The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States

Parag Mahale; Meredith S Shiels; Charles F Lynch; Srinath Chinnakotla; Linda L Wong; Brenda Y Hernandez; Karen S Pawlish; Jie Li; Georgetta Alverson; Maria J Schymura; Eric A Engels

doi:10.1158/1055-9965.EPI-20-1188

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The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States

Journal article

Open access

Peer reviewed

The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States

Parag Mahale, Meredith S Shiels, Charles F Lynch, Srinath Chinnakotla, Linda L Wong, Brenda Y Hernandez, Karen S Pawlish, Jie Li, Georgetta Alverson, Maria J Schymura, …

Cancer epidemiology, biomarkers & prevention, Vol.30(3), pp.513-520

03/2021

DOI: 10.1158/1055-9965.EPI-20-1188

PMCID: PMC8052263

PMID: 33199438

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Abstract

Hepatocellular carcinoma (HCC) carries a poor prognosis. Liver transplantation (LT) is potentially curative for localized HCC. We evaluated the impact of LT on U.S. general population HCC-specific mortality rates. The Transplant Cancer Match Study links the U.S. transplant registry with 17 cancer registries. We calculated age-standardized incidence (1987-2017) and incidence-based mortality (IBM) rates (1991-2017) for adult HCCs. We partitioned population-level IBM rates by cancer stage and calculated counterfactual IBM rates assuming transplanted cases had not received a transplant. Among 129,487 HCC cases, 45.9% had localized cancer. HCC incidence increased on average 4.0% annually [95% confidence interval (CI) = 3.6-4.5]. IBM also increased for HCC overall (2.9% annually; 95% CI = 1.7-4.2) and specifically for localized stage HCC (4.8% annually; 95% CI = 4.0-5.5). The proportion of HCC-related transplants jumped sharply from 6.7% (2001) to 18.0% (2002), and further increased to 40.0% (2017). HCC-specific mortality declined among both nontransplanted and transplanted cases over time. In the absence of transplants, IBM for localized HCC would have increased at 5.3% instead of 4.8% annually. LT has provided survival benefit to patients with localized HCC. However, diagnosis of many cases at advanced stages, limited availability of donor livers, and improved mortality for patients without transplants have limited the impact of transplantation on general population HCC-specific mortality rates. Although LT rates continue to rise, better screening and treatment modalities are needed to halt the rising HCC mortality rates in the United States. .

Adolescent

Adult

Aged

Carcinoma, Hepatocellular - mortality

Female

Humans

Incidence

Liver Neoplasms - mortality

Liver Transplantation - methods

Liver Transplantation - mortality

Male

Middle Aged

Prognosis

Survival Analysis

United States

Young Adult

Details

Title: Subtitle: The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States
Creators: Parag Mahale - Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland. parag.mahale@maine.gov shielsms@mail.nih.gov
Meredith S Shiels - Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland. parag.mahale@maine.gov shielsms@mail.nih.gov
Charles F Lynch - Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa
Srinath Chinnakotla - Department of Surgery, University of Minnesota, Minneapolis, Minnesota
Linda L Wong - University of Hawai'i Cancer Center, Honolulu, Hawaii
Brenda Y Hernandez - Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, Hawaii
Karen S Pawlish - Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
Jie Li - Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
Georgetta Alverson - Michigan Cancer Surveillance Program, Michigan Department of Health and Human Services, Lansing, Michigan
Maria J Schymura - Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York
Eric A Engels - Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
Resource Type: Journal article
Publication Details: Cancer epidemiology, biomarkers & prevention, Vol.30(3), pp.513-520
DOI: 10.1158/1055-9965.EPI-20-1188
PMID: 33199438
PMCID: PMC8052263
NLM abbreviation: Cancer Epidemiol Biomarkers Prev
ISSN: 1055-9965
eISSN: 1538-7755
Grant note: U58 DP000807 / NCCDPHP CDC HHS U58 DP000824 / NCCDPHP CDC HHS HHSN261201800005C / NCI NIH HHS HHSN261201000036C / NCI NIH HHS U58 DP000848 / NCCDPHP CDC HHS HHSN261201000034C / NCI NIH HHS U58 DP003875 / NCCDPHP CDC HHS HHSN261201300021C / NCI NIH HHS HHSN261201000035C / NCI NIH HHS N01PC35143 / NCI NIH HHS HHSN261201800002C / NCI NIH HHS Z99 CA999999 / Intramural NIH HHS U58 DP003883 / NCCDPHP CDC HHS HHSN261201000035I / NCI NIH HHS
Language: English
Date published: 03/2021
Academic Unit: Epidemiology
Record Identifier: 9984214805302771

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