HCC and Cirrhosis Mamta K. Jain, MD, MPH January16,2018

U.S. (SEER) Incidence of Liver and Bile Duct Cancer 1992-2012

http://seer.cancer.gov/statfacts/html/livibd.html

U.S. Incidence Rates by Age 2008-12

http://seer.cancer.gov/statfacts/html/livibd.html

U.S. Incidence Rates by Sex 2008-12

http://seer.cancer.gov/statfacts/html/livibd.html

Among U.S. Veterans 2001 to 2013: Cirrhosis and HCC Incidence and Deaths

Beste LA et al. Gastroenterology. 2015 Aug 5

Liver Cancer – Fastest Growing Cancerrelated Death Rate in the US Trends in US Cancer Mortality Rates All Other Cancers (Average)

Corpus & Uterus, NOS Testis Lung & Bronchus (Female) Esophagus Thyroid

Liver -2

-1.5

-1

-0.5

0

0.5

1

1.5

2

Annual Percent Change (1994-2003)* National Cancer Institute Websie. Available at:http://seer.cancer(csr/1975_2003/section.html

Mortality from Liver Cancer in US 2006-10

Altekruse S, et al Am J Gastroenterol. 2014 Apr; 109(4): 542–553.

HCC in Texas

Texas HCC Incidence Doubled in the Past 15 Years

HCC in Texas 

Texas HCC mean incidence 9.3/100,000 persons: 2nd highest in U.S.



National mean incidence is 7.9/100,000



2,000 new cases in Texas this year  Incidence

in Dallas county is 11.7/100,000

 Incidence

in South Texas as high as 19.1/100,000

http://www.thetcr.org/article/view/1864/html

Risk Factors for HCC

Risk Factors for HCC 

Cirrhosis from any etiology



Viral hepatitis (Hepatitis B and/or C)



Nonalcoholic fatty liver disease (Obesity and Diabetes)



Heavy alcohol use



Hereditary hemochromatosis



Environmental toxins  Aflatoxin,

contaminated drinking water, betel nut chewing

Trends in HCC Etiology ~50% increase in HCV-related HCC between 1991-2008

Others: 21% Others: 38%

Others: 46%

HBV: 4% NAFLD: 11%

HBV:10% NAFLD:7%

HBV: 4% Alcohol alone: 25%

Alcohol alone: 45%

Alcohol and HCV: 17%

Alcohol and HCV: 7% HCV alone: 18%

1976-1990

Alcohol alone: 19%

1991-2000

HCV alone: 28%

2001-2008

Yang JD, et al. Mayo Clin Proc. 2012;87:9-16.

El-Serag HB, Rudolph KL Gastroenterology 2007: 132:2557-76

HCV infection and HCC

Time from HCV infection until serious complications

http://www.hepatitisc.uw.edu/go/evaluationstaging-monitoring/natural-history/coreconcept/all

Chronic HCV in Texas In 2000, nearly 400,000 Texans (1.79%) were estimated to be chronically HCVinfected There is a 17 fold higher risk of developing HCC in HCVinfected individuals Yalamanchili K. Proc (Bayl Univ Med Cent). 2005 Jan; 18(1): 3–6.

HCC Prevention

HCC Surveillance Associated with Improved Survival in Patients with Cirrhosis 2010 American Association for the Study of Liver Diseases (AASLD) guideline = liver ultrasound every 6 months

Author El-Serag 2011

Tong 2010

Wong 2008

Tanaka 2006

Trevisani 2002

Lead Time 70 days

118 days

236 days

238 days

98 - 239 days

Survival Rates

Significance

Median survival

OR 0.81

298 vs. 130 days

(95%CI 0.70 – 0.94)

3-year survival 62.5% vs. 36.6% 2-year survival 49.4% vs. 28.6% Median survival 6.3 vs. 5.3 years Median survival 30 vs. 20 months

p=0.007

p=0.035

p=0.016

p