Incidence, Outcomes of HCC in Louisiana Continue to Lag Behind Nation

Rates of hepatocellular carcinoma (HCC) are rising in Louisiana at a rate much faster than the national average, according to a new report.

The authors of the study described the data as “unsettling,” and called for new strategies to help lower incidence rates and improve survival rates in the state. The study was published in Dialogues in Health.

Corresponding author John M. Lyons III, MD, of the Louisiana State University Health Sciences Center-New Orleans, and colleagues, said the incidence of HCC in the United States has tripled in the past 40 years, and the cancer type is the third most common cause of cancer mortality globally. Still, evidence suggests HCC incidence is growing even faster in Louisiana, and Lyons and colleagues said relatively little has been written about the problem. In an effort to raise awareness and spark new strategies to reverse the trend, the investigators pulled 10 years of data (2005-2015) from the Surveillance Epidemiology and End Results (SEER) database and the Louisiana Tumor Registry. They then calculated incidence and 12-month relative survival data to compare trends nationally and in Louisiana.

They found an average annual percentage change in age-adjusted HCC of 6% in Louisiana (95% CI, 4.7-7.3) over the study period, nearly double the national rate of 3.1% (95% CI, 2.4-3.7).

“When we looked at the incidence trend in Louisiana compared to the US, we noted that the US trend started to diminish between 2009 and 2015,” Lyons and colleagues said. “By comparison, there was no corresponding diminishment of the incidence rate in Louisiana.”

In terms of 12-month survival, the national rate was 48.2% in the study period (95% CI, 47.8-48.6) compared to 40.7% in Louisiana (95% CI, 38.9-42.4). Older age at diagnosis, advanced disease stage, and lack of surgery were all factors associated with Louisiana’s worse survival rates, the authors said. They noted that liver-directed surgery is under-utilized nationally, but the problem is even worse in Louisiana.

“Despite 29% of cases having documented stage I or II disease, only 23.1% of cases underwent surgical treatment for their HCC,” they noted.

Lyons and colleagues did find, however, that relative survival improved at similar rates in both the country and Louisiana.

The investigators said the state’s higher HCC rates appear to be based largely on higher rates of risk factors for HCC among Louisiana's population. For instance, the state ranks in the top 10 nationally in terms of hepatitis B and C rates, and it is in the top 5 states in terms of obesity. The state also has the second-highest poverty rate in the nation, a factor that could contribute to the state’s lower 12-month survival rate.

Lyons and colleagues said the state has made efforts to improve public health, such as its Hepatitis C Virus Elimination Program, which is designed to increase access to antiviral treatment.

Still, while survival outcomes appear to be improving, the authors said the state’s overall survival rate and persistent disparities in outcomes remain causes for serious concern.

“Further work will focus on identifying risk factors for treatment underutilization, working to streamline patient care throughout the state to higher volume specialty centers,” they concluded.

Reference

Lyons J, Danos D, Maniscalco L, et al. Trends in hepatocellular carcinoma in Louisiana, 2005–2015. Dialogues in Health. 2022;1:100041. doi:10.1016/j.dialog.2022.100041