Originally published as JCO Early Release 10.1200/JCO.2008.20.7753 on February 17 2009

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Hepatocellular Carcinoma Incidence, Mortality, and Survival Trends in the United States From 1975 to 2005

Sean F. Altekruse, Katherine A. McGlynn, Marsha E. Reichman

From the Division of Cancer Control and Population Sciences, and the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD.

Corresponding author: Sean F. Altekruse, DVM, MPH, PhD, Cancer Statistics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 6116 Executive Blvd Suite 504, Bethesda, MD 20892-8316; e-mail: altekrusesf{at}mail.nih.gov.

Purpose Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality worldwide. Incidence rates are increasing in the United States. Monitoring incidence, survival, and mortality rates within at-risk populations can facilitate control efforts.

Methods Age-adjusted incidence trends for HCC were examined in the Surveillance, Epidemiology, and End Results (SEER) registries from 1975 to 2005. Age-specific rates were examined for birth cohorts born between 1900 and 1959. Age-adjusted incidence and cause-specific survival rates from 1992 to 2005 were examined in the SEER 13 registries by race/ethnicity, stage, and treatment. United States liver cancer mortality rates were also examined.

Results Age-adjusted HCC incidence rates tripled between 1975 and 2005. Incidence rates increased in each 10-year birth cohort from 1900 through the 1950s. Asians/Pacific Islanders had higher incidence and mortality rates than other racial/ethnic groups, but experienced a significant decrease in mortality rates over time. From 2000 to 2005, marked increases in incidence rates occurred among Hispanic, black, and white middle-aged men. Between 1992 and 2004, 2- to 4-year HCC survival rates doubled, as more patients were diagnosed with localized and regional HCC and prognosis improved, particularly for patients with reported treatment. Recent 1-year survival rates remained, however, less than 50%.

Conclusion HCC incidence and mortality rates continue to increase, particularly among middle-aged black, Hispanic, and white men. Screening of at-risk groups and treatment of localized-stage tumors may contribute to increasing HCC survival rates in the United States. More progress is needed.

S.F.A., K.A.M., and M.E.R. contributed equally to this work.

Supported by the Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, National Institutes of Health.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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