Affiliation:
1. National Cancer Institute, Bethesda, MD;
2. Information Management Services Inc, Calverton, MD;
3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD;
4. Division of Cancer Epidemiology and Genetics, Bethesda, MD;
5. Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, MD;
6. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD;
Abstract
201 Background: HCC is the 6thmost common occurring cancer worldwide and the 4th leading cause of cancer mortality, with a survival of 6-9 months. While survival varies by stage at diagnosis and treatment, the effect of HCC etiology on survival is unclear. We analyzed the SEER-Medicare database to evaluate whether HCC survival varied by etiology, after adjusting for stage, treatment, and survival. Methods: A total of 11,522 SEER-Medicare HCC cases (ICD-O-3 codes C22 for topography, 8170-8175 for morphology) met criteria for the Cox proportional hazard analyses to assess survival differences among the risk factors for hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, alcohol disorders, and metabolic disorders. These analyses were adjusted for covariates for gender, age at diagnosis, race, ethnicity, tumor size and extent of disease, a modified Charlson Index of comorbidities, and treatments that included resection, transplantation, ablation, arterial directed therapy and radiotherapy. Cases with multiple and unknown etiologies were included in analyses, however genetic disorders and primary biliary cirrhosis were excluded due to their rarity. Results: HBV associated cases had the highest proportion of single nodules (40% vs 33% overall), localized stage disease (57% vs 49%), treatment (40% vs 27%), and greatest frequency of resection (18.6% vs 9%). Non-Hispanic Asians/Pacific Islanders accounted for 69% of HBV infection-related HCC cases but only 16% of all cases. HBV associated cases had better survival than did HCC cases with other etiologies. Specifically, after adjusting for demographic and clinical attributes, compared to cases with HBV infection, the risk of death was highest for alcohol-related HCC (HR=1.69; 95%CI:1.42-2.01) followed by multiple etiologies (HR = 1.40; 95% CI: 1.20-1.64), metabolic disorders (HR = 1.32; 95% CI: 1.13-1.55), HCV infection (HR = 1.30; 95% CI: 1.10-1.53), and HCC of unknown etiology (HR = 1.22; 95% CI: 1.04-1.43). Conclusions: Persons with HBV associated HCC had better survival than persons with HCC of other etiologies. Efforts to identify people with any etiologic risk factors for HCC, treat their conditions, and screen for HCC may improve overall survival.
Publisher
American Society of Clinical Oncology (ASCO)