Trends in hepatocellular carcinoma stage by racial/ethnic group in the United States, 1992-2019

Christian S Alvarez; Jennifer Ruhl; Gretchen Flynn; Barry I Graubard; Katherine A McGlynn

doi:10.1016/j.jhepr.2023.100868

Trends in hepatocellular carcinoma stage by racial/ethnic group in the United States, 1992-2019

JHEP Rep. 2023 Jul 29;5(11):100868. doi: 10.1016/j.jhepr.2023.100868. eCollection 2023 Nov.

Authors

Christian S Alvarez¹, Jennifer Ruhl², Gretchen Flynn³, Barry I Graubard¹, Katherine A McGlynn¹

Affiliations

¹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
² Division of Cancer Control and Population Sciences, NCI, Rockville, MD, USA.
³ Information Management Services, Calverton, MD, USA.

Abstract

Background & aims: Although incidence rates of hepatocellular carcinoma (HCC) began to decline in the United States in the past decade, disparities in rates among racial/ethnic groups have persisted. Whether disparities in stage at diagnosis have remained over time, however, is unclear.

Methods: National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program has created a new staging-over-time variable that facilitates the examination of trends in HCC stage. Thus, the proportions of HCCs diagnosed by stage between 1992 and 2019 were examined among non-Hispanic White, non-Hispanic Black (NHB), Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native (AI/AN) individuals. HCC incidence between 1992 and 2019 was also analysed using Joinpoint regression.

Results: Between 1992 and 2019, the proportion of stage 1 HCCs increased and the proportion of stage 4 HCCs decreased among non-Hispanic White, NHB, Hispanic, and Asian/Pacific Islander individuals. Among AI/AN persons, the proportion of stage 1 tumours remained stable, and the proportion of stage 4 tumours declined. In the most recent time period, NHB individuals had the lowest proportions of stage 1 HCCs (32%) and the highest proportion of stage 4 HCCs (20%) of any group. Joinpoint analysis found that HCC incidence began to decline by 2013 among all groups except AI/AN individuals, the only group that had an increase in incidence.

Conclusions: Despite generally favourable trends in HCC stage and incidence rates, disparities remain. NHB persons continue to have less favourable stages at diagnosis, and incidence rates continue to increase among AI/AN persons.

Impact and implications: HCC incidence rates among most United States racial/ethnic groups began to decline in recent years, but whether stage at diagnosis also improved was unclear. As a result, a new SEER stage variable was used to examine stage trends by race/ethnicity. Although the finding of generally favourable trends in stage as well as incidence is encouraging, continuity disparities in both stage and incidence require serious attention.

Keywords: Carcinomas; Hepatocellular; Neoplasm staging; Race/ethnicity; Trends; US population.