Recent Trends of Incidence, Mortality, Treatment, and Overall Survival of Hepatocellular Carcinoma in the United States.

Abstract

Background & aims: With the COVID-19 pandemic, changes in liver disease etiologies, and expanded therapeutic options for hepatocellular carcinoma (HCC), recent trends in the incidence and mortality rates, tumor burden, treatment, and overall survival (OS) of HCC in the U.S. warrant investigation.

Methods: The Surveillance, Epidemiology, and End Results database was used to assess trends in incidence, mortality, tumor burden, and OS. Logistic regression analysis identified factors associated with curative treatment and no treatment, while Cox regression analysis identified factors associated with OS.

Results: HCC incidence rates increased from 2000 to 2014, plateaued from 2014 to 2019, and declined from 2019 to 2022 (annual percent change [APC]=-3.74%; 95%CI=-4.65% to -2.39%; p<0.001). Incidence-based mortality increased from 2000 to 2013 and then plateaued through 2022. Compared to 2016-2019, the COVID-19 pandemic (2020-2022) was associated with lower odds of curative treatment (aOR=0.87; 95%CI=0.82-0.91; p<0.001) and increased likelihood of no treatment (aOR=1.48; 95%CI=1.41-1.54; p<0.001). OS improved from 2000 to 2019 but did not significantly change during 2020-2022 (versus 2016-2019: aHR=0.98; 95%CI=0.95-1.01; p=0.2). Conversely, OS improved among patients <50 years old, those with distant HCC, and non-Hispanic Blacks. Non-Hispanic Black race was not associated with worse survival (aHR=1.01, 95%CI=0.99-1.03, p=0.4).

Conclusion: HCC incidence rates have started to decline, and incidence-based mortality has plateaued. Given lower early-stage detection and curative treatments during the COVID-19 pandemic, longer-term follow-up is warranted to assess the impact on survival. The reduced survival disparities between non-Hispanic Black and White patients may reflect improved equitable medical access.