title: Trends in early-stage hepatocellular carcinoma, California 1988-2010.
abstract: OBJECTIVE
  California Cancer Registry data were used to explore the impact of hepatocellular carcinoma (HCC) surveillance on patient outcomes. The purpose of this analysis was to determine the trend in diagnosis of early-stage HCC in California from 1988 to 2010.
  
  
  METHODS
  Patients 20+ years old, diagnosed with early HCC during 1988-2010 in California, were included. Stratified proportions of early HCC were evaluated to estimate any trends and significant disparities. The primary endpoint was the average annual percent change (AAPC) of the proportion of early-stage HCC; 2- and 5-year survival trends were calculated for age, sex, race, SES, and stage.
  
  
  RESULTS
  A total of 13,855 patients were diagnosed with early HCC. The proportion of patients diagnosed early increased from 19.2 to 49.2 % between 1988 and 2010, at an AAPC of 4.3 %. The proportion of cases diagnosed with early HCC increased in all demographic groups. Both the 2- and 5-year cause-specific survival analyses showed that survival among HCC patients has been increasing since 1988.
  
  
  CONCLUSIONS
  The proportion of HCC cases diagnosed early, and the 2- and 5-year survival trends of all HCC patients have increased in California since 1988. It is not entirely clear whether better diagnostic imaging or better surveillance has led to these findings and whether earlier diagnosis has led to improved patient survival. This increase in survival among patients with HCC may be correlated with the innovation of new treatments and most importantly that patients are being diagnosed earlier to receive such treatments.
authors.affiliation: Public Health Institute, Cancer Registry of Greater California, Sacramento, USA. drodriguez@crgc-cancer.org.
authors.forename: Danielle N
authors.initials: DN
authors.lastname: Rodriguez
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Cara
authors.initials: C
authors.lastname: Torruellas
authors.affiliation: Public Health Institute, Cancer Registry of Greater California, Sacramento, USA.|Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA, USA.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Cress
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D055815:Young Adult
keywords: Average annual percent change (AAPC); Early HCC; Hepatocellular carcinoma; Liver cancer; Survival analysis