Epidemiology

Liver cancer fastest growing malignancy in US: Liver Cancer Network

Last Updated: 2004-11-01 15:41:11 -0400 (Reuters Health)

By Martha Kerr

BOSTON (Reuters Health) - A preliminary report from the Liver Cancer Network shows that hepatocellular carcinoma (HCC) is the fastest growing cancer in the US and hepatitis C infection is involved in more than half of cases, investigators told attendees here Monday at the 55th annual meeting of the American Association for the Study of Liver Diseases.

In presenting the early data, lead investigator Dr. Alex S. Befeler of St. Louis University, Missouri, noted that the Network was established because of a dearth of information about the epidemiology of liver cancer and also to better analyze the numerous and often competing HCC staging systems.

The Network has currently enrolled approximately 250 patients to date from 6 centers. Serum has been collected and demographics, risk factors for HCC, liver disease, tumor characteristics and treatment protocols recorded.

The mean HCC patient age was 59 years old, 75% are male, 80% Caucasian, 10% African American, 4% Hispanic and 4% East Asian. The mean follow-up was approximately 6 months.

Most HCC patients (87%) had underlying liver disease and more than half (52%) of those enrolled had hepatitis C infection. A history of alcohol abuse was involved in 20% of those cases, with a history of alcohol abuse present in 12% of the group overall. Eleven percent had hepatitis B infection and 2% had hemochromatosis.

Dr. Befeler reported that 42% were asymptomatic on presentation. Among the treatments given were radiofrequency ablation (13%), surgical resection (12%), transplantation (9%), experimental protocols (4%) and systemic chemotherapy (6%). Forty percent received no treatment.

"HCC in the US is almost always associated with chronic liver disease," the Network data show. Survival is "significantly better for those who were asymptomatic at presentation or who were candidates for liver transplantation," Dr. Befeler said. He added that a major problem has been that "oncologists and tumor registries have poor staging systems," which is further confounded by frequent competition and conflict between the systems.

"The UNOS organ allocation system is best," Dr. Befeler told Reuters Health. The Tumor Node Metastasis (TMN) system, which classifies patients according to tumor size, "doesn't work very well," he noted, nor does the Barcelona Clinic Staging System or Japan's Okuda system -- the original staging system for HCC.

The bottom line, and the primary reason for the Liver Cancer Network, is that "chemotherapy is generally ineffective for liver cancer. Liver transplantation is the best approach...Most patients also have advanced cirrhosis, so drug metabolism is poor," Dr. Befeler added.