Hepatocellular carcinoma survival data highlight importance of early detection

Key takeaways:

• Survival for people with HCC has improved over the past decade.
• Much of the improvement has been limited to individuals with early-stage disease who received curative treatment.

Survival for people with hepatocellular carcinoma has improved over the last decade, according to study results.

However, much of the improvement has been limited to individuals with early-stage disease who received potentially curative treatment.

This finding underscores the importance of surveillance to ensure HCC detection at earlier stages, investigators concluded.

“Liver cancer remains a deadly condition, but we are making considerable progress in its management,” Nizar A. Mukhtar, MD, director of hepatology at Kaiser Permanente San Francisco Medical Center and associate program director of Kaiser Permanente Northern California Gastroenterology Fellowship Program, told Healio. “Identifying patients at early stages of disease and providing both curative and noncurative treatments does appear to offer a survival benefit. We identified high-risk groups based on demographic and clinical factors that may inform discussions regarding prognosis, treatment allocation — particularly with respect to liver transplantation — and targeted interventions to improve clinical outcomes.”

HCC is the leading cause of cancer death globally for individuals with cirrhosis.

Mukhtar and colleagues conducted a retrospective cohort study to evaluate survival among people with HCC treated in a large integrated health care system in the United States.

All-cause and HCC-specific mortality served as primary endpoints.

Researchers adjusted Cox proportional hazards regression analyses for age at diagnosis, sex, race and ethnicity, cause of disease, Barcelona Clinic Liver Cancer (BCLC) stage, alpha-fetoprotein level and treatment type.

The study included 3,441 adults (median age, 65 years; 75% men) who received an HCC diagnosis between Jan. 1, 2006, and Dec. 31, 2019. Follow-up ended on Dec. 31, 2020.

About one-third (34.7%) of the patient population received curative treatment, whereas 39.9% received noncurative treatment and (25.3%) received no treatment.

Nearly three-quarters (72.7%) of people in the cohort died of any cause during the study period, and about half (52.6%) died due to HCC.

Multivariable analysis showed that people aged 70 years or older (adjusted HR = 1.39; 95% CI, 1.22-1.59), men (adjusted HR = 1.2; 95% CI, 1.07-1.35), those with BCLC stage C or D (adjusted HR = 2.4; 95% CI, 2.15-2.67), those who received noncurative treatment (adjusted HR = 2.51; 95% CI, 2.16-2.9) and those who received no treatment (adjusted HR = 3.15; 95% CI, 2.64-3.76) had higher risks for all-cause mortality at 5 years.

People who identified as Asian or Other Pacific Islander had lower all-cause mortality (HR vs. non-Hispanic white = 0.76; 95% CI, 0.65-0.88).

Multivariable analysis for HCC-specific mortality revealed similar results.

Patients diagnosed between 2013 and 2019 had improved survival outcomes compared with those diagnosed from 2006 to 2012. The survival improvement corresponded with greater use of curative treatment in the later era (39.4% vs. 28.2%; P < .001). In addition, a lower percentage of patients diagnosed in the later era received systemic therapy (6.2% vs. 11%) or no HCC treatment (20.3% vs. 32.4%; P < .001).

Researchers acknowledged study limitations, including its retrospective nature — creating the potential for bias — and the fact the results do not account for the effects of newer treatments, such as transarterial radioembolization or other systemic immunotherapies.

“We were happy to see that survival has improved over time, in large part due to identification of patients at earlier stages of disease and linkage to care for a growing armamentarium of treatment options available within our health care system,” Muktar told Healio. “Importantly, we did not observe poorer survival [among] Black or Hispanic/Latinx patients compared with white patients, suggesting that observed HCC-related health disparities may be attenuated in our integrated health care system. Moreover, Asian or Other Pacific Islanders had better outcomes compared with other race/ethnicity groups, and further research is needed to understand the underlying reasons for this survival benefit, as there may be useful implications for other patients.”

Muktar and colleagues are conducting additional research using individual- and community-level measures of socioeconomic status from this cohort to assess whether race or ethnicity, insurance type and neighborhood deprivation are associated with HCC stage at diagnosis, receipt of treatment and OS.

For more information:

Nizar A. Mukhtar, MD, can be reached at nizar.a.mukhtar@kp.org.

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Sources/Disclosures

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Disclosures:
A Kaiser Permanente community health grant supported the study. Mukhtar and colleagues report no relevant financial disclosures.

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