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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Research Article

The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States

Parag Mahale, Meredith S. Shiels, Charles F. Lynch, Srinath Chinnakotla, Linda L Wong, Brenda Y. Hernandez, Karen S. Pawlish, Jie Li, Georgetta Alverson, Maria J Schymura and Eric A. Engels
Parag Mahale
1Division of Cancer Epidemiology and Genetics, National Cancer Institute
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  • For correspondence: parag.mahale@nih.gov
Meredith S. Shiels
1Division of Cancer Epidemiology and Genetics, National Cancer Institute
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  • ORCID record for Meredith S. Shiels
Charles F. Lynch
2Department of Epidemiology, University of Iowa
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Srinath Chinnakotla
3University of Minnesota
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Linda L Wong
4Cancer Center, University of Hawaii at Manoa
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Brenda Y. Hernandez
5Department of Epidemiology, University of Hawaii Cancer Center
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Karen S. Pawlish
6Cancer Epidemiology Services, New Jersey Department of Health & Senior Services
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Jie Li
6Cancer Epidemiology Services, New Jersey Department of Health & Senior Services
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Georgetta Alverson
7Division for Vital Records and Health Statistics Birth/Cancer Sureveillance Section, Michigan Department of Health and Human Services
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  • ORCID record for Georgetta Alverson
Maria J Schymura
8New York State Department of Health
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Eric A. Engels
1Division of Cancer Epidemiology and Genetics, National Cancer Institute
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DOI: 10.1158/1055-9965.EPI-20-1188
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Abstract

Background: Hepatocellular carcinoma (HCC) carries a poor prognosis. Liver transplantation (LT) is potentially curative for localized HCC. We evaluated the impact of LT on US general population HCC-specific mortality rates. Methods: The Transplant Cancer Match Study links the US transplant registry with 17 cancer registries. We calculated age-standardized incidence (1987-2017) and incidence-based mortality (IBM) rates (1991-2017) for adult HCCs. We partitioned population-level IBM rates by cancer stage and calculated counterfactual IBM rates assuming transplanted cases had not received a transplant. Results: Among 129,487 HCC cases, 45.9% had localized cancer. HCC incidence increased on average 4.0% annually (95%CI=3.6%-4.5%). IBM also increased for HCC overall (2.9% annually; 95%CI=1.7%-4.2%) and specifically for localized stage HCC (4.8% annually; 95%CI=4.0%-5.5%). The proportion of HCC-related transplants jumped sharply from 6.7% (2001) to 18.0% (2002), and further increased to 40.0% (2017). HCC-specific mortality declined among both non-transplanted and transplanted cases over time. In the absence of transplants, IBM for localized HCC would have increased at 5.3% instead of 4.8% annually. Conclusions: LT has provided survival benefit to patients with localized HCC. However, diagnosis of many cases at advanced stages, limited availability of donor livers, and improved mortality for non-transplanted patients have limited the impact of transplantation on general population HCC-specific mortality rates. Impact: Though LT rates continue to rise, better screening and treatment modalities are needed to halt the rising HCC mortality rates in the US.

  • Received August 9, 2020.
  • Revision received October 12, 2020.
  • Accepted November 11, 2020.
  • Copyright ©2020, American Association for Cancer Research.

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This OnlineFirst version was published on November 16, 2020
doi: 10.1158/1055-9965.EPI-20-1188

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The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States
Parag Mahale, Meredith S. Shiels, Charles F. Lynch, Srinath Chinnakotla, Linda L Wong, Brenda Y. Hernandez, Karen S. Pawlish, Jie Li, Georgetta Alverson, Maria J Schymura and Eric A. Engels
Cancer Epidemiol Biomarkers Prev November 16 2020 DOI: 10.1158/1055-9965.EPI-20-1188

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The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States
Parag Mahale, Meredith S. Shiels, Charles F. Lynch, Srinath Chinnakotla, Linda L Wong, Brenda Y. Hernandez, Karen S. Pawlish, Jie Li, Georgetta Alverson, Maria J Schymura and Eric A. Engels
Cancer Epidemiol Biomarkers Prev November 16 2020 DOI: 10.1158/1055-9965.EPI-20-1188
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