Outcome of Hepatocellular Carcinoma Detected During Surveillance: Comparing USA and Japan.
Hepatocellular Carcinoma
Japan
Liver Dysfunction
Prognosis
Surveillance
Tumor Burden
United States
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
13
08
2020
revised:
21
09
2020
accepted:
20
10
2020
pubmed:
10
12
2020
medline:
11
11
2021
entrez:
9
12
2020
Statut:
ppublish
Résumé
Differences in outcomes of hepatocellular carcinoma (HCC) between countries have been largely attributed to variation in the conduct of surveillance and subsequent HCC treatment eligibility. However, differences in outcomes among those detected under surveillance have not been well described. We compared characteristics and prognosis between patients with surveillance-detected HCC from the United States (US) and Japan. Patients in whom initial HCC was detected under surveillance between January 2006 and December 2015 from two centers in the US and two from Japan were included. Survival was compared between patients from the US and Japan using multivariable Cox regression analysis and propensity-score matched analysis. We performed subgroup analyses by liver disease etiology, tumor stage, and type of HCC treatment. Of 3788 HCC patients, 1797 (47.4%) were diagnosed under surveillance, 715 from the US and 1082 from Japan. Patients from the US diagnosed under surveillance had worse liver dysfunction and larger tumor burden than those from Japan. In multivariate analysis, US patients with surveillance-detected HCC had significantly worse survival than those from Japan (HR 1.17, 95% CI 1.00-1.35), which was also observed in propensity-score matched analysis. However, this difference was no longer significant after adjusting for treatment type (HR 1.07, 95% CI 0.92-1.25). When stratified by treatment type, survival was comparable between the two countries except lower survival among patients who underwent resection in the US versus Japan. Prognosis of patients with surveillance-detected HCC is poorer in the US than Japan, primarily driven by differences in treatment delivery. Studies are necessary to elucidate reasons for these differences.
Sections du résumé
BACKGROUND & AIMS
Differences in outcomes of hepatocellular carcinoma (HCC) between countries have been largely attributed to variation in the conduct of surveillance and subsequent HCC treatment eligibility. However, differences in outcomes among those detected under surveillance have not been well described. We compared characteristics and prognosis between patients with surveillance-detected HCC from the United States (US) and Japan.
METHODS
Patients in whom initial HCC was detected under surveillance between January 2006 and December 2015 from two centers in the US and two from Japan were included. Survival was compared between patients from the US and Japan using multivariable Cox regression analysis and propensity-score matched analysis. We performed subgroup analyses by liver disease etiology, tumor stage, and type of HCC treatment.
RESULTS
Of 3788 HCC patients, 1797 (47.4%) were diagnosed under surveillance, 715 from the US and 1082 from Japan. Patients from the US diagnosed under surveillance had worse liver dysfunction and larger tumor burden than those from Japan. In multivariate analysis, US patients with surveillance-detected HCC had significantly worse survival than those from Japan (HR 1.17, 95% CI 1.00-1.35), which was also observed in propensity-score matched analysis. However, this difference was no longer significant after adjusting for treatment type (HR 1.07, 95% CI 0.92-1.25). When stratified by treatment type, survival was comparable between the two countries except lower survival among patients who underwent resection in the US versus Japan.
CONCLUSIONS
Prognosis of patients with surveillance-detected HCC is poorer in the US than Japan, primarily driven by differences in treatment delivery. Studies are necessary to elucidate reasons for these differences.
Identifiants
pubmed: 33295281
pii: S1542-3565(20)31491-9
doi: 10.1016/j.cgh.2020.10.033
pmc: PMC10195158
mid: NIHMS1896045
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2379-2388.e6Subventions
Organisme : NCI NIH HHS
ID : U01 CA230669
Pays : United States
Organisme : NCI NIH HHS
ID : U01 CA230694
Pays : United States
Informations de copyright
Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.
Références
PLoS Med. 2014 Apr 01;11(4):e1001624
pubmed: 24691105
Am J Med. 2017 Sep;130(9):1099-1106.e1
pubmed: 28213044
JAMA Oncol. 2017 Apr 01;3(4):456-463
pubmed: 27657493
Hepatology. 2020 Nov;72(5):1654-1665
pubmed: 32017165
J Hepatol. 2018 Jul;69(1):182-236
pubmed: 29628281
Hepatol Res. 2019 Oct;49(10):1109-1113
pubmed: 31336394
J Hepatol. 2014 Aug;61(2):333-41
pubmed: 24717522
Hepatology. 2011 Mar;53(3):1020-2
pubmed: 21374666
Liver Int. 2016 Aug;36(8):1196-205
pubmed: 26901163
Hepatol Int. 2010 Mar 18;4(2):439-74
pubmed: 20827404
Clin Gastroenterol Hepatol. 2014 Nov;12(11):1927-33.e2
pubmed: 24582947
Dig Dis Sci. 2020 Jun;65(6):1669-1678
pubmed: 31643036
J Clin Oncol. 2016 Mar 20;34(9):980-6
pubmed: 26811521
Ann Intern Med. 2014 Aug 19;161(4):261-9
pubmed: 24934699
Hepatology. 2018 Aug;68(2):723-750
pubmed: 29624699
Br J Cancer. 2017 Feb 14;116(4):441-447
pubmed: 28081537
Cancer Epidemiol Biomarkers Prev. 2016 Jan;25(1):16-27
pubmed: 26667886
Liver Cancer. 2015 Mar;4(2):85-95
pubmed: 26020031
Aliment Pharmacol Ther. 2017 Jan;45(1):169-177
pubmed: 27862091
Gut. 2021 Feb;70(2):401-407
pubmed: 32398224
Gastroenterology. 2017 Jun;152(8):1954-1964
pubmed: 28283421
Clin Gastroenterol Hepatol. 2016 Jun;14(6):875-886.e6
pubmed: 26775025
JAMA Oncol. 2017 Nov 1;3(11):1582-1584
pubmed: 28796862
Liver Int. 2008 Jan;28(1):79-87
pubmed: 17900247
Am J Med. 2015 Jan;128(1):90.e1-7
pubmed: 25116425
CA Cancer J Clin. 2015 Mar;65(2):87-108
pubmed: 25651787
Hepatology. 2021 Feb;73(2):713-725
pubmed: 32383272
Clin Gastroenterol Hepatol. 2021 May;19(5):987-995.e1
pubmed: 32629122
Hepatology. 2005 Nov;42(5):1208-36
pubmed: 16250051
J Hepatol. 2010 Aug;53(2):291-7
pubmed: 20483497
Ann Surg Oncol. 2014 Apr;21(4):1287-95
pubmed: 24318095
J Gastroenterol. 2009;44 Suppl 19:119-21
pubmed: 19148805