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The Epidemiology of Hepatocellular Carcinoma in the USA

  • GI Oncology (R Bresalier, Section Editor)
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Abstract

Purpose of Review

To discuss current knowledge and recent findings regarding the epidemiology of hepatocellular carcinoma (HCC) in the USA.

Recent Finding

The US incidence rate of HCC is increasing, although the pace may have somewhat slowed since 2010. In 2012, incidence rates of HCC in Hispanics surpassed those of Asians. The recent epidemiological changes in major risk factors for HCC include increasing hepatitis C virus post-sustained virologic response, suppressed hepatitis B virus on nucleoside analogues, and alcoholic and non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease has the greatest proportion of the burden of the main risk factors for HCC in the USA, followed by alcoholic liver disease, and hepatitis C virus and hepatitis B virus infections.

Summary

This review focuses on current knowledge regarding the recent epidemiological trends in HCC, with an emphasis on future directions.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010(127):2893–917.

    Article  CAS  Google Scholar 

  2. Singal AG, El-Serag HB. Hepatocellular carcinoma from epidemiology to prevention: translating knowledge into practice. Clin Gastroenterol Hepatol. 2015;13:2140–51.

    Article  Google Scholar 

  3. • White DL, Thrift AP, Kanwal F, Davila J, El-Serag HB. Incidence of hepatocellular carcinoma in all 50 United States, from 2000 Through 2012. Gastroenterology. 2017;152:812–820 e815. This study describes the most recent updated US national incidence of HCC using the US Cancer Statistics registry.

    Article  Google Scholar 

  4. Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999–2016: observational study. BMJ. 2018;362:k2817.

    Article  Google Scholar 

  5. El-Serag HB, Kanwal F. Epidemiology of hepatocellular carcinoma in the United States: where are we? where do we go? Hepatology. 2014;60:1767–75.

    Article  Google Scholar 

  6. Altekruse SF, Henley SJ, Cucinelli JE, McGlynn KA. Changing hepatocellular carcinoma incidence and liver cancer mortality rates in the United States. Am J Gastroenterol. 2014;109:542–53.

    Article  Google Scholar 

  7. Petrick JL, Kelly SP, Altekruse SF, McGlynn KA, Rosenberg PS. Future of hepatocellular carcinoma incidence in the United States forecast through 2030. J Clin Oncol. 2016;34:1787–94.

    Article  CAS  Google Scholar 

  8. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–14.

    Article  Google Scholar 

  9. Kallwitz ER, Daviglus ML, Allison MA, Emory KT, Zhao L, Kuniholm MH, et al. Prevalence of suspected nonalcoholic fatty liver disease in Hispanic/Latino individuals differs by heritage. Clin Gastroenterol Hepatol. 2015;13:569–76.

    Article  Google Scholar 

  10. Mittal S, Sada YH, El-Serag HB, Kanwal F, Duan Z, Temple S, et al. Temporal trends of nonalcoholic fatty liver disease–related hepatocellular carcinoma in the Veteran Affairs population. Clin Gastroenterol Hepatol. 2015;13:594–601 e591.

    Article  Google Scholar 

  11. Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127:S35–50.

    Article  Google Scholar 

  12. Chen CJ, Yang HI, Iloeje UH, Group R-HS. Hepatitis B virus DNA levels and outcomes in chronic hepatitis B. Hepatology. 2009;49:S72–84.

    Article  CAS  Google Scholar 

  13. Kim HS, Rotundo L, Yang JD, Kim D, Kothari N, Feurdean M, et al. Racial/ethnic disparities in the prevalence and awareness of hepatitis B virus infection and immunity in the United States. J Viral Hepat. 2017;24:1052–66.

    Article  CAS  Google Scholar 

  14. Yang JD, Kim WR, Coelho R, Mettler TA, Benson JT, Sanderson SO, et al. Cirrhosis is present in most patients with hepatitis B and hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2011;9:64–70.

    Article  Google Scholar 

  15. Chayanupatkul M, Omino R, Mittal S, Kramer JR, Richardson P, Thrift AP, et al. Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection. J Hepatol. 2017;66:355–62.

    Article  Google Scholar 

  16. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142:1264–73 e1261.

    Article  Google Scholar 

  17. Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol. 2008;48:335–52.

    Article  Google Scholar 

  18. Kao JH, Chen PJ, Lai MY, Chen DS. Basal core promoter mutations of hepatitis B virus increase the risk of hepatocellular carcinoma in hepatitis B carriers. Gastroenterology. 2003;124:327–34.

    Article  CAS  Google Scholar 

  19. Ni YH, Chang MH, Wang KJ, Hsu HY, Chen HL, Kao JH, et al. Clinical relevance of hepatitis B virus genotype in children with chronic infection and hepatocellular carcinoma. Gastroenterology. 2004;127:1733–8.

    Article  CAS  Google Scholar 

  20. Liu CJ, Chen BF, Chen PJ, Lai MY, Huang WL, Kao JH, et al. Role of hepatitis B viral load and basal core promoter mutation in hepatocellular carcinoma in hepatitis B carriers. J Infect Dis. 2006;193:1258–65.

    Article  CAS  Google Scholar 

  21. Yang HI, Yeh SH, Chen PJ, Iloeje UH, Jen CL, Su J, et al. Associations between hepatitis B virus genotype and mutants and the risk of hepatocellular carcinoma. J Natl Cancer Inst. 2008;100:1134–43.

    Article  CAS  Google Scholar 

  22. Papatheodoridis GV, Idilman R, Dalekos GN, Buti M, Chi H, van Boemmel F, et al. The risk of hepatocellular carcinoma decreases after the first 5 years of entecavir or tenofovir in Caucasians with chronic hepatitis B. Hepatology. 2017;66:1444–53.

    Article  CAS  Google Scholar 

  23. Rosenberg ES, Hall EW, Sullivan PS, Sanchez TH, Workowski KA, Ward JW, et al. Estimation of state-level prevalence of hepatitis C virus infection, US states and District of Columbia, 2010. Clin Infect Dis. 2017;64:1573–81.

    Article  Google Scholar 

  24. Lok AS, Seeff LB, Morgan TR, di Bisceglie AM, Sterling RK, Curto TM, et al. Incidence of hepatocellular carcinoma and associated risk factors in hepatitis C-related advanced liver disease. Gastroenterology. 2009;136:138–48.

    Article  CAS  Google Scholar 

  25. Sangiovanni A, Del Ninno E, Fasani P, De Fazio C, Ronchi G, Romeo R, et al. Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance. Gastroenterology. 2004;126:1005–14.

    Article  Google Scholar 

  26. Benvegnu L, Gios M, Boccato S, Alberti A. Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications. Gut. 2004;53:744–9.

    Article  CAS  Google Scholar 

  27. Kanwal F, Kramer JR, Ilyas J, Duan Z, El-Serag HB. HCV genotype 3 is associated with an increased risk of cirrhosis and hepatocellular cancer in a national sample of U.S. Veterans with HCV. Hepatology. 2014;60:98–105.

    Article  CAS  Google Scholar 

  28. Chang KC, Wu YY, Hung CH, Lu SN, Lee CM, Chiu KW, et al. Clinical-guide risk prediction of hepatocellular carcinoma development in chronic hepatitis C patients after interferon-based therapy. Br J Cancer. 2013;109:2481–8.

    Article  CAS  Google Scholar 

  29. El-Serag HB, Kramer J, Duan Z, Kanwal F. Racial differences in the progression to cirrhosis and hepatocellular carcinoma in HCV-infected veterans. Am J Gastroenterol. 2014;109:1427–35.

    Article  Google Scholar 

  30. Abu Dayyeh BK, Yang M, Fuchs BC, Karl DL, Yamada S, Sninsky JJ, et al. A functional polymorphism in the epidermal growth factor gene is associated with risk for hepatocellular carcinoma. Gastroenterology. 2011;141:141–9.

    Article  CAS  Google Scholar 

  31. El-Serag HB, Kanwal F, Richardson P, Kramer J. Risk of hepatocellular carcinoma after sustained virological response in veterans with hepatitis C virus infection. Hepatology. 2016;64:130–7.

    Article  CAS  Google Scholar 

  32. Kanwal F, Kramer J, Asch SM, Chayanupatkul M, Cao Y, El-Serag HB. Risk of hepatocellular cancer in HCV patients treated with direct-acting antiviral agents. Gastroenterology. 2017;153:996–1005 e1001.

    Article  CAS  Google Scholar 

  33. Volk ML, Tocco R, Saini S, Lok AS. Public health impact of antiviral therapy for hepatitis C in the United States. Hepatology. 2009;50:1750–5.

    Article  Google Scholar 

  34. Welzel TM, Graubard BI, Quraishi S, Zeuzem S, Davila JA, El-Serag HB, et al. Population-attributable fractions of risk factors for hepatocellular carcinoma in the United States. Am J Gastroenterol. 2013;108:1314–21.

    Article  Google Scholar 

  35. El-Serag HB, Hampel H, Javadi F. The association between diabetes and hepatocellular carcinoma: a systematic review of epidemiologic evidence. Clin Gastroenterol Hepatol. 2006;4:369–80.

    Article  Google Scholar 

  36. Wang P, Kang D, Cao W, Wang Y, Liu Z. Diabetes mellitus and risk of hepatocellular carcinoma: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2012;28:109–22.

    Article  Google Scholar 

  37. Mantovani A, Targher G. Type 2 diabetes mellitus and risk of hepatocellular carcinoma: spotlight on nonalcoholic fatty liver disease. Ann Transl Med. 2017;5:270.

    Article  Google Scholar 

  38. Singh S, Singh PP, Singh AG, Murad MH, Sanchez W. Anti-diabetic medications and the risk of hepatocellular cancer: a systematic review and meta-analysis. Am J Gastroenterol. 2013;108:881–91 quiz 892.

    Article  CAS  Google Scholar 

  39. Chen Y, Wang X, Wang J, Yan Z, Luo J. Excess body weight and the risk of primary liver cancer: an updated meta-analysis of prospective studies. Eur J Cancer. 2012;48:2137–45.

    Article  Google Scholar 

  40. Stepanova M, De Avila L, Afendy M, Younossi I, Pham H, Cable R, et al. Direct and indirect economic burden of chronic liver disease in the United States. Clin Gastroenterol Hepatol. 2017;15:759–766. e755.

    Article  Google Scholar 

  41. Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124–31.

    Article  Google Scholar 

  42. Paradis V, Zalinski S, Chelbi E, Guedj N, Degos F, Vilgrain V, et al. Hepatocellular carcinomas in patients with metabolic syndrome often develop without significant liver fibrosis: a pathological analysis. Hepatology. 2009;49:851–9.

    Article  Google Scholar 

  43. Yasui K, Hashimoto E, Komorizono Y, Koike K, Arii S, Imai Y, et al. Characteristics of patients with nonalcoholic steatohepatitis who develop hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2011;9:428–33 quiz e450.

    Article  Google Scholar 

  44. Ahmed A, Wong RJ, Harrison SA. Nonalcoholic fatty liver disease review: diagnosis, treatment, and outcomes. Clin Gastroenterol Hepatol. 2015;13:2062–70.

    Article  Google Scholar 

  45. Rich NE, Oji S, Mufti AR, Browning JD, Parikh ND, Odewole M, Mayo H, Singal AG: Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2017.

  46. Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the US. Hepatology. 2014;59:2188–95.

    Article  Google Scholar 

  47. White DL, Kanwal F, El-Serag HB. Association between nonalcoholic fatty liver disease and risk for hepatocellular cancer, based on systematic review. Clin Gastroenterol Hepatol. 2012;10:1342–59 e1342.

    Article  Google Scholar 

  48. • Kanwal F, Kramer JR, Mapakshi S, Natarajan Y, Chayanupatkul M, Richardson PA, Li L, Desiderio R, Thrift AP, Asch SM, et al.: Risk of hepatocellular cancer in patients with non-alcoholic fatty liver disease. Gastroenterology 2018. This study confirms that non-alcoholic fatty liver disease is a risk factor for HCC using the largest to date national VA database.

  49. Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9:524–530 e521 quiz e560.

    Article  Google Scholar 

  50. Kim D, Li AA, Gadiparthi C, Khan MA, Cholankeril G, Glenn JS, et al. Changing trends in etiology-based annual mortality from chronic liver disease, from 2007 through 2016. Gastroenterology. 2018(155):1154–63 e1153.

  51. Deleuran T, Gronbaek H, Vilstrup H, Jepsen P. Cirrhosis and mortality risks of biopsy-verified alcoholic pure steatosis and steatohepatitis: a nationwide registry-based study. Aliment Pharmacol Ther. 2012;35:1336–42.

    Article  CAS  Google Scholar 

  52. Donato F, Tagger A, Gelatti U, Parrinello G, Boffetta P, Albertini A, et al. Alcohol and hepatocellular carcinoma: the effect of lifetime intake and hepatitis virus infections in men and women. Am J Epidemiol. 2002;155:323–31.

    Article  CAS  Google Scholar 

  53. Hutchinson SJ, Bird SM, Goldberg DJ. Influence of alcohol on the progression of hepatitis C virus infection: a meta-analysis. Clin Gastroenterol Hepatol. 2005;3:1150–9.

    Article  Google Scholar 

  54. Turati F, Galeone C, Rota M, Pelucchi C, Negri E, Bagnardi V, et al. Alcohol and liver cancer: a systematic review and meta-analysis of prospective studies. Ann Oncol. 2014;25:1526–35.

    Article  CAS  Google Scholar 

  55. Zachou K, Muratori P, Koukoulis GK, Granito A, Gatselis N, Fabbri A, et al. Review article: autoimmune hepatitis—current management and challenges. Aliment Pharmacol Ther. 2013;38:887–913.

    Article  CAS  Google Scholar 

  56. Manns MP, Czaja AJ, Gorham JD, Krawitt EL, Mieli-Vergani G, Vergani D, et al. Diagnosis and management of autoimmune hepatitis. Hepatology. 2010;51:2193–213.

    Article  CAS  Google Scholar 

  57. Krawitt EL. Autoimmune hepatitis. N Engl J Med. 2006;354:54–66.

    Article  CAS  Google Scholar 

  58. Tansel A, Katz LH, El-Serag HB, Thrift AP, Parepally M, Shakhatreh MH, et al. Incidence and determinants of hepatocellular carcinoma in autoimmune hepatitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017;15:1207–17 e1204.

    Article  Google Scholar 

  59. Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol. 2013;47(Suppl):S2–6.

    Article  Google Scholar 

  60. Papatheodoridis GV, Chan HL, Hansen BE, Janssen HL, Lampertico P. Risk of hepatocellular carcinoma in chronic hepatitis B: assessment and modification with current antiviral therapy. J Hepatol. 2015;62:956–67.

    Article  Google Scholar 

  61. Zhang XX, Wang LF, ** L, Li YY, Hao SL, Shi YC, et al. Primary biliary cirrhosis-associated hepatocellular carcinoma in Chinese patients: incidence and risk factors. World J Gastroenterol. 2015;21:3554–63.

    Article  CAS  Google Scholar 

  62. Ngu JH, Gearry RB, Frampton CM, Stedman CA. Mortality and the risk of malignancy in autoimmune liver diseases: a population-based study in Canterbury, New Zealand. Hepatology. 2012;55:522–9.

    Article  Google Scholar 

  63. Jackson H, Solaymani-Dodaran M, Card TR, Aithal GP, Logan R, West J. Influence of ursodeoxycholic acid on the mortality and malignancy associated with primary biliary cirrhosis: a population-based cohort study. Hepatology. 2007;46:1131–7.

    Article  CAS  Google Scholar 

  64. Hosonuma K, Sato K, Yanagisawa M, Kakizaki S, Takagi H, Hirato J, et al. Incidence, mortality, and predictive factors of hepatocellular carcinoma in primary biliary cirrhosis. Gastroenterol Res Pract. 2013;2013:168012.

    Article  Google Scholar 

  65. Zenouzi R, Weismuller TJ, Hubener P, Schulze K, Bubenheim M, Pannicke N, et al. Low risk of hepatocellular carcinoma in patients with primary sclerosing cholangitis with cirrhosis. Clin Gastroenterol Hepatol. 2014;12:1733–8.

    Article  Google Scholar 

  66. Ali AH, Tabibian JH, Nasser-Ghodsi N, Lennon RJ, DeLeon T, Borad MJ, et al. Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis. Hepatology. 2018;67:2338–51.

    Article  CAS  Google Scholar 

  67. Khalaf N, Ying J, Mittal S, Temple S, Kanwal F, Davila J, et al. Natural history of untreated hepatocellular carcinoma in a US cohort and the role of cancer surveillance. Clin Gastroenterol Hepatol. 2017;15:273–81 e271.

    Article  Google Scholar 

  68. Cabibbo G, Maida M, Genco C, Parisi P, Peralta M, Antonucci M, et al. Natural history of untreatable hepatocellular carcinoma: a retrospective cohort study. World J Hepatol. 2012;4:256–61.

    Article  Google Scholar 

  69. Giannini EG, Farinati F, Ciccarese F, Pecorelli A, Rapaccini GL, Di Marco M, et al. Prognosis of untreated hepatocellular carcinoma. Hepatology. 2015;61:184–90.

    Article  Google Scholar 

  70. Arguedas MR, Chen VK, Eloubeidi MA, Fallon MB. Screening for hepatocellular carcinoma in patients with hepatitis C cirrhosis: a cost-utility analysis. Am J Gastroenterol. 2003;98:679–90.

    Article  Google Scholar 

  71. Lin OS, Keeffe EB, Sanders GD, Owens DK. Cost-effectiveness of screening for hepatocellular carcinoma in patients with cirrhosis due to chronic hepatitis C. Aliment Pharmacol Ther. 2004;19:1159–72.

    Article  CAS  Google Scholar 

  72. Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67:358–80.

    Article  Google Scholar 

  73. Kew E, Marcus R. Some characteristics of Mozambican Shangaans with primary hepatocellular cancer. S Afr Med J. 1977;51:306–9.

    CAS  PubMed  Google Scholar 

  74. Kew MC, Macerollo P. Effect of age on the etiologic role of the hepatitis B virus in hepatocellular carcinoma in blacks. Gastroenterology. 1988;94:439–42.

    Article  CAS  Google Scholar 

  75. White DL, Richardson P, Tayoub N, Davila JA, Kanwal F, El-Serag HB. The updated model: an adjusted serum alpha-fetoprotein-based algorithm for hepatocellular carcinoma detection with hepatitis C virus-related cirrhosis. Gastroenterology. 2015;149:1986–7.

    Article  Google Scholar 

  76. The Texas Hepatocellular Carcinoma Consortium (THCCC). 2015.

  77. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2004;130:417–22.

    PubMed  Google Scholar 

  78. Chang MH, Chen CJ, Lai MS, Hsu HM, Wu TC, Kong MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med. 1997;336:1855–9.

    Article  CAS  Google Scholar 

  79. Hu YC, Yeh CC, Chen RY, Su CT, Wang WC, Bai CH, et al. Seroprevalence of hepatitis B virus in Taiwan 30 years after the commencement of the national vaccination program. PeerJ. 2018;6:e4297.

    Article  Google Scholar 

  80. WHO: WHO. Global hepatitis report. 2017:http://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/.

  81. Yeo YH, Le MH, Chang ET, Henry L, Nguyen MH: The prevalence of undetectable vaccine-induced immunity against hepatitis B virus in US adults at high risk for infection. Hepatology 2018.

  82. WHO: Combating hepatitis B and C to reach elimination by 2030. May, 2016:http://apps.who.int/iris/bitstream/10665/206453/206451/WHO_HIV_202016.206404_eng.pdf.

  83. Kim HS, Yang JD Awareness rate of chronic viral hepatitis in the United States: a population-based study. Gastroenterology 2018, 154 , Issue 6, Supplement 1, Pages S-728–S-729:S728–729.

  84. Ampuero J, Romero-Gomez M. Prevention of hepatocellular carcinoma by correction of metabolic abnormalities: role of statins and metformin. World J Hepatol. 2015;7:1105–11.

    Article  Google Scholar 

  85. Singh S, Singh PP, Singh AG, Murad MH, Sanchez W. Statins are associated with a reduced risk of hepatocellular cancer: a systematic review and meta-analysis. Gastroenterology. 2013;144:323–32.

    Article  CAS  Google Scholar 

  86. Kennedy OJ, Roderick P, Buchanan R, Fallowfield JA, Hayes PC, Parkes J. Coffee, including caffeinated and decaffeinated coffee, and the risk of hepatocellular carcinoma: a systematic review and dose-response meta-analysis. BMJ Open. 2017;7:e013739.

    Article  Google Scholar 

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NIH NCI (R01CA190776) and NIDDK Grants (P30DK056338) to Dr. El-Serag.

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Kim, Hs., El-Serag, H.B. The Epidemiology of Hepatocellular Carcinoma in the USA. Curr Gastroenterol Rep 21, 17 (2019). https://doi.org/10.1007/s11894-019-0681-x

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