AASLD2020[752]752 肝细胞癌发病率下降 美国

StephenW

752
DECLINING INCIDENCE OF HEPATOCELLULAR CARCINOMA IN
THE UNITED STATES
Meredith Shiels and Thomas R. O’Brien, Division of Cancer
Epidemiology and Genetics, National Cancer Institute
Background: In the United States, hepatocellular carcinoma
(HCC) rates had been increasing for decades, until recent
years when rates flattened and then potentially declined.
Previously, we reported that HCC rates in 2016 were 4% lower
than 2015, with the largest decline (7%) observed among
50-64-year-olds (Shiels and O’Brien, Gastroenterology,
2020) Though the decline in 2016 was pronounced, it was
unclear whether it was the beginning of a downward trend
Here, we examined whether the decline in HCC rates
continued through 2017 Methods: Data on HCC rates were
obtained from the 20 cancer registries in the Surveillance,
Epidemiology and End Results Program Incidence rates for
2000-2017 were age-standardized to the 2000 US population
in 5-year age categories We used Joinpoint regression to
identify statistically significant changes in rate trajectories and
to estimate annual percent changes (APCs) in rates Results:
During 2000-2017, 128,854 HCC cases occurred during
2 02 billion person-years of follow-up (rate=5 9 per 100,000
person-years) After increasing from 3 9 per 100,000 in 2000
to 6 8 per 100,000 in 2014, HCC rates fell to 6 3 in 2017
(Figure 1), a decline of 2 8% per year (95% CI: -4 7, -0 9;
p=0 01) during 2014-2017 Temporal trends varied notably
by age group HCC rates were low (0 3 per 100,000) and
stable among 20-34-year-olds (APC=-0 3; 95% CI: -1 6, 1 0)
Among 35-49-year-olds, rates were stable during 2000-2006
(APC=0.8; 95% CI: -1.5, 3.2) and then declined significantly
4 9% per year (95% CI: -5 9, -3 8) during 2006-2017 Among
50-64-year-olds HCC rates increased 9 4% per year (95% CI:
8 3, 10 6) during 2000-2007 and 4 3% per year (95% CI: 2 4,
6 2) during 2007-2012 before plateauing during 2012-2015
(APC=-1 3; 95% CI: -6 3, 4 0) and declining 9 5% per year
(95% CI: -14 4, -4 3) during 2015-2017 We observed the
highest HCC rates among those aged ≥65 years (23.3 per
100,000) In this age group, rates increased 3 6% per year
(95% CI: 3 3, 3 9) during 2000-2015 before plateauing during
2015-2017 (APC=0 1; 95% CI -4 9, 5 3) By race/ethnicity,
HCC rates have decreased recently among Hispanics (2014-
2017, APC=-4.2; 95% CI -7.7, -0.6), Asian/Pacific Islanders
(2007-2015, APC=-2 2; 95% CI -3 3, -1 0; 2015-2017, APC=-
7 5; 95% CI -15 1, 0 7) and non-Hispanic Whites (2014-2017,
APC -2 6; 95% CI -5 5, 0 4) These rates have plateaued
among non-Hispanic Blacks (2009-2017, APC 0 1; 95% CI
-1 0, 1 2), but continued to increase among American Indians
and Alaska Natives (2000-2017, APC 4 9; 95% CI 3 3, 6 4)
Conclusion: The overall incidence of HCC continued to fall
in the United States through 2017 The most rapid declines
in recent years were observed among 35-64-year-olds,
Hispanics and Asian/Pacific Islanders.

StephenW

752
肝细胞癌发病率下降
美国
梅里迪思·希尔斯（Meredith Shiels）和托马斯·R·奥布莱恩（Thomas R.O’Brien），癌症部
美国国家癌症研究所流行病学和遗传学
背景：在美国，肝细胞癌
（HCC）率一直在上升，直到最近
率趋于平稳，然后可能下降的年份。
之前，我们曾报道2016年的HCC发生率降低了4％
比2015年下降幅度最大（7％）
50-64岁（Shiels和O’Brien，胃肠病学，
2020）尽管2016年的下降明显，但这是
不清楚这是否是下降趋势的开始
在这里，我们检查了HCC率是否下降
持续到2017年方法：HCC发生率数据
从监测的20个癌症登记处获得，
流行病学和最终结果计划的发病率
2000-2017年按2000年美国人口年龄标准化
在5岁年龄段中，我们使用Joinpoint回归
确定速率轨迹的统计显着变化，并
估计费率的年度变化百分比（APC）结果：
在2000-2017年期间，有128,854例HCC病例
2020亿人年的随访率（每10万人= 5 9
从2000年的每10万人3 9增加到
降至2014年的每10万人6 8，HCC率在2017年降至6 3
（图1），每年下降2 8％（95％CI：-4 7 -0 9；
2014-2017年期间p = 0 01）时间趋势显着变化
按年龄段划分的HCC发生率较低（每10万人中0 3），
在20-34岁的人群中保持稳定（APC = -0 3; 95％CI：-1 6，1 0）
在2000年至2006年期间，年龄在35-49岁之间的人数保持稳定
（APC = 0.8； 95％CI：-1.5，3.2），然后显着下降
2006-2017年期间每年4 9％（95％CI：-5 9，-3 8）
50-64岁的HCC率每年增加9 4％（95％CI：
2000年至2007年期间分别为8 3、10 6）和每年4 3％（95％CI：2 4，
6 2）在2007-2012年期间，然后在2012-2015年达到稳定
（APC = -1 3; 95％CI：-6 3，4 0）并且每年下降9 5％
（95％CI：-14 4，-4 3）在2015-2017年期间
≥65岁的人群中HCC发生率最高（23.3
100,000）在这个年龄段，比率每年增长3 6％
（95％CI：3 3，3 9）在2000-2015年期间达到稳定水平
2015-2017（APC = 0 1; 95％CI -4 9，5 3）按种族/民族，
西班牙裔患者中的HCC率最近有所下降（2014-
2017年，APC = -4.2; 95％CI -7.7，-0.6），亚太岛民
（2007-2015，APC = -2 2; 95％CI -3 3，-1 0; 2015-2017，APC =-
7 5; 95％CI -15 1，0 7）和非西班牙裔白人（2014-2017，
APC -2 6; 95％CI -5 5，0 4）这些比率已经稳定
在非西班牙裔黑人中（2009-2017，APC 0 1; 95％CI
-1 0，1 2），但在美洲印第安人中继续增加
和阿拉斯加原住民（2000-2017，APC 4 9; 95％CI 3 3，6 4）
结论：肝癌的总发病率持续下降
到2017年美国降幅最快
最近几年在35-64岁的人群中观察到
西班牙裔和亚洲/太平洋岛民。