肝细胞癌生存的病因分析：SEER-Medicare数据库分析

StephenW

Hepatocellular Carcinoma Survival by Etiology: A SEER-Medicare Database Analysis
Gagandeep Brar  1   2 , Tim F Greten  1 , Barry I Graubard  3 , Timothy S McNeel  4 , Jessica L Petrick  5 , Katherine A McGlynn  3 , Sean F Altekruse  6
Affiliations
Affiliations

    1
    Gastrointestinal Malignancy Section Thoracic and Gastrointestinal Malignancies Branch Center for Cancer Research National Cancer Institute National Institutes of Health Bethesda MD.
    2
    Present address: Department of Hematology and Oncology Weill Cornell Medical College New York NY.
    3
    Division of Cancer Epidemiology and Genetics National Cancer Institute National Institutes of Health Bethesda MD.
    4
    Information Management Services Inc. Calverton MD.
    5
    Slone Epidemiology Center Boston University Boston MA.
    6
    Division of Cardiovascular Science National Heart, Lung and Blood Institute National Institutes of Health Bethesda MD.

    PMID: 33024922 PMCID: PMC7527688 DOI: 10.1002/hep4.1564

Abstract

In the United States, hepatocellular carcinoma (HCC) survival varies with tumor characteristics, patient comorbidities, and treatment. The effect of HCC etiology on survival is less clearly defined. The relationship between HCC etiology and mortality was examined using Surveillance, Epidemiology, and End Results-Medicare data. In a cohort of 11,522 HCC cases diagnosed from 2000 through 2014, etiologies were identified from Medicare data, including metabolic disorders (32.9%), hepatitis C virus (8.2%), alcohol (4.7%), hepatitis B virus (HBV, 2.1%), rare etiologies (0.9%), multiple etiologies (26.7%), and unknown etiology (24.4%). After adjusting for demographics, tumor characteristics, comorbidities and treatment, hazard ratios (HRs) and survival curves by HCC etiology were estimated using Cox proportional hazard models. Compared with HBV-related HCC cases, higher mortality was observed for those with alcohol-related HCC (HR 1.49; 95% confidence interval [95% CI] 1.25-1.77), metabolic disorder-related HCC (HR 1.25; 95% CI 1.07-1.47), and multiple etiology-related HCC (HR 1.25; 95% CI 1.07-1.46), but was not statistically significant for hepatitis C virus-related, rare disorder-related, and HCC of unknown etiology. For all HCC etiologies, there was short median survival ranging from 6.1 months for alcohol to 10.3 months for HBV. Conclusion: More favorable survival was seen with HBV-related HCC. To the extent that HCC screening is more common among persons with HBV infection compared to those with other etiologic risk factors, population-based HCC screening, applied evenly to persons across all HCC etiology categories, could shift HCC diagnosis to earlier stages, when cases with good clinical status are more amenable to curative therapy.

Published 2020. This article is a U.S. Government work and is in the public domain in the US

StephenW

肝细胞癌生存的病因分析：SEER-Medicare数据库分析
Gagandeep Brar 1 2，Tim F Greten 1，Barry I Graubard 3，Timothy S McNeel 4，Jessica L Petrick 5，Katherine A McGlynn 3，Sean F Altekruse 6
隶属关系
隶属关系

    1个
    胃肠道恶性肿瘤科胸腔和胃肠道恶性肿瘤科癌症研究中心美国国家癌症研究所美国国立卫生研究院贝塞斯达医学博士。
    2
    现在的地址：纽约州威尔康奈尔医学院血液与肿瘤学系。
    3
    美国国立卫生研究院癌症研究所流行病学和遗传学系Bethesda医学博士。
    4
    信息管理服务公司。Calverton MD。
    5
    波士顿大学波士顿流行病学中心。
    6
    美国国立卫生研究院肺与血液研究所心血管科学系Bethesda医学博士。

    PMID：33024922 PMCID：PMC7527688 DOI：10.1002 / hep4.1564

抽象

在美国，肝细胞癌（HCC）的存活率随肿瘤特征，患者合并症和治疗而异。肝癌病因对生存的影响尚不清楚。使用监视，流行病学和最终结果医疗保险数据检查了HCC病因与死亡率之间的关系。在2000年至2014年诊断的11,522例HCC病例中，根据Medicare数据确定了病因，包括代谢异常（32.9％），丙型肝炎病毒（8.2％），酒精（4.7％），乙型肝炎病毒（HBV，2.1％ ），罕见病因（0.9％），多种病因（26.7％）和未知病因（24.4％）。经过人口统计学调整后，使用Cox比例风险模型通过HCC病因学评估了肿瘤特征，合并症和治疗，风险比（HRs）和生存曲线。与HBV相关的HCC病例相比，酒精相关的HCC（HR 1.49； 95％置信区间[95％CI] 1.25-1.77），代谢紊乱相关的HCC（HR 1.25; 95％CI 1.07）的死亡率更高。 -1.47）和多种病因相关的HCC（HR 1.25； 95％CI 1.07-1.46），但对于丙型肝炎病毒相关，罕见疾病相关的HCC和病因不明的HCC没有统计学意义。就所有HCC病因而言，中位生存期很短，从饮酒6.1个月到HBV到10.3个月不等。结论：HBV相关的肝癌的存活率更高。在某种程度上，与其他病因危险因素相比，HBV感染者更常进行HCC筛查，基于人群的HCC筛查平均适用于所有HCC病因类别的人群，可能将HCC诊断转移到早期阶段。良好的临床状态更适合治疗。

2020年出版。本文是美国政府的工作，在美国属于公共领域

StephenW

https://aasldpubs.onlinelibrary. ... t/10.1002/hep4.1564