Epidemiology of hepatocellular carcinoma in Finistère Prospective study from June 2002 to May 2003

doi:10.1016/S0399-8320(07)89370-5

Gastroentérologie Clinique et Biologique

Volume 31, Issue 3, March 2007, Pages 259-264

https://doi.org/10.1016/S0399-8320(07)89370-5 Get rights and content

Summary

Objectives

The aims of this prospective study were to evaluate the incidence of hepatocellular carcinoma (HCC) in Finistère, an administrative district of western France, and to highlight epidemiological characteristics.

Methods

From June 1^st 2002 to May 31^st 2003, all cases of HCC in Finistère were registered prospectively. Standardized incidence rates were calculated.

Results

One hundred and six cases of HCC were registered. Standardized incidence rates were 13.8/100000 among men and 0.8/100000 among women. Among the incident cases of HCC, 52% were discovered in patients consulting for symptoms, and 28% in patients undergoing screening. The new non-invasive diagnostic criteria of HCC were used in 60% of cases. HCC was associated with cirrhosis in 89 patients (84%). Excessive alcohol intake was the main cause of cirrhosis. In all, 27 patients (25.5%) received potentially curative treatment.

Conclusion

Incidence of HCC is high in Finistère. The proportion of patients given potentially curative treatment is still low, illustrating how difficult screening can be when alcoholic cirrhosis predominates in the target population.

Résumé

Objectifs

Les buts de cette étude prospective étaient de mesurer l’incidence du carcinome hépatocellulaire (CHC) dans le département du Finistère et de dégager ses principales caractéristiques épidémiologiques.

Méthodes

Du 1^er juin 2002 au 31 mai 2003, tous les cas de CHC du Finistère ont été enregistrés de façon prospective. Les taux d’incidence ont été standardisés selon la population mondiale de référence.

Résultats

Cent six cas de CHC ont été enregistrés. Les taux d’incidence annuels standardisés selon les populations mondiales de référence étaient de 13,8/100 000 habitants chez l’homme et de 0,8/100 000 chez la femme. Le CHC était découvert à l’occasion de symptômes dans 52 % des cas, et grâce au dépistage dans 28 % des cas. Les nouveaux critères de diagnostic non invasifs du CHC ont été utilisés dans 60 % des cas. Dans 89 cas (84 %), le CHC était associé à une cirrhose, dont la cause était majoritairement alcoolique. Au total, 27 malades (25,5 %) ont eu un traitement à visée curative.

Conclusions

L’incidence du CHC est élevée dans le Finistère. La proportion de cancers traités de façon curative reste faible, et montre les difficultés du dépistage dans une population de malades ayant en grande majorité une cirrhose alcoolique.

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Cited by (12)

Benefits and harms of screening for hepatocellular carcinoma in high-risk populations: systematic review and meta-analysis
2023, Journal of the National Cancer Center
The incidence and mortality of hepatocellular carcinoma (HCC) have been increasing around the world. Current guidelines recommend HCC screening in high-risk population. However, the strength of evidence of benefits and harms of HCC screening to support the recommendation was unclear. The objective is to systematically synthesize current evidence on the benefits and harms of HCC screening.
We searched PubMed and nine other databases until August 20, 2021. We included cohort studies and RCTs that compared the benefits and harms of screening and non-screening in high-risk population of HCC. Case series studies that reported harms of HCC screening were also included. Pooled risk ratio (RR), according to HCC screening status, was calculated for each benefit outcome (e.g., HCC mortality, survival rate, proportion of early HCC), using head-to-head meta-analysis. The harmful outcomes (e.g., proportion of physiological harms provided by non-comparative studies were pooled by prevalence of meta-analysis. Analysis on publication bias and quality of life, subgroup analysis, and sensitivity analysis were also conducted.
We included 70 studies, including four random clinical trials (RCTs), 63 cohort studies,three case series studies. The meta-analysis of RCTs showed HCC screening was significantly associated with reduced HCC mortality (RR [risk ratio], 0.73 [95% CI, 0.56–0.96]; I² = 75.1%), prolonged overall survival rates (1-year, RR, 1.72 [95% CI, 1.13–2.61]; I² = 72.5%; 3-year, RR, 2.86 [95% CI, 1.78–4.58]; I² = 10.1%; and 5-year, RR, 2.76 [95% CI, 1.37–5.54]; I² = 28.3%), increased proportion of early HCC detection (RR, 2.68 [95% CI, 1.77–4.06]; I² = 50.4%). Similarly, meta-analysis of cohort studies indicated HCC screening was more effective than non-screening. However, pooled proportion of physiological harms was 16.30% (95% CI: 8.92%–23.67%) and most harms were of a mild to moderate severity.
The existing evidence suggests HCC screening is more effective than non-screening in high-risk population. However, harms of screening should not be ignored.
A nationwide study on hepatocellular carcinoma
2020, Cancer Epidemiology
Citation Excerpt :
This puts decision for surveillance in the hands of few caretakers which could be the reason for this better surveillance rate on a nationwide basis. An Australian study reported the proportion diagnosed by surveillance to be 35 % [35], and studies from Belgium [36], France [22] and Italy [15] reported 36 %, 28 % and 36 % respectively, which is similar to the results of the current study. Non-cirrhotic HCC patients were two times more likely to be surgical candidates than cirrhotic HCC patients whereas none of them underwent a liver transplant.
Population based studies on the epidemiology of HCC are scarce. We aimed to compare CG (cirrhotic HCC group) with NCG (non-cirrhotic HCC group), analyze incidence, etiology and survival among patients diagnosed in Iceland in a population-based cohort. A previous study from Iceland (1984–1998) showed an incidence of HCC of 1.1/100.000, mostly with NCG.
A nationwide, population based retrospective study. Information on patients with HCC during 1998−2017 was obtained and medical records viewed.
Overall 152 patients with HCC were identified. The mean incidence was 1.7/100.000 and increased by 8% annually. Alcohol and hepatitis C combined was more common as a risk factor in CG than in the NCG (13 % vs. 2%, p = 0.03). Tumor size was larger in NCG (11 cm vs 5 cm, p < 0.01) and portal vein thrombosis less common (11 % vs. 30 %, p = 0.03). Overall, 44 % in NCG underwent surgical treatment vs. 23 % in CG (p = 0.02). The proportion of patients diagnosed by surveillance in 1998−2007 was 3% and 19 % in 2008−2017 (p = 0.03). The disease specific median survival for cirrhotic patients diagnosed by surveillance was 519 days and 86 days in other cirrhotic patients, hazard ratio 0.45 (p = 0.007, CI 0.25−0.81).
A major increase in the incidence of patients with HCC has occurred. The non-cirrhotic HCC presented with larger size tumors, lower proportion of portal vein thrombosis and were more likely to be surgical candidates, although not affecting prognosis. Diagnosis by surveillance in patients with cirrhosis has increased and the survival of those patients is better compared to others.
Clinical characteristics of hepatocellular carcinoma in Spain. Comparison with the 2008-2009 period and analysis of the causes of diagnosis out of screening programs. Analysis of 686 cases in 73 centers
2017, Medicina Clinica
En 2010 publicamos que en España el 53% de los carcinomas hepatocelulares (CHC) se diagnostican fuera de programas de cribado, lo que conlleva una menor supervivencia. El objetivo del presente estudio es evaluar la situación actual y las causas del diagnóstico fuera de cribado.
Registro prospectivo entre el 1 de octubre de 2014 y el 31 de enero de 2015 en 73 centros asistenciales españoles de segundo/tercer nivel. Se registraron las características basales y el primer tratamiento de los tumores primarios hepáticos incidentales de ese período.
Se incluyeron 720 pacientes: CHC (n = 686), colangiocarcinoma intrahepático (n = 29), hepatocolangiocarcinoma (n = 2), otros (n = 3). Los pacientes con CHC fueron varones en el 82% de los casos; media de 67 años; cirrosis en el 87%; etiología: alcohol 35%, VHC 30%, alcohol y VHC 15%, enfermedad hepática por depósito de grasa 6%; estadio tumoral: BCLC-0 11%, A 43%, B 19%, C 16% y D 11%; tratamiento inicial: quimioembolización transarterial (23%), ablación percutánea (22%), tratamiento sintomático (20%), resección (11%), sorafenib (11%). Se diagnosticaron fuera de cribado 356 pacientes (53%). Los motivos principales fueron la ausencia de diagnóstico previo de hepatopatía (76%) y la mala adherencia al cribado (18%). Estos pacientes eran predominantemente varones (p < 0,001), de etiología alcohólica (p < 0,001), con consumo activo de alcohol (p < 0,001) y se diagnosticaron en estadios más avanzados (p < 0,001), recibiendo menos tratamientos radicales (p < 0,001).
En España, la principal causa del diagnóstico de CHC fuera del cribado es la ausencia de diagnóstico previo de enfermedad hepática, principalmente en varones con consumo de alcohol. La detección de hepatopatía en población asintomática y la mejora de la adherencia al cribado son los principales aspectos para mejorar la detección precoz.
In 2010 we published that 53% of cases of hepatocellular carcinoma (HCC) detected in Spain were diagnosed outside the context of standard screening programs, which consequently leads to lower survival rates. The aim of this study was to analyze the current situation and the causes of diagnosis out of screening programs.
Prospective registry of 73 second- and third-level Spanish healthcare centers carried out between October 1, 2014 and January 31, 2015. The baseline characteristics of the disease and the first treatment administered for the incidental primary liver tumors during such period were recorded.
A total of 720 patients were included in the study: HCC (n = 686), intrahepatic cholangiocarcinoma (n = 29), hepatic cholangiocarcinoma (n = 2), other (n = 3). HCC characteristics: male 82%; mean age 67 years; cirrhosis 87%; main etiologies: alcohol 35%, HCV 30%, alcohol and HCV 15%, non-alcoholic fatty liver disease 6%; tumor stage: BCLC-0 11%, A 43%, B 19%, C 16% and D 11%; first treatment: transarterial chemoembolization (23%), percutaneous ablation (22%), symptomatic treatment (20%), resection (11%), sorafenib (11%). Three hundred and fifty-six patients (53%) were diagnosed outside of screening programs, mainly owing to the fact that they suffered from an undiagnosed liver disease (76%) and to the poor adherence to the screening program (18%). These patients were mainly male (P < .001), with an alcoholic etiology (P < .001) and active alcohol consumption (P < .001). Moreover, the disease was predominantly diagnosed at more advanced stages (P < .001) and was addressed with less radical treatments (P < .001).
In Spain, the main cause of diagnosis of a HCC outside the context of a screening program is the absence of a prior diagnosis of a liver disease, particularly in alcohol-consuming men. Detecting a liver disease in asymptomatic populations and improving adherence to screening programs are the main areas that must be subject to improvement in order to improve the early detection of HCC.
The burden of liver disease in Europe: A review of available epidemiological data
2013, Journal of Hepatology
To survey the burden of liver disease in Europe and its causes 260 epidemiological studies published in the last five years were reviewed.
The incidence and prevalence of cirrhosis and primary liver cancer are key to understand the burden of liver disease. They represent the end-stage of liver pathology and thus are indicative of the associated mortality. About 0.1% of Hungarian males will die of cirrhosis every year compared with 0.001% of Greek females. WHO estimate that liver cancer is responsible for around 47,000 deaths per year in the EU.
Harmful alcohol consumption, viral hepatitis B and C and metabolic syndromes related to overweight and obesity are the leading causes of cirrhosis and primary liver cancer in Europe.
Chronic hepatitis B affects 0.5–0.7% of the European population. In the last decade the prevalence of chronic hepatitis C was 0.13–3.26%. It is of great concern that about 90% of people in Europe infected by viral hepatitis are unaware of their status. Available data suggest the prevalence rate of NAFLD is 2–44% in the general European population (including obese children) and 42.6–69.5% in people with type 2 diabetes.
Each of these four major causes of liver disease is amenable to prevention and treatment, reducing the burden of liver disease in Europe and saving lives. Further surveys are urgently needed to implement cost-effective prevention programmes and novel treatments to tackle this problem.
Survival improvement in Child-Pugh C cirrhotic patients with hepatocellular carcinoma diagnosed during 1990-2002
2010, Gastroenterologie Clinique et Biologique
The aim of this study was to describe the evolution of diagnostic modalities, treatment and survival in cases of hepatocellular carcinoma (HCC) between 1990 and 2002 in Calvados.
All cases registered as HCC in the Calvados Tumour Registry from 1990 to 2002 were retrospectively reviewed. Incidence rates were standardized in comparison to the world reference population. The Kaplan–Meier method was used for survival analysis, and the log-rank test and Cox's model were used to compare patient survival according to demographic and tumour characteristics, as well as diagnosis period. Multivariate analysis were performed to determine independent prognostic factors and to assess the impact of the diagnosis period on survival.
From 1990 to 2002, 729 cases registered as HCC were retrospectively validated. Standard incidence rates were 11.1/100,000 in men and 1.9/100,000 in women. Mean age was 66.6 ± 11.8 years. Cirrhosis was present in 90.4% of cases. The cause of cirrhosis was alcohol in 66.8% of cases, HCV in 12.5%, HBV in 2.9%, haemochromatosis in 3.5%, and “other” in 13.1%. Curative treatment was possible in 14.7% of cases. Median survival was 7.15 months. On multivariate analysis, male gender, age greater than 70 years, Child–Pugh C (advanced-stage) cirrhosis, portal or suprahepatic venous thrombosis, alpha-fetoprotein (AFP) level greater than 200 ng/mL and non-curative treatment were poor prognostic factors. However, the diagnosis period was a good prognostic factor, associated with survival improvement over time in Child–Pugh C patients independent of tumour size, but not in Child–Pugh A and B.
From 1990 to 2002, improvement in the survival of Child–Pugh C cirrhosis patients with HCC was observed that was apparently essentially attributable to better management of cirrhosis, and an improved balance between treatment and the degree of portal hypertension and hepatocellular insufficiency.
Le but de cette étude rétrospective était de décrire l’évolution des modes de diagnostic, de la prise en charge thérapeutique et de la survie des patients ayant un carcinome hépatocellulaire (CHC) diagnostiqué dans le département du Calvados entre 1990 et 2002.
La population de l’étude était constituée des patients atteints d’un CHC et recensés, au registre des tumeurs digestives du Calvados de janvier 1990 à décembre 2002. Les taux d’incidence ont été standardisés selon la population mondiale de référence. L’analyse de la survie a été réalisée par la méthode de Kaplan-Meier et le modèle de Cox pour l’analyse multivariée.
Un total de 729 cas de CHC ont été validés sur la période. Les taux d’incidence standardisés selon la population mondiale étaient de 11,1/100 000 habitants chez l’homme et de 1,9/100 000 habitants chez la femme. L’âge moyen au diagnostic était de 66,6 ± 11,8 ans. Une cirrhose était associée dans 90,4 % des cas. La cirrhose était pour 77,2 % alcoolique ; 13 % virale C ; 3,4 % virale B ; 3,5 % une hémochromatose ; et pour 13,1 % d’origine indéterminée. Seuls 14,7 % des patients ont pu bénéficier d’un traitement curatif. La médiane de survie était de 7,15 mois. En analyse multivariée, les variables pronostiques péjoratives étaient le sexe masculin, l’âge supérieur à 70 ans, le score de Child élevé, le stade tumoral avancé, l’existence d’une thrombose portale ou sus-hépatique, un taux d’alphafœtoprotéine supérieur à 200 ng/mL et un traitement non curatif. Une période de diagnostic récent était un facteur pronostique favorable, avec une amélioration de la survie au cours du temps chez les patients Child-Pugh C, quelle que soit la taille tumorale mais pas chez les Child-Pugh A et B.
La survie des patients cirrhotiques Child-Pugh C atteints de CHC semble s’améliorer entre 1990 et 2002, probablement en raison d’une meilleure prise en charge de la cirrhose et d’un traitement mieux adapté au degré d’insuffisance hépatocellulaire et d’hypertension portale.
Prognosis of advanced hepatocellular carcinoma: Comparison of three staging systems in two French clinical trials
2008, Annals of Oncology
Citation Excerpt :
In particular, a high standard of follow-up was applied, resulting in a minimal rate of lost to follow-up, a large number of events and an adequate overall statistical power as compared with previous publications. The population of our study is limited to patients with advanced HCC, representing between 60% and 75% of all patients treated in France [25]. They formed a rather homogenous sample not representative of the whole HCC population, limiting conclusions to the palliative setting.
The objective of this study was to assess the performance of three staging systems [Okuda, Cancer of the Liver Italian Program (CLIP) and Barcelona Clinic Liver Cancer group (BCLC)], for predicting survival in patients with hepatocellular carcinoma (HCC) and to explore how to improve prognostic classification among French patients with HCC whose main etiology is alcoholic cirrhosis.
We have pooled two randomized clinical trials in palliative condition from the Fédération Francophone de Cancerologie Digestive. They had included 416 and 122 patients. Performances of Okuda, CLIP and BCLC scores have been compared using Akaike information criterion, discriminatory ability (Harrell's C and the Royston's D statistics), monotonicity of gradients and predictive accuracy (Schemper statistics Vs). To explore how to improve classifications, univariate and multivariate Cox model analyses were carried out.
The pooled database included 538 patients. The median survival was 5.3 months (95% confidence interval 4.6–6.2). For all statistics CLIP staging system had a better prognostic ability. Performances of all staging systems were rather disappointing. World Health Organization performance status (WHO PS) for CLIP or α-fetoprotein for BCLC allowed a significant improvement of prognostic information.
Our results indicate that CLIP staging seems to be most adapted to palliative setting and that it could be better by associating WHO PS.

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Original articleEpidemiology of hepatocellular carcinoma in Finistère Prospective study from June 2002 to May 2003Épidémiologie du carcinome hépatocellulaire dans le département du Finistère. Étude prospective de juin 2002 à mai 2003

Summary

Objectives

Methods

Results

Conclusion

Résumé

Objectifs

Méthodes

Résultats

Conclusions

J Hepatol

J Hepatol

J Hepatol

J Hepatol

Lancet

Hepatology

Hepatology

Hepatology

J Hepatol

J Hepatol

Gastroenterology

Cancer incidence and mortality in France over the period 1978-2000

Rev Epidemiol Sante Publique

Augmentation de l’incidence du carcinome hépatocellulaire dans les pays occidentaux. Quelles raisons et quelles conséquences?

Gastroenterol Clin Biol

Original article
Epidemiology of hepatocellular carcinoma in Finistère Prospective study from June 2002 to May 2003Épidémiologie du carcinome hépatocellulaire dans le département du Finistère. Étude prospective de juin 2002 à mai 2003