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      Updates in Characteristics and Survival Rates of Hepatocellular Carcinoma in a Nationwide Cohort of Real-World US Patients, 2003–2021

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          Abstract

          Background & Aim

          Causes of hepatocellular carcinoma (HCC) may change as treatments become available for some liver diseases. We examined the distribution of HCC cause and survival of a nationwide cohort of insured patients.

          Methods

          Optum’s de-identified Clinformatics ® Data Mart Database (CDM), 2003–2021.

          Results

          A total of 34707 patients with HCC were included: mean age: 68.3±11.6 years, 61% male, 62% Caucasian, 74% cirrhosis. Non-alcoholic fatty liver disease (NAFLD) was the most common etiology (38.9%), then hepatitis C virus (HCV) (25.3%), cryptogenic (18.0%), alcohol-associated liver disease (9.4%), other liver diseases (5.8%) and hepatitis B virus (HBV) at 2.6%. NAFLD patients were the oldest (mean age 71.1±11.2) and had the highest Charlson Comorbidity Index (CCI) (mean 10.5±3.9), while HCV were the youngest (mean age 64.2±9.2 years) and HBV had the lowest CCI (mean 7.2±4.4) (both P<0.0001). The overall 5-year survival was 18.8% (95% CI 18.2–19.3) but was lower in the recent 2014–2021 period vs 2003–2013 (18.1% vs 19.5%, P=0.003). The 2014–2021 cohort (inclusive of HCV treatment advances) was significantly older, with more females, fewer Caucasians, more African Americans, more Hispanics, fewer Asians, more cirrhosis, more NAFLD, and higher CCI (all P<0.001). On multivariable analysis, males (aHR: 1.13), Caucasians (aHR: 1.46), African Americans (aHR: 1.53) and Hispanics (aHR: 1.28) vs Asians, 2014–2021 (vs 2003–2013) cohort (aHR: 1.12), NAFLD (aHR: 1.14) or cryptogenic liver disease (aHR: 1.45) were associated with increased mortality (all P<0.001).

          Conclusion

          HCC patients in more recent time 2014–2021 were more likely to be older, more likely to have nonviral etiology, and had worse survival compared to those from 2003 to 2013.

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          Most cited references29

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          A global view of hepatocellular carcinoma: trends, risk, prevention and management

          Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly nonalcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid. All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. HCC surveillance and early detection increase the chance of potentially curative treatment; however, HCC surveillance is substantially underutilized, even in countries with sufficient medical resources. Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumour characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and local expertise. Catheter-based locoregional treatment is used in patients with intermediate-stage cancer. Kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC. Together, rational deployment of prevention, attainment of global goals for viral hepatitis eradication, and improvements in HCC surveillance and therapy hold promise for achieving a substantial reduction in the worldwide HCC burden within the next few decades.
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            The Global Epidemiology of NAFLD and NASH in Patients with type 2 diabetes: A Systematic Review and Meta-analysis

            Although non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and NASH with advanced fibrosis are closely associated with type 2 diabetes mellitus (T2DM), their global prevalence rates have not been well described. Our aim was to estimate the prevalence of NAFLD, NASH, and advanced fibrosis among patients with T2DM, by regions of the world.
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              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.
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                Author and article information

                Journal
                J Hepatocell Carcinoma
                J Hepatocell Carcinoma
                jhc
                Journal of Hepatocellular Carcinoma
                Dove
                2253-5969
                02 December 2023
                2023
                : 10
                : 2147-2158
                Affiliations
                [1 ]Division of Gastroenterology and Hepatology, Stanford University Medical Center , Palo Alto, CA, USA
                [2 ]Department of Epidemiology and Population Health, Stanford University School of Medicine , Palo Alto, CA, USA
                [3 ]Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore , Singapore, Singapore
                [4 ]Division of Gastroenterology and Hepatology, National University Health System , Singapore, Singapore
                [5 ]Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System , Palo Alto, CA, USA
                Author notes
                Correspondence: Mindie H Nguyen, Department of Medicine and Department of Epidemiology and Population Health (by courtesy), Stanford University Medical Center , 780 Welch Road, CJ250K, Palo Alto, CA, 94304, USA, Tel +1 650-498-5691, Fax +1 650-498-5692, Email mindiehn@stanford.edu
                Author information
                http://orcid.org/0000-0002-6275-4989
                Article
                420603
                10.2147/JHC.S420603
                10700040
                38076642
                f5237bc2-b93a-46b1-8a29-faa483130179
                © 2023 Tran et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 06 July 2023
                : 25 October 2023
                Page count
                Figures: 1, Tables: 4, References: 30, Pages: 12
                Funding
                Funded by: funding;
                No external funding to disclose in this study.
                Categories
                Original Research

                ethnic disparities,nafld,nonviral,epidemiology
                ethnic disparities, nafld, nonviral, epidemiology

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