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Incidence and Survival Trends for Hepatocellular Carcinoma in Patients With Ishak Fibrosis Scores of 5-6, 2005-2014: A SEER Analysis

Year: 2018

Type: article

Abstract: Introduction: In the United States, 50-70% of hepatocellular carcinoma occurs in patients with HCV and cirrhosis. In 2011, the Food and Drug Administration approved telaprevir and boceprevir, two directacting antiviral agents (DAAs), for the treatment of HCV genotype 1 infections. In 2014, with the advent of interferon (IFN)-free DAA regimens, cure rates surpassed 90%. The purpose of this study is to assess the trend in HCC incidence and survival in patients with Ishak scores of 5-6—who would predominantly be patients with HCV in the US—and to determine if the introduction of DAAs since 2011 has led to improvements in incidence and survival. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) registry to extract HCC data on patients with Ishak fibrosis scores of 5 and 6 from 2005 to 2014. Results: HCC incidence increased from 2005 to approximately 2011 overall and decreased thereafter in nearly all subgroups. The annual percent change (APC) in men and woman after approximately 2011 was -6.98 and -15.92 respectively (figure 1). After 2011, APC for whites (-6.07), blacks (-17.93), Asian or Pacific Islanders (API) (-7.22), localized stage (-3.78), regional (APC -5.86), and distant (APC -8.23) all decreased as well (table 1). Moreover, between 2005-2010, localized HCC accounted for 57% of HCC diagnoses compared to 61% after 2011. Five-year survival was greater in women than men (34.8% vs. 32.3%, p<0.0002). Five-year survival in the subgroups based upon race, disease stage, and AFP level was highest in API (43.3% 95%CI 40.0%-46.5%), patients with localized disease (46.5% 95%CI 44.6%-48.3%), and those with negative/normal AFP levels (46.8% 95%CI 43.8%-49.7%) respectively. On multivariable analysis, mortality was higher in individuals diagnosed before 2011 than those diagnosed later (HR of 1.10, 95% CI 1.04-1.16)(figure 2). Conclusion: In patients with Ishak scores of 5-6 in the US, the incidence of HCC declined after the introduction of DAAs in almost all groups by sex, race, and stage. Survival was influenced by sex, race, stage, and AFP levels. Improved survival also coincided with the introduction of novel DAAs. However, the temporal correlation between the introduction of interferon-containing DAA regimens in 2011 and either reduced incidence of HCC or improvement in survival may be causally related to other factors. The trend toward a higher incidence of localized HCC may be related to improved screening.833_A Figure 1. Male vs Female Incidence Rate 2005-2014; decimal place indicates number of months in year833_B Figure 2. Annual Percent Change and Hazard Ratios for HCC Ishak Fibrosis scores of 5-6833_C Figure 3. Survival based on pre and post 2011 HCV treatment

Source: The American Journal of Gastroenterology

DOI: 10.14309/00000434-201810001-00833

Authors: Nicolas Patel, Peter S. Liang, Michael Poles, Ira M. Jacobson

Institutions: NYU Langone Health, VA NY Harbor Healthcare System

Language: English

Topic: Hepatocellular Carcinoma Treatment and Prognosis

Subfield: Hepatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,390