Survival of hepatocellular carcinoma in Puerto Rico.
BACKGROUND
Blacks and Hispanics in the United States (US) have the lowest survival rates of hepatocellular carcinoma (HCC), mainly associated to the presence of advanced disease at diagnosis when intervention is least beneficial. This study compared the survival distribution and relative survival of HCC in Puerto Rico (PR) during 1988-1992 and 1998-2002.


METHODS
All HCC cases in the PR Central Cancer Registry database for 1988-1992 (n = 306) and 1998-2002 (n = 333) were identified. Patient characteristics and clinical variables were compared between study periods. Survival by age at diagnosis, sex, tumor stage and treatment was estimated using the Kaplan-Meier method, and survival curves were compared using the Wilcoxon test. A Cox proportional hazards model was employed to assess the effect of period of diagnosis on survival, after adjusting for confounders. One- and three-year survival rates were also calculated.


RESULTS
Patients diagnosed during 1998-2002 (median: 3.08 months, 95% CI: 2.30-4.16) had a longer observed survival than those diagnosed from 1988-1992 (median: 1.80 months, 95% CI: 1.44-2.52). A significant interaction was observed between the variables age and period of diagnosis, where only among persons aged > or = 60 years the risk of HCC death was lower (sex-adjusted HR = 0.72; 95% CI: 0.59-0.88) in patients diagnosed during 1998-2002 as compared to those diagnosed during 1988-1992. The overall one- and three-year relative survival during 1998-2002 was approximately 6% (22.4% vs. 16.6%) and 2% higher (9.0% vs. 6.7%) respectively, as compared to 1988-1992.


CONCLUSIONS
We observed a temporal improvement in the survival of HCC in PR during the last decade. However, this survival is inferior to the one observed in the US population. Further studies are needed to identify factors that explain these disparities.
Romero Marrero
Carlos
C
Department of Medicine, Division of Gastroenterology, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067. cromero@rcm.upr.edu
Ortiz
Ana P
AP
Pérez
Cynthia M
CM
Pérez
Javier
J
Torres
Esther A
EA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011647:Puerto Rico / Q000453:epidemiology; D012042:Registries; D012306:Risk; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D000970:Antineoplastic Agents