Melissa Yan1, John Ha1, Maria Aguilar1, Taft Bhuket2, Benny Liu2, Robert G Gish3, Ramsey Cheung4, Robert J Wong5. 1. Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States. 2. Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States. 3. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States. 4. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States. 5. Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States. Electronic address: rowong@alamedahealthsystem.org.
Abstract
BACKGROUND & AIMS: Individuals born between 1945 and 1965 account for nearly 75% of hepatitis C virus (HCV) infections in the United States. As this cohort ages, progressive HCV-related liver disease leading to cirrhosis and hepatocellular carcinoma (HCC) will place a significant burden on the healthcare system. We aim to evaluate birth cohort-specific disparities in HCC stage at diagnosis, treatment rates, and overall survival with a focus on the 1945-1965 birth cohort. METHODS: A population-based retrospective cohort study of adult patients with HCC identified in the Surveillance, Epidemiology, and End Results 2003-2011 registry evaluated birth cohort-specific disparities in the prevalence and outcomes of HCC, including multivariate logistic regression models to evaluate disparities in HCC stage at diagnosis and HCC treatment received. Birth cohort-specific survival was evaluated with Kaplan-Meier methods and multivariate Cox proportional hazard models. RESULTS: The proportion of HCC represented by the 1945-1965 cohort increased by 64% from 2003-2011, and accounted for 57.4% of all HCC in 2011. Compared to patients born after 1965, the 1945-1965 cohort were more likely to have HCC within Milan criteria (OR, 3.66; 95% CI, 3.13-4.28; p<0.001). However, among patients with HCC within Milan criteria, the 1945-1965 cohort had no difference in receipt of surgical treatment, but had higher overall long-term survival (HR, 0.82; 95% CI, 0.69-0.97; p<0.03). CONCLUSIONS: The 1945-1965 birth cohort accounts for the majority of HCC in the United States. Despite earlier HCC stage at diagnosis, no difference in receipt of surgical treatment was observed, but higher overall survival was achieved.
BACKGROUND & AIMS: Individuals born between 1945 and 1965 account for nearly 75% of hepatitis C virus (HCV) infections in the United States. As this cohort ages, progressive HCV-related liver disease leading to cirrhosis and hepatocellular carcinoma (HCC) will place a significant burden on the healthcare system. We aim to evaluate birth cohort-specific disparities in HCC stage at diagnosis, treatment rates, and overall survival with a focus on the 1945-1965 birth cohort. METHODS: A population-based retrospective cohort study of adult patients with HCC identified in the Surveillance, Epidemiology, and End Results 2003-2011 registry evaluated birth cohort-specific disparities in the prevalence and outcomes of HCC, including multivariate logistic regression models to evaluate disparities in HCC stage at diagnosis and HCC treatment received. Birth cohort-specific survival was evaluated with Kaplan-Meier methods and multivariate Cox proportional hazard models. RESULTS: The proportion of HCC represented by the 1945-1965 cohort increased by 64% from 2003-2011, and accounted for 57.4% of all HCC in 2011. Compared to patients born after 1965, the 1945-1965 cohort were more likely to have HCC within Milan criteria (OR, 3.66; 95% CI, 3.13-4.28; p<0.001). However, among patients with HCC within Milan criteria, the 1945-1965 cohort had no difference in receipt of surgical treatment, but had higher overall long-term survival (HR, 0.82; 95% CI, 0.69-0.97; p<0.03). CONCLUSIONS: The 1945-1965 birth cohort accounts for the majority of HCC in the United States. Despite earlier HCC stage at diagnosis, no difference in receipt of surgical treatment was observed, but higher overall survival was achieved.
Authors: George Cholankeril; Eric R Yoo; Ryan B Perumpail; Andy Liu; Jeevin S Sandhu; Satheesh Nair; Menghan Hu; Aijaz Ahmed Journal: Diseases Date: 2017-09-26
Authors: Elizabeth S Aby; Adam C Winters; Jonathan Lin; Aileen Bui; Jenna Kawamoto; Matthew B Goetz; Debika Bhattacharya; Joseph R Pisegna; Folasade P May; Arpan A Patel; Jihane N Benhammou Journal: Hepatol Commun Date: 2020-04-24