Trends in survival of patients with hepatocellular carcinoma between 1977 and 1996 in the United States

The recent increase in the incidence of hepatocellular cancer in the United States is thought to underlie the rising mortality of this malignancy. How ever, it remains unknown whether survival of patients with hepatocellular c arcinoma (HCC) has changed during the same time period. Using the SEER data base (Surveillance, Epidemiology, and End Results) of the National Cancer I nstitute, we examined the temporal changes and determinants of survival amo ng patients with histologically proven HCC over a 20-year period. Between 1 977 and 1996, 7,389 patients diagnosed with HCC were followed in the surviv al database of SEER, The overall 1-year relative survival rate increased fr om 14% (95% confidence intervals (CI): 12-16) during 1977-1981 to 23% (95% CI: 21-24) during 1992 to 1996. Between the same two time periods, less imp rovement was seen in the S-year survival rates, which increased from 2% (95 % CI: 1-3) to only 5% (95% CI: 4-7), The median survival increased slightly from 0.57 years during 1977 to 1981 to 0.64 years during 1992 to 1996, In general, there were no significant differences in survival between men and women or between ethnic groups. During 1987 to 1991, a small fraction (0.8% ) of patients underwent radical surgery; these patients had 1-year survival of 59% (95% CI: 35-83%), and 5-year survival of 35% (95% CI: 12-58%). Simi lar rates were seen during 1992-1996. In conclusion, a small improvement in survival of patients with HCC was seen between 1977 and 1996. Most of this apparent benefit is restricted to the first year following cancer diagnosi s, raising the possibility of lead-time bias. There were no significant dif ferences related to gender or ethnicity.