Predictors of five-year survival among patients with hepatocellular carcinoma in the United States an analysis of SEER-Medicare

• Published in: Cancer causes & control Vol. 32; no. 4; pp. 317 - 325
• Main Authors: Zhang, Xiaotao, El-Serag, Hashem B., Thrift, Aaron P.
• Format: Journal Article
• Language: English
• Published: Cham Springer Science + Business Media 01.04.2021; Springer International Publishing; Springer Nature B.V
• Subjects: Ablation Techniques; Aged; Aged, 80 and over; Biomedical and Life Sciences; Biomedicine; Cancer Research; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Comorbidity; Databases, Factual; Diagnosis; Epidemiology; Female; Hematology; Hepatocellular carcinoma; Humans; Liver cancer; Liver Neoplasms - diagnosis; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Liver Transplantation; Logistic Models; Male; Medicare; Neoplasm Staging; Odds Ratio; Oncology; ORIGINAL PAPER; Palliative care; Patients; Public Health; SEER Program; Surgery; Survival; Transplants & implants; United States - epidemiology; United States; Palliative care; Hepatocellular carcinoma; 5-year survival; SEER-Medicare; Curative intent treatment
• ISSN: 0957-5243; 1573-7225; 1573-7225
• DOI: 10.1007/s10552-020-01386-x

Background Most patients with hepatocellular carcinoma (HCC) are ≥ 65 years old at diagnosis and ~ 20% present with disease amenable to curative intent surgical therapy. The aim of this study was to examine whether treatment, the demographic variables, and clinical factors could predict 5-year survival among HCC patients. Methods We included patients, 66 years or older, diagnosed with a first primary HCC from 1994 through 2007 in the SEER-Medicare database, and followed up until death or 31 December 2012. Curative intent treatment was defined as liver transplantation, surgery resection, or ablation. We estimated odds ratios (OR) and 95% confidence intervals (CI) for associations with 5-year survival using logistic regression. Results We identified 10,826 patients with HCC with mean age 75.3 (standard deviation, 6.4) years. Most were male (62.2%) and non-Hispanic white (59.7%). Overall, only 8.1% of patients were alive 5 years post-HCC diagnosis date. Among all patients that survived ≥ 5 years, 69.8% received potentially curative treatment. Conversely, patients who received potentially curative treatment represented only 15.7% of patients who survived < 5 years. Curative intent treatment was the strongest predictor for surviving ≥ 5 years (vs. none/palliative treatment; adjusted OR 8.12, 95% CI 6.90–9.64). While stage at diagnosis and comorbidities were also independently associated with ≥ 5-year survival in HCC patients, these factors did not improve discrimination between short- and long-term survivors. Conclusions Curative intent treatment was the strongest predictor for survival ≥ 5 years among HCC patients. Given the limited availability of liver transplant and limited eligibility for surgical resection, finding curative intent HCC therapies remain critically important.