The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States

Details

• Alternative Title:
  Cancer Epidemiol Biomarkers Prev
• Personal Author:
  Mahale, Parag ; Shiels, Meredith S. ; Lynch, Charles F. ; Chinnakotla, Srinath ; Wong, Linda L. ; Hernandez, Brenda Y. ; Pawlish, Karen S. ; Li, Jie ; Alverson, Georgetta ; Schymura, Maria J. ; Engels, Eric A.
• Description:
  Background:
  
  Hepatocellular carcinoma (HCC) carries a poor prognosis. Liver transplantation (LT) is potentially curative for localized HCC. We evaluated the impact of LT on US general population HCC-specific mortality rates.
  
  Methods:
  
  The Transplant Cancer Match Study links the US transplant registry with 17 cancer registries. We calculated age-standardized incidence (1987–2017) and incidence-based mortality (IBM) rates (1991–2017) for adult HCCs. We partitioned population-level IBM rates by cancer stage and calculated counterfactual IBM rates assuming transplanted cases had not received a transplant.
  
  Results:
  
  Among 129,487 HCC cases, 45.9% had localized cancer. HCC incidence increased on average 4.0% annually (95%CI=3.6%−4.5%). IBM also increased for HCC overall (2.9% annually; 95%CI=1.7%−4.2%) and specifically for localized stage HCC (4.8% annually; 95%CI=4.0%−5.5%). The proportion of HCC-related transplants jumped sharply from 6.7% (2001) to 18.0% (2002), and further increased to 40.0% (2017). HCC-specific mortality declined among both non-transplanted and transplanted cases over time. In the absence of transplants, IBM for localized HCC would have increased at 5.3% instead of 4.8% annually.
  
  Conclusions:
  
  LT has provided survival benefit to patients with localized HCC. However, diagnosis of many cases at advanced stages, limited availability of donor livers, and improved mortality for non-transplanted patients have limited the impact of transplantation on general population HCC-specific mortality rates.
  
  Impact:
  
  Though LT rates continue to rise, better screening and treatment modalities are needed to halt the rising HCC mortality rates in the US.
  
  
• Subjects:
  Article Epidemiology Hepatocellular Carcinoma Incidence-based Mortality Liver Cancer Liver Transplantation Trends
• Source:
  Cancer Epidemiol Biomarkers Prev. 30(3):513-520
• Pubmed ID:
  33199438
• Pubmed Central ID:
  PMC8052263
• Document Type:
  Journal Article
• Funding:
  N01PC35143/CA/NCI NIH HHSUnited States/ ; HHSN261201800005C/CA/NCI NIH HHSUnited States/ ; U58 DP003883/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP003875/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201000036C/CA/NCI NIH HHSUnited States/ ; U58 DP000807/DP/NCCDPHP CDC HHSUnited States/ ; Z99 CA999999/ImNIH/Intramural NIH HHSUnited States/ ; U58 DP000848/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201800002C/CA/NCI NIH HHSUnited States/ ; U58 DP000824/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201300021C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/PC/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/
• Volume:
  30
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f19831080d3573aad631f7c786db7fbc7972258d0b594bed705c8ae22e7c4e2a
• Download URL:
  https://stacks.cdc.gov/view/cdc/105371/cdc_105371_DS1.pdf
• File Type:
  [PDF - 818.83 KB ]