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Epidemiology of Metastatic Hepatocellular Carcinoma, A Nationwide Perspective

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Abstract

Background

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver.

Aims

The aim of this study was to describe the prevalence, trends, and predictors of metastatic HCC on a national scale.

Methods

We used two nationwide datasets for our study: the University Health Consortium (UHC) and the Nationwide Inpatient Sample (NIS) databases. We included adults with a primary diagnosis of HCC from 2000 to 2011. We collected information regarding demographics, insurance, HCC risk factors, liver decompensation, and the sites and frequencies of metastases. Multivariable regression analysis was used to examine predictors of metastatic HCC. Trend analysis was performed to examine the change in metastatic HCC prevalence over time.

Results

We included 25,671 and 26,054 HCC patients from UHC and NIS, respectively. Prevalence of metastatic HCC was 18 % with lung being the most frequent site (31 %). Compared with Caucasian, African American ethnicity was an independent predictor of metastasis in both the NIS [OR 1.13 (1.02–1.25)] and UHC [OR 1.4 (1.3–1.6)] databases. Lack of long-term insurance was associated with significantly higher prevalence of metastasis in both the NIS [OR 1.6 (1.4–1.9)] and UHC [OR 1.9 (1.6–2.2)] databases. There has been an increased prevalence of metastatic HCC over the last decade with an annual percentage change of +1.25 and +1.60 % (p = 0.03 and p = 0.08) for the NIS and UHC databases, respectively.

Conclusions

Metastasis is not rare among HCC patients and is rising in prevalence over the last decade. Lungs were the most common metastatic site. Ethnicity and insurance status are independent predictors of metastasis.

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References

  1. Nordenstedt H, White DL, El-Serag HB. The changing pattern of epidemiology in hepatocellular carcinoma. Dig Liver Dis. 2010;42:S206–S214.

    Article  PubMed  PubMed Central  Google Scholar 

  2. El-Serag HB. Epidemiology of hepatocellular carcinoma in USA. Hepatol Res. 2007;37:S88–S94.

    Article  PubMed  Google Scholar 

  3. El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011;365:1118–1127.

    Article  PubMed  CAS  Google Scholar 

  4. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142:1264–1273; e1261.

  5. Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology. 2002;35:519–524.

    Article  PubMed  Google Scholar 

  6. Tang ZY. Hepatocellular carcinoma–cause, treatment and metastasis. World J Gastroenterol. 2001;7:445–454.

    PubMed  CAS  Google Scholar 

  7. Shuto T, Hirohashi K, Kubo S, et al. Treatment of adrenal metastases after hepatic resection of a hepatocellular carcinoma. Dig Surg. 2001;18:294–297.

    Article  PubMed  CAS  Google Scholar 

  8. Fukutomi M, Yokota M, Chuman H, et al. Increased incidence of bone metastases in hepatocellular carcinoma. Eur J Gastroenterol Hepatol. 2001;13:1083–1088.

    Article  PubMed  CAS  Google Scholar 

  9. Seinfeld J, Wagner AS, Kleinschmidt-DeMasters BK. Brain metastases from hepatocellular carcinoma in US patients. J Neurooncol. 2006;76:93–98.

    Article  PubMed  Google Scholar 

  10. Natsuizaka M, Omura T, Akaike T, et al. Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol. 2005;20:1781–1787.

    Article  PubMed  Google Scholar 

  11. Duggal R, Garg M, Kalra N, Srinivasan R, Chawla Y. Spleen metastasis from hepatocellular carcinoma: report of a case with diagnosis by fine needle aspiration cytology. Acta Cytol. 2010;54:783–786.

    PubMed  Google Scholar 

  12. Longo R, Mocini D, Santini M, et al. Unusual sites of metastatic malignancy: case 1. Cardiac metastasis in hepatocellular carcinoma. J Clin Oncol. 2004;22:5012–5014.

    Article  PubMed  Google Scholar 

  13. Kolarević D, Tomasević Z, Boricić I, et al. Metastasis of hepatocellular carcinoma presented as a tumor of the maxillary sinus and retrobulbar tumor. Vojnosanit Pregl. 2011;68:359–362.

    Article  PubMed  Google Scholar 

  14. Lin CP, Cheng JS, Lai KH, et al. Gastrointestinal metastasis in hepatocellular carcinoma: radiological and endoscopic studies of 11 cases. J Gastroenterol Hepatol. 2000;15:536–541.

    Article  PubMed  CAS  Google Scholar 

  15. Liang HH, Wu CH, Tam KW, Chai CY, Lin SE, Chen SC. Thyroid metastasis in a patient with hepatocellular carcinoma: case report and review of literature. World J Surg Oncol. 2007;5:144.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kim HS, Shin JW, Kim GY, et al. Metastasis of hepatocellular carcinoma to the small bowel manifested by intussusception. World J Gastroenterol. 2006;12:1969–1971.

    PubMed  PubMed Central  Google Scholar 

  17. Kunizaki M, Hidaka S, Isomoto H, et al. Diagnosis of small-bowel metastasis of hepatocellular carcinoma by double-balloon enteroscopy. Int J Surg Case Rep. 2012;3:263–265.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lee YT, Geer DA. Primary liver cancer: pattern of metastasis. J Surg Oncol. 1987;36:26–31.

    Article  PubMed  CAS  Google Scholar 

  19. Katyal S, Oliver JH, Peterson MS, Ferris JV, Carr BS, Baron RL. Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000;216:698–703.

    Article  PubMed  CAS  Google Scholar 

  20. Yoo SJ, Cheon JH, Lee SW, et al. Extrahepatic metastasis of hepatocellular carcinoma to the nasal cavity manifested as massive epistaxis: a case report. Korean J Hepatol. 2004;10:228–232.

    PubMed  Google Scholar 

  21. University Health Consortium. http://www.uhc.edu. Accessed 9/5/2014.

  22. (HCUP) HCaUP. National Inpatient Sample. http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 9/4/2014.

  23. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.

    Article  PubMed  CAS  Google Scholar 

  24. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619.

    Article  PubMed  CAS  Google Scholar 

  25. Shavers VL, Harlan LC, Stevens JL. Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer. 2003;97:134–147.

    Article  PubMed  Google Scholar 

  26. Simons JP, Ng SC, Hill JS, Shah SA, Zhou Z, Tseng JF. In-hospital mortality from liver resection for hepatocellular carcinoma: a simple risk score. Cancer. 2010;116:1733–1738.

    Article  PubMed  Google Scholar 

  27. Institute NC. Joinpoint Regression Program. 2011; http://surveillance.cancer.gov/joinpoint/. Accessed 2/10/2012.

  28. Clegg LX, Hankey BF, Tiwari R, Feuer EJ, Edwards BK. Estimating average annual per cent change in trend analysis. Stat Med. 2009;28:3670–3682.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sloane D, Chen H, Howell C. Racial disparity in primary hepatocellular carcinoma: tumor stage at presentation, surgical treatment and survival. J Natl Med Assoc. 2006;98:1934–1939.

    PubMed  PubMed Central  Google Scholar 

  30. Davila JA, El-Serag HB. Racial differences in survival of hepatocellular carcinoma in the United States: a population-based study. Clin Gastroenterol Hepatol. 2006;4:104–110; quiz 104–105.

  31. Smith-Bindman R, Miglioretti DL, Johnson E, et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996–2010. JAMA. 2012;307:2400–2409.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Ali Abbas contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and statistical analysis. Sabeen Medvedev contributed to acquisition of data, drafting of the manuscript; critical revision of the manuscript. Nathan Shores contributed to interpretation of data; critical revision of the manuscript. Lydia Bazzano contributed to study design critical revision of the manuscript and the analysis. Ahmed Dehal contributed to acquisition of data, drafting of the manuscript; critical revision of the manuscript. Jay Hutchings contributed to acquisition of data, critical revision of the manuscript, and study supervision. Luis Balart contributed to critical revision of the manuscript for important intellectual content, study supervision.

Conflict of interest

All authors have no potential conflicts (financial, professional, or personal) that are relevant to this manuscript. The study was conducted, and the manuscript was written and reviewed solely by the authors.

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Correspondence to Ali Abbas.

Appendix

Appendix

See Tables 3, 4 and Fig. 4.

Table 3 Site-specific metastasis
Table 4 Trend of liver cirrhosis, decompensation, and metastatic HCC over the last decade
Fig. 4
figure 4

Most frequent sites of metastasis in HCC

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Abbas, A., Medvedev, S., Shores, N. et al. Epidemiology of Metastatic Hepatocellular Carcinoma, A Nationwide Perspective. Dig Dis Sci 59, 2813–2820 (2014). https://doi.org/10.1007/s10620-014-3229-9

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  • DOI: https://doi.org/10.1007/s10620-014-3229-9

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