title: Birth cohort-specific disparities in hepatocellular carcinoma stage at diagnosis, treatment, and long-term survival.
abstract: OBJECTIVE
  Individuals born between 1945 and 1965 account for nearly 75% of hepatitis C virus (HCV) infections in the United States. As this cohort ages, progressive HCV-related liver disease leading to cirrhosis and hepatocellular carcinoma (HCC) will place a significant burden on the healthcare system. We aim to evaluate birth cohort-specific disparities in HCC stage at diagnosis, treatment rates, and overall survival with a focus on the 1945-1965 birth cohort.
  
  
  METHODS
  A population-based retrospective cohort study of adult patients with HCC identified in the Surveillance, Epidemiology, and End Results 2003-2011 registry evaluated birth cohort-specific disparities in the prevalence and outcomes of HCC, including multivariate logistic regression models to evaluate disparities in HCC stage at diagnosis and HCC treatment received. Birth cohort-specific survival was evaluated with Kaplan-Meier methods and multivariate Cox proportional hazard models.
  
  
  RESULTS
  The proportion of HCC represented by the 1945-1965 cohort increased by 64% from 2003-2011, and accounted for 57.4% of all HCC in 2011. Compared to patients born after 1965, the 1945-1965 cohort were more likely to have HCC within Milan criteria (OR, 3.66; 95% CI, 3.13-4.28; p<0.001). However, among patients with HCC within Milan criteria, the 1945-1965 cohort had no difference in receipt of surgical treatment, but had higher overall long-term survival (HR, 0.82; 95% CI, 0.69-0.97; p<0.03).
  
  
  CONCLUSIONS
  The 1945-1965 birth cohort accounts for the majority of HCC in the United States. Despite earlier HCC stage at diagnosis, no difference in receipt of surgical treatment was observed, but higher overall survival was achieved.
authors.affiliation: Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States.
authors.forename: Melissa
authors.initials: M
authors.lastname: Yan
authors.affiliation: Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States.
authors.forename: John
authors.initials: J
authors.lastname: Ha
authors.affiliation: Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Aguilar
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States.
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States.
authors.forename: Benny
authors.initials: B
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gish
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.
authors.forename: Ramsey
authors.initials: R
authors.lastname: Cheung
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States. Electronic address: rowong@alamedahealthsystem.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D054624:Health Status Disparities; D006498:Hepatectomy / Q000706:statistics & numerical data*; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Hepatitis C virus; Liver cancer; SEER