pheterogeneity=0.46) for the association between generation status and HCC risk. Among HCC cases, similar distributions of tumor grade or stage at diagnosis were observed across generations. Conclusions. 2nd and 3rd generation US Mexicans have a significantly higher risk of HCC compared to 1st generation US Mexicans. Targeted interventions focusing on healthier lifestyle behaviors are much needed for US-born Mexicans reduce HCC risk. Citation Format: Nicholas Acuna, Kali Zhou, Paulo Pinheiro, Tiffany Lim, Lynne Wilkens, Loic Le Marchand, Veronica Wendy Setiawan. The role of generation on hepatocellular carcinoma risk among US Mexicans in Los Angeles [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C110.

Hepatocellular Carcinoma Incidence Is Decreasing Among Younger Adults in the United States

Incidence rates for hepatocellular carcinoma (HCC) increased rapidly in the United States since the 1990s, but have plateaued or started to decrease in other industrialized countries. It unclear if and when a similar trend will be observed in the United States. We examined trends in HCC incidence rates in the United States by age, sex, and race/ethnicity of patients. We calculated age-adjusted HCC incidence rates using data from the Surveillance, Epidemiology, and End Results program of cancer registries from 1992 through 2015. We estimated incidence rates by 10-year age group and used joinpoint regression to quantify the magnitude and direction of trends, overall and by sex and race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and Asian/Pacific Islander). HCC incidence increased by 4.8% per year from 1992 through 2010 (from 4.1 per 100,000 to 9.4 per 100,000) but then started to plateau (annual percentage change, -0.7; 95% CI, -2.0 to 0.7). Incidence rates steadily increased among persons 60 years or older in all racial/ethnic groups except Asian/Pacific Islanders 70 to 79 years old. In contrast, incidence rates decreased in younger and middle-aged adults, in men and women of all races/ethnicities, beginning in the mid-2000s. Rates decreased by 6.2% per year in persons 40 to 49 years old and by 10.3% per year in persons 50 to 59 years old. Annual decreases in incidence were larger among middle-aged blacks (17.2% decrease per year since 2012) compared with adults of the same age in other racial/ethnic groups. In an analysis of data from the Surveillance, Epidemiology, and End Results program of cancer registries from 1992 through 2015, we found the incidence of HCC to be decreasing among younger and middle-aged adults in the United States, regardless of sex, race, or ethnicity. It is unclear whether current decreases in incidence will reduce the burden of HCC in the future.

Epidemiology and Management of Hepatocellular Carcinoma

The major risk factors for hepatocellular carcinoma (HCC) in contemporary clinical practice are becoming increasingly related to sustained virological response after hepatitis C, suppressed hepatitis B virus during treatment, and alcoholic and nonalcoholic fatty liver disease. We review the emerging data on the risk and determinants of HCC in these conditions and the implications of HCC surveillance. However, from a public health perspective, active hepatitis C and B continue to drive most of the global burden of HCC. In United States, the age-adjusted incidence rates of HCC in Hispanics have surpassed those of HCC in Asians. Prognosis in HCC is complex because of the competing risk imposed by underlying cirrhosis and presence of malignancy. In addition to tumor burden, liver function and performance status; additional parameters including tumor biopsy, serum markers, and subclassification of current staging systems; and taking into account patterns of tumor progression may improve patient selection for therapy. Advancements in the treatment of HCC have included identification of patients who are most likely to derive a clinically significant benefit from the available therapeutic options. Additionally, the combination strategies of locoregional therapies and/or systemic therapy are being investigated.

The Effect of HIV Viral Control on the Incidence of Hepatocellular Carcinoma in Veterans With Hepatitis C and HIV Coinfection

HIV increases the risk of progression to hepatic fibrosis and cirrhosis among individuals coinfected with hepatitis C virus (HCV). However, the impact of HIV-related immune suppression on the risk of hepatocellular carcinoma (HCC) is currently unknown. We used the Veterans Affairs HIV Clinical Case Registry to identify patients with HIV infection between 1985 and 2010 and HCV coinfection (positive HCV RNA or genotype test) between 1995 and 2010. The outcome was incident HCC as indicated by International Classification of Diseases, 9th revision, Clinical Modification code (87% positive predictive value). Patients with HCV monoinfection were included as a comparison group for HCC incidence. Age-adjusted HCC incidence rates were calculated for the coinfected cohort and HCV monoinfected cohort. Cox proportional hazard models were used to determine hazard ratios (HRs) and 95% confidence intervals (CIs) for each risk factor on the time to HCC diagnosis in the coinfected cohort. There were 66,991 veterans with HIV; 8563 had at least 1 positive HCV RNA test, and 234 of these developed HCC. The overall age-adjusted incidence rate of HCC in monoinfected patients was 2.99/1000 person-years vs. 4.44/1000 person-years in coinfected patients. In patients with coinfection, presence of cirrhosis (HR = 4.88; 95% CI: 3.30 to 7.21), HIV diagnosis >2002 (HR = 4.65; 95% CI: 2.70 to 8.02), and a recent low CD4 cell count <200 (HR = 1.71; 95% CI: 1.20 to 2.45) were associated with an increased risk for HCC. The risk of HCC in HCV- and HIV-coinfected veteran men was higher than HCV monoinfection. Diagnosis of cirrhosis and low recent CD4 cell count were the most important predictors of developing HCC in this group.

Epidemiological Trends of Hepatocellular Carcinoma in Austria

Background/Aims: The heterogeneous epidemiology of hepatocellular carcinoma (HCC) with the highest incidence rates in East Asia, sub-Saharan Africa and Melanesia results from variations in the main risk factors. We investigated epidemiological trends, including incidence and mortality, of patients diagnosed with HCC over a 20-year period in Austria. Methods: Data on age-adjusted incidence rates of HCC were obtained from the Austrian National Cancer Registry, which compiles nationwide data on all newly diagnosed cancers. Data on age-adjusted mortality were obtained from the national death registry (Statistics Austria). Results: Of 24,939 patients diagnosed with hepatobiliary tumors between 1990 and 2009, 8,561 subjects had HCC (m/f ratio 75/25%; mean age 69 years). Lymph node and distant metastases were present in 7.5 and 12.2%, respectively. The age-adjusted incidence rate was significantly higher in men than women (m/f ratio 4.5/1) and markedly increased in men (4.68/5.10) but remained stable in women (1.18/1.11). Similarly, the age-adjusted mortality rate was significantly higher in men than women (m/f ratio 4.5/1), increased in men (4.02/4.98) and remained stable in women (0.92/1.0). The median overall survival was 4.5 months for men and 3.2 months for women with 1-/5-year survival rates of 33/11% and 28/10%, respectively. Conclusion: HCC is the most common hepatobiliary neoplasia in Austria and has a very poor prognosis. The age-adjusted incidence and mortality rates were higher in males, increased over time in men and remained stable in women. Extrahepatic metastases were rarely diagnosed and associated with dismal survival.

Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go?

Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go?

Incidence of hepatocellular carcinoma in Texas Latinos, 1995-2010: an update.

BackgroundA previous study showed Hepatocellular Carcinoma (HCC) rates to be higher among Latinos in Texas and highest among South Texas Latinos compared to other non-Hispanic whites (NHW) and other Latinos in the United States (U.S.). We used more recent data to assess trends in HCC among Texas Latinos and to reassess the elevated HCC incidence rate in Texas Latinos.MethodsWe used data from the U.S. SEER Program and the Texas Cancer Registry to calculate annual and 3-year moving average age-specific and age-adjusted HCC incidence rates, annual percent changes (APCs), and their corresponding 95% confidence intervals for Latinos and NHW in the U.S., Texas and South Texas.ResultsTexas Latino male and female incidence rates were 3.1 and 4.0 times higher than their NHW counterparts in SEER regions. Latino males and females in South Texas had the highest rates of HCC incidence overall; rate ratios were 3.6 and 4.2 among South Texas Latino males and females compared to SEER NHW counterparts. There are statistically significant increases in HCC incidence rates in all groups (Texas and South Texas Latinos and NHW groups) and across all age groups. The elevated HCC rates in Texas Latinos are consistent over the 1995–2010 period.ConclusionsThe incidence of HCC among Latinos in South Texas remains higher than elsewhere in the U.S. and warrants closer investigation of potential risk factors related to prevailing conditions unique to the population including higher obesity and diabetes rates, environmental, cultural and socioeconomic factors and possibly genetic predisposition.

Incidence and Risk Factors for Hepatocellular Carcinoma in Texas Latinos: Implications for Prevention Research

BackgroundHepatocellular carcinoma (HCC) is increasing in the U.S. despite a decline in cancer overall. Latinos have higher rates of HCC than the general population according to the Surveillance, Epidemiology, and End Results (SEER) Program. Not included in SEER, Texas Latinos make up one-fifth of the U.S. Latino population. To determine whether HCC incidence differs among U.S. and Texas Latinos, this descriptive study compares HCC incidence from 1995 through 2006 among three Latino populations: U.S. SEER, Texas overall and a South Texas subset. To identify lines of prevention research, we compare prevalence of known HCC risk factors among these Latino groups.MethodsData were collected from the U.S. SEER Program, Texas Cancer Registry and Texas Department of State Health Services (TDSHS). Annual age-specific and age-adjusted HCC incidence rates, annual percent changes (APCs) and 95% confidence intervals were calculated as well as prevalence of obesity, diabetes, heavy alcohol use and cigarette smoking.ResultsOf the three Latino groups compared, South Texas Latinos had the highest age-adjusted HCC incidence rates and SEER Latinos had the lowest (10.6/100,000 (10.1–11.1) and 7.5/100,000 (7.2–7.7), respectively). HCC incidence significantly increased over time (APCs>0) among Latinos in all three geographic groups. Between 1995 and 2006, there was an increase in obesity among all three populations, and obesity was highest among South Texas Latinos. Diabetes increased among U.S. Latinos, and Latino women in South Texas had significantly higher diabetes prevalence than U.S. Latino women. Cigarette smoking and heavy alcohol use were similar among groups.ConclusionsThe incidence of HCC among Latinos in South Texas is higher than elsewhere in the United States. Higher rates of HCC among Texas and South Texas Latinos may be associated with greater prevalence of obesity and diabetes, risk factors for HCC that are amenable to intervention.

Abstract 3595: Hepatocellular carcinoma and diabetes among Latinos: Implications for prevention

Abstract Introduction. Hepatocellular carcinoma (HCC) has increased in the U.S. from 1975-2006 while overall cancer has declined. Moreover, HCC among South Texas Latinos is higher than other U.S. Latinos. In recent years a number of risk factors have been associated with HCC including hepatitis-C virus infection, heavy alcohol use, obesity, diabetes and others. Of these, only diabetes exhibits characteristics which make it a candidate for why HCC is increasing in the U.S. Latino population and increasingly higher among South Texas Latinos. This study compares incidence rates of HCC and prevalence rates of diabetes among U.S. Latinos and South Texas Latinos. We hypothesize that these data implicate diabetes in HCC and suggest a clear path to informed HCC prevention. Methods. Data from the U.S. SEER (Surveillance, Epidemiology, and End Results) Program, Texas Cancer Registry, and the Texas Department of State Health Services (TDSHS) were obtained. Age-adjusted HCC incidence rates were calculated using SEER*Stat and SPSS software and aggregated over 3-year periods. Likewise, annual prevalence of diabetes was calculated and aggregated over the same periods. For each measure values for the mutually exclusive U.S. and South Texas populations were compared. Trend slopes for both HCC and diabetes were calculated and displayed graphically. Group differences were assessed at p &amp;lt; .05 if confidence intervals did not overlap. Results. U.S. (SEER) Latino HCC incidence averaged 6.1/100,000 during 1995-1997 and increased to 8.0 during 2004-2006 (slope m = 0.455). South Texas Latino rates averaged 9.2 and 11.7 during the same periods (slope m = 0.625) (incidence rate difference, p &amp;lt; .05). Simultaneously, the prevalence rate of diabetes was 5.9% and 7.7% among U.S. SEER Latinos (slope m = 0.450) and 7.6% and 9.6% among South Texas Latinos (slope m = 0.500) (prevalence rate difference, p &amp;lt; .05). Although slope differences could not be calculated, they indicate a greater rate of increase among South Texas Latinos than U.S. SEER Latinos. Conclusion. Our findings support observations that HCC and diabetes are increasing in the United States. We have described an important relationship between increasing rates of HCC and diabetes in the U.S. SEER and South Texas Latino populations. We suggest this relationship may explain higher rates of HCC among Latinos. There is a need to focus HCC etiological research to account for this relationship while simultaneously on other attributable risks for the disease as well as genetic, cultural and socioeconomic predisposing features. We note that diabetes is preventable or treatable. The potential contribution of this research can firmly establish associations and inform HCC prevention. Acknowledgements. The San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174) and the National Cancer Institute, Redes En Acción (U01-CA86117). Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3595. doi:1538-7445.AM2012-3595

Abstract PR1: Hepatocellular carcinoma research and prevention in South Texas: The imperative

Abstract Introduction: Hepatocellular carcinoma (HCC) incidence is increasing in the U.S. for unknown reasons despite a decline in cancer overall during 1975–2006. Latinos have higher rates of HCC than other groups, and attributable risks for HCC among Latinos have been identified. This study compared HCC incidence and behavioral risk factors associated with it from 1995 through 2006 between U.S. Latinos, Texas Latinos and a South Texas Latino subset. We hypothesized that HCC incidence is higher among South Texas Latinos in conjunction with higher attributable behavioral risk factors during the same period. Methods: Data from the U.S. SEER (Surveillance, Epidemiology, and End Results) Program, Texas Cancer Registry, and the Texas Department of State Health Services (TDSHS) were obtained. Annual age-specific and age-adjusted HCC incidence rates, annual percent changes (APCs) and 95% confidence intervals (CI) were calculated as well as prevalences of obesity, diabetes, heavy alcohol use and smoking. Analyses were performed using SEER*Stat and SPSS Complex Samples software. Groups were compared using Chi-Squared and T-Tests with differences assessed at p &amp;lt; .05 if confidence intervals did not overlap. Results: Latinos accounted for more than a third of HCC in Texas and nearly three-fourths of all HCC in South Texas, significantly greater proportions than SEER. More than 70% of HCC in Latinos occurred in men, with similar percentages observed among SEER, Texas and South Texas groups. HCC in Latinos was highest in South Texas (10.6/100,000) and Texas (9.7/100,000) compared to SEER (7.5/100,000). South Texas Latinos were older than their SEER counterparts (Median = 67 vs. 62). More South Texas and Texas Latinos than SEER resided in rural areas (14.8%, 14.3% vs. 5.2%). Prevalence percentages of HCC-related behavioral risk factors for Latinos in the U.S., Texas and South Texas for two time periods, 1995–1997 and 2004–2006 show that obesity increased among all three groups of Latinos overall from the first to the second time period. Additionally, Texas and South Texas Latinos had higher obesity prevalence than U.S. Latinos during the most recent period (30.2% and 35.0% versus 26.7%). Moreover diabetes prevalence increased among U.S. Latinos. Texas and South Texas Latinos also showed an increasing pattern, although confidence intervals overlapped. For 2004–2006, the prevalence of diabetes was higher in South Texas Latinas than U.S. Latinas (10.3% and 7.8%, respectively). Heavy alcohol and cigarette use did not change significantly over time among any Latino group. Conclusion: Our findings support observations that HCC is alarmingly on the rise in the United States. We have described an important constellation of risks for HCC in this group that may result in higher rates of the disease among Latinos. Most if not all of these risks are modifiable, preventable or treatable. Clearly there is a need to focus on HCC etiological research and intervention that takes into account not only the most significant attributable risks for the disease, but also genetic, cultural and socioeconomic predisposing features. The potential contribution of these to HCC indicates a need for etiologic research to firmly establish associations and inform HCC-related prevention interventions. Acknowledgements: This research was possible by grants from the San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174) and the National Cancer Institute, Redes En Acción (U01-CA86117). Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):PR1.

Trends in incidence of hepatocellular carcinoma after diagnosis of hepatitis B or C infection: a population‐based cohort study, 1992–2007

Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major risk factors for hepatocellular carcinoma (HCC). We examined trends in the incidence of HCC among a population-based cohort of people infected with HBV or HCV. HBV and HCV cases notified to the New South Wales Health Department between 1992 and 2007 were linked to the Central Cancer Registry, Registry of Births, Deaths and Marriages, and National HIV/AIDS Registries. Crude HCC incidence rates were estimated using person-time methodology. Age-standardized incidence rates were calculated using the 2001 Australian population. Trends in incidence were examined using join point regression models. Between 1992 and 2007, 1201 people had a linked HCC record: 556 of those with HBV; 592 with HCV; 45 with HBV/HCV co-infection; and 8 with HIV co-infection. The overall age-standardized HCC incidence rates declined non-significantly from 148.0 (95% confidence intervals (CI) 63.7, 287.4) per 100,000 population in 1995 to 101.2 (95% CI 67.3, 144.6) in 2007 among the HBV monoinfected group and significantly from 151.8 (95% CI 62.4, 299.8) per 100,000 population to 75.3 (95% CI 50.8, 105.5) among the HCV monoinfected group. However, incidence rates in the HCV monoinfected group progressively increased from the period 1992-1997 to 2004-2007 when adjusted for age, sex, and birth cohort, and the total number of cases per annum continued to increase. Despite declines in the age-adjusted incidence rates of HCC over time, the absolute number of cases increased likely due to the ageing cohort and an increasing prevalence of both hepatitis B and C in Australia.

Hepatocellular Carcinoma Incidence, Mortality, and Survival Trends in the United States From 1975 to 2005

Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality worldwide. Incidence rates are increasing in the United States. Monitoring incidence, survival, and mortality rates within at-risk populations can facilitate control efforts. Age-adjusted incidence trends for HCC were examined in the Surveillance, Epidemiology, and End Results (SEER) registries from 1975 to 2005. Age-specific rates were examined for birth cohorts born between 1900 and 1959. Age-adjusted incidence and cause-specific survival rates from 1992 to 2005 were examined in the SEER 13 registries by race/ethnicity, stage, and treatment. United States liver cancer mortality rates were also examined. Age-adjusted HCC incidence rates tripled between 1975 and 2005. Incidence rates increased in each 10-year birth cohort from 1900 through the 1950s. Asians/Pacific Islanders had higher incidence and mortality rates than other racial/ethnic groups, but experienced a significant decrease in mortality rates over time. From 2000 to 2005, marked increases in incidence rates occurred among Hispanic, black, and white middle-aged men. Between 1992 and 2004, 2- to 4-year HCC survival rates doubled, as more patients were diagnosed with localized and regional HCC and prognosis improved, particularly for patients with reported treatment. Recent 1-year survival rates remained, however, less than 50%. HCC incidence and mortality rates continue to increase, particularly among middle-aged black, Hispanic, and white men. Screening of at-risk groups and treatment of localized-stage tumors may contribute to increasing HCC survival rates in the United States. More progress is needed.

Hepatocellular carcinoma incidence trends in Canada: analysis by birth cohort and period of diagnosis

We examined birth cohort and calendar period trends in hepatocellular carcinoma (HCC) incidence in Canada (1976-2000). We also projected HCC incidence rates through 2015. Data were obtained from the Canadian Cancer Registry on all cases of HCC diagnosed among persons aged 20 years and older in Canada from 1976 to 2000 and was used to describe trends in HCC incidence rates. We found that age-adjusted HCC incidence rates increased faster in males compared with females, 3.4% per year [95% confidence interval (CI): 3.0-3.8%] vs 2.2% per year (95% CI: 1.5-2.8%). An increasing birth cohort trend accelerated among males around the 1940 birth cohort and decelerated among females around the 1935 birth cohort. For calendar period trends, the increasing HCC risk was relatively constant over time among males whereas there was an acceleration in HCC risk around 1988 among females. Age-adjusted HCC incidence rates were projected to increase 73% in males and 28% in females from 1996 to 2015. Our results suggest that HCC incidence rates will continue to increase in Canada during the next decade as persons born in more recent birth cohorts, who face a relatively greater risk for HCC, age.