A 30-Year, Population-Based Study Shows Improved Management and Prognosis of Hepatocellular Carcinoma

BACKGROUND & AIMS Little is known about the impact of changes in the management of hepatocellular carcinoma (HCC) over time We assessed trends in the pattern of care and in prognosis at a population level METHODS Data on diagnostic conditions, treatment, and prognosis from 1976 2005 were collected by the population based digestive cancer registry of Burgundy (France) A nonconditional logistic regression was used to identify factors associated with treatment for cure A multivariate relative survival analysis was also per formed RESULTS The context of HCC diagnosis has changed, the proportion of asymptomatic patients increased from 56% (1976-1985) to 372% (1996-2005) The proportion of cases diagnosed on the basis of morphologic criteria in creased from 14% during 1976-1985 to 35 6% during 1996 2005, whereas histologically verified cases decreased from 62 2% to 41 2% between the same time periods The proportion of patients who were treated with intent to cure increased from 2 7% (1976-1985) to 196% (1996-2005) This increase was associated with improvements in relative survival from 4 7% (1976-1985) to 32 8% (1996-2005) at 1 year and from 1 4% to 10 0% at 5 years The 5 year relative survival of patients treated with curative intent increased, reaching 46 6% for the 1996 2005 period In the multivariate relative survival analysis, age, period of diagnosis, clinical presentation, alpha fetoprotein level, and treatment were independent prognostic factors CONCLUSIONS During a 30 year period, there was an increase m the number of HCCs diagnosed m asymptomatic subjects that was associated with the development of new effective therapies, this association might account for improvements in prognosis of patients with HCC