Temporal liver cancer trends in HBV-endemic population mapped
medwireNews: A South Korean population-based study shows an increase in liver cancer burden over a 14-year period, while another analysis in the same population shows an improvement in the survival of patients with hepatocellular cancer (HCC) in the past decade.
Using data from the Korea Central Cancer Registry (KCCR) and Korean Statistical Information Service, Young-Suk Lim (University of Ulsan College of Medicine, Seoul) and colleagues found that the crude death rate for liver cancer increased from 20.5 per 100,000 persons in 1999 to 22.6 per 100,000 persons in 2013, equating to a 10.2% increase.
The crude incidence rate for liver cancer also rose during this period, at 28.2 and 32.0 per 100,000 persons in 1999 and 2013, respectively (15.3% increase).
But the age-standardized rates for liver cancer mortality and incidence decreased from 1999 to 2013, by 26.9% and 27.5%, respectively. The researchers argue, however, that crude rates are “more helpful in determining disease burden and specific needs for services required for a given population.”
They also examined mortality due to liver disease (including viral hepatitis), finding a decrease in the crude death rate of 64.6% – from 21.2 per 100,000 persons in 1993 to 7.5 per 100,000 persons in 2013 – and in the age-standardized death rate of 75.0%, from 24.0 to 6.0.
This “marked decrease in liver disease mortality may increase the life expectancy and the number of patients at risk of developing HCC, inadvertently leading to increased HCC incidence and mortality in the population,” Lim et al hypothesize in the Journal of Gastroenterology and Hepatology.
Noting that the use of antiviral drugs for hepatitis B virus (HBV) infection, which is one of the major causes of liver disease and cancer, increased “precipitously” during the study period, they conclude that the burden of liver cancer is likely to persist over the coming decades.
The second study, also led by Young-Suk Lim, suggests, however, that these patients with liver cancer can at least expect improved survival relative to if they had been diagnosed a decade ago.
The team drew on the KCCR to identify 4515 patients diagnosed with HCC from 2003–2005 and 4582 who were diagnosed between 2008 and 2010.
Over 5 years of follow-up, age-adjusted overall survival (OS) was significantly better for patients diagnosed in the 2008–2010 cohort than the 2003–2005 cohort, with median survival times of 28.4 and 17.2 months, respectively (p<0.001).
The findings were similar in a multivariable analysis and a propensity score-matched analysis, which gave hazard ratios of 0.82 and 0.86, respectively, in favor of the later cohort, the study authors report in Hepatology.
Of note, the survival gain was significant only for patients with HBV-related HCC, with a median OS of 30.4 months for the 2008–2010 cohort versus 16.1 months for the 2003–2005 cohort (p<0.001).
And the study also found a substantial increase in the annual number of HCC patients receiving oral anti-HBV drugs, at 93 in 2005, which is when reimbursement for antivirals against HBV was approved for patients with HCC, to 28,520 in 2010.
Describing the improvement in survival among patients with HBV-related HCC as “encouraging,” the investigators emphasize “the importance of managing viral hepatitis as a step toward improving patient outcomes.”
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