Ten-Year Trends in Hepatocellular Carcinoma Mortality: Examining the Interaction Between Fibrosis Score and Patient Age
Abstract
1. Introduction
2. Methods
2.1. Study Design
2.2. Cohort Selection
2.2.1. Inclusion Criteria
2.2.2. Exclusion Criteria
2.3. Variables of Interest
2.3.1. Primary Exposures
2.3.2. Outcome Measures
2.3.3. Survival Time
2.3.4. Demographic and Clinical Characteristics
2.3.5. Treatment Details and Limitations
2.4. Statistical Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | ||
---|---|---|
Total | N | % |
15,796 | 100 | |
Gender | ||
Female | 3597 | 22.77 |
Male | 12,199 | 77.23 |
Age at Diagnosis, years | ||
00–39 | 193 | 1.22 |
40–59 | 5355 | 33.90 |
60–79 | 9417 | 59.62 |
80+ | 831 | 5.26 |
Marital Status | ||
Married | 7947 | 50.31 |
Single | 4222 | 26.73 |
Divorced/separated | 2425 | 15.35 |
Widowed | 1202 | 7.61 |
Tumor Stage | ||
Localized | 9638 | 61.02 |
Regional | 4572 | 28.94 |
Distant | 1586 | 10.04 |
Race | ||
Non-Hispanic white | 7548 | 47.78 |
Non-Hispanic black | 1736 | 10.99 |
Hispanic | 3682 | 23.31 |
Other | 2830 | 17.92 |
Living Area | ||
Counties in metropolitan areas of 1 million persons | 9944 | 62.95 |
Counties in metropolitan areas of 250,000 to 1 million persons | 3488 | 22.08 |
Counties in metropolitan areas of 250,000 persons | 1053 | 6.67 |
Nonmetropolitan counties adjacent to a metropolitan area | 784 | 4.96 |
Nonmetropolitan counties not adjacent to a metropolitan area | 527 | 3.34 |
Income Per Year | ||
<$40,000 | 139 | 0.88 |
$40,000–59,999 | 2151 | 13.62 |
$60,000–79,999 | 5648 | 35.76 |
$80,000–99,999 | 4822 | 30.53 |
$100,000+ | 3036 | 19.22 |
Fibrosis Score | ||
Mild/moderate fibrosis | 2844 | 18.26 |
Cirrhosis | 12,912 | 81.74 |
Radiation | ||
No | 13,834 | 87.58 |
Yes | 1962 | 12.42 |
Chemotherapy | ||
No | 8807 | 55.75 |
Yes | 6989 | 44.25 |
Surgery | ||
No | 878 | 5.56 |
Yes | 14,918 | 94.44 |
Year of Diagnosis | ||
2010 | 1235 | 7.82 |
2011 | 1395 | 8.83 |
2012 | 1500 | 9.50 |
2013 | 1463 | 9.26 |
2014 | 1551 | 9.82 |
2015 | 1655 | 10.48 |
2016 | 1535 | 9.72 |
2017 | 1394 | 8.83 |
2018 | 1197 | 7.58 |
2019 | 1205 | 7.63 |
2020 | 831 | 5.26 |
2021 | 835 | 5.29 |
Characteristics | Overall Mortality. Crude Proportional Hazard Ratio (95% Confidence Interval) | Cancer-Related Mortality. Crude Proportional Hazard Ratio (95% Confidence Interval) |
---|---|---|
Gender | ||
Female | 1(reference) | 1(reference) |
Male | 1.19(1.13–1.25) ** | 1.20(1.12–1.27) ** |
Age at diagnosis, years | ||
00–39 | 1(reference) | 1(reference) |
40–59 | 1.77(1.41–2.24) ** | 1.71(1.33–2.21) ** |
60–79 | 1.86(1.48–2.34) ** | 1.79(1.39–2.31) ** |
80+ | 3.08(2.41–3.93) ** | 2.78(2.12–3.64) ** |
Marital status | ||
Married | 1(reference) | 1(reference) |
Single | 1.25(1.19–1.32) ** | |
Divorced/separated | 1.31(1.23–1.39) ** | |
Widowed | 1.34(1.23–1.45) ** | |
Tumor stage | ||
Localized | 1(reference) | 1(reference) |
Regional | 2.22(2.12–2.32) ** | 2.53(2.41–2.66) ** |
Distant | 4.92(4.61–5.26) ** | 5.74(5.34–6.17) ** |
Race | ||
Non-Hispanic white | 1(reference) | 1(reference) |
Non-Hispanic black | 1.07(1.01–1.14) * | 1.05(0.98–1.13) |
Hispanic | 0.99(0.94–1.04) | 0.99(0.93–1.04) |
Other | 0.78(0.74–0.83) ** | 0.77(0.72–0.82) ** |
Living area | ||
Counties in metropolitan areas of 1 million persons | 1(reference) | 1(reference) |
Counties in metropolitan areas of 250,000 to 1 million persons | 1.12(1.06–1.17) ** | 1.15(1.08–1.21) ** |
Counties in metropolitan areas of 250,000 persons | 1.20(1.03–1.21) ** | 1.17(1.07–1.28) ** |
Nonmetropolitan counties adjacent to a metropolitan area | 1.21(1.11–1.33) ** | 1.27(1.15- 1.40) ** |
Nonmetropolitan counties not adjacent to a metropolitan area | 1.08(0.96–1.21) | 1.12(0.99–1.27) |
Income per year | ||
<$40,000 | 1(reference) | 1(reference) |
$40,000–59,999 | 0.99(0.80–1.23) | 1.03(0.81–1.30) |
$60,000–79,999 | 1.12(1.03–1.21) ** | 0.89(0.70–1.12) |
$80,000–99,999 | 1.21(1.11–1.33) ** | 0.83(0.66–1.06) |
$100,000+ | 0.70(0.57–0.87) ** | 0.70(0.55–0.88) ** |
Fibrosis score | ||
Mild/moderate fibrosis | 1(reference) | 1(reference) |
Cirrhosis | 1.28(1.21–1.35) ** | 1.28(1.20–1.36) ** |
Radiation | ||
No | 1(reference) | 1(reference) |
Yes | 1.26(1.18–1.33) ** | 1.33(1.24–1.41) ** |
Chemotherapy | ||
No | 1(reference) | 1(reference) |
Yes | 1.06(1.02–1.10) ** | 1.11(1.06–1.16) ** |
Surgery | ||
No | 1(reference) | 1(reference) |
Yes | 0.48(0.44–0.52) ** | 0.47(0.43–0.51) ** |
Characteristics | Overall Mortality. Adjusted Proportional Hazard Ratio (95% Confidence Interval) | Cancer-Related Mortality. Adjusted Proportional Hazard Ratio (95% Confidence Interval) |
---|---|---|
Gender | ||
Female | 1(reference) | 1(reference) |
Male | 1.18(1.12–1.25) ** | 1.17(1.11–1.24) ** |
Age at diagnosis, years | ||
00–39 | 1(reference) | 1(reference) |
40–59 | 1.68(1.33–2.12) ** | 1.62(1.25–2.09) ** |
60–79 | 1.85(1.47–2.34) ** | 1.79(1.38–2.31) ** |
80+ | 3.25(2.54–4.16) ** | 2.95(2.25–3.88) ** |
Marital status | ||
Married | 1(reference) | 1(reference) |
Single | 1.26(1.20–1.33) ** | 1.22(1.16–1.29) ** |
Divorced/separated | 1.26(1.19–1.34) ** | 1.23(1.15–1.31) ** |
Widowed | 1.33(1.23–1.45) ** | 1.30(1.19–1.42) ** |
Tumor stage | ||
Localized | 1(reference) | 1(reference) |
Regional | 2.17(2.08–2.27) ** | 2.46(2.34–2.58) ** |
Distant | 4.81(4.49–5.15) ** | 5.57(5.18–6.00) ** |
Race | ||
Non-Hispanic white | 1(reference) | 1(reference) |
Non-Hispanic black | 1.02(0.96–1.10) | 1.02(0.94–1.10) |
Hispanic | 1.04(0.99–1.10) | 1.05(0.99–1.11) |
Other | 0.93(0.87–0.98) * | 0.93(0.87–0.99) * |
Living area | ||
Counties in metropolitan areas of 1 million persons | 1(reference) | 1(reference) |
Counties in metropolitan areas of 250,000 to 1 million persons | 1.05(0.99–1.11) | 1.08(1.01–1.14) * |
Counties in metropolitan areas of 250,000 persons | 0.99(0.91–1.09) | 1.03(0.94–1.14) |
Nonmetropolitan counties adjacent to a metropolitan area | 1.09(0.98–1.21) | 1.14(1.02–1.28) * |
Nonmetropolitan counties not adjacent to a metropolitan area | 0.98(0.87–1.12) | 1.02(0.89–1.18) |
Income per year | ||
<$40,000 | 1(reference) | 1(reference) |
$40,000–59,999 | 1.04(0.84–1.29) | 1.08(0.85–1.38) |
$60,000–79,999 | 0.95(0.76–1.19) | 1.01(0.79–1.29) |
$80,000–99,999 | 0.92(0.73–1.14) | 0.94(0.73–1.21) |
$100,000+ | 0.84(0.67–1.05) | 0.87(0.68–1.13) |
Fibrosis score | ||
Mild/moderate fibrosis | 1(reference) | 1(reference) |
Cirrhosis | 1.26(1.20–1.34) ** | 1.25(1.18–1.34) ** |
Radiation | ||
No | 1(reference) | 1(reference) |
Yes | 1.01(0.95–1.07) | 1.05(0.98–1.12) |
Chemotherapy | ||
No | 1(reference) | 1(reference) |
Yes | 0.92(0.88–0.96) ** | 0.94(0.90–0.99) * |
Surgery | ||
No | 1(reference) | 1(reference) |
Yes | 0.60(0.56–0.65) ** | 0.60(0.55–0.66) ** |
Fibrosis Score and Age (Fibrosis Score#Age) | Overall Mortality | Cancer-Specific Mortality |
---|---|---|
Mild/moderate fibrosis # 00–39 | 1(reference) | 1(reference) |
Cirrhosis # 00–39 | 1.91(0.19–3.05) | 1.55(0.93–2.57) |
Cirrhosis # 40–59 | 0.69(0.42–1.11) | 0.80(0.48–1.35) |
Cirrhosis # 60–79 | 0.66(0.41–1.06) | 0.83(0.49–1.38) |
Cirrhosis 80+ | 0.57(0.35–0.95) * | 0.71(0.41–1.23) |
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Bangolo, A.; Tran, H.H.-V.; Alqinai, B.; Goyal, R.; Ahmed, S.; Qasim, A.; Rojas, G.; Madan, S.; Barbosa, H.; Mustafa, Z.; et al. Ten-Year Trends in Hepatocellular Carcinoma Mortality: Examining the Interaction Between Fibrosis Score and Patient Age. Diseases 2025, 13, 256. https://doi.org/10.3390/diseases13080256
Bangolo A, Tran HH-V, Alqinai B, Goyal R, Ahmed S, Qasim A, Rojas G, Madan S, Barbosa H, Mustafa Z, et al. Ten-Year Trends in Hepatocellular Carcinoma Mortality: Examining the Interaction Between Fibrosis Score and Patient Age. Diseases. 2025; 13(8):256. https://doi.org/10.3390/diseases13080256
Chicago/Turabian StyleBangolo, Ayrton, Hadrian Hoang-Vu Tran, Budoor Alqinai, Rishabh Goyal, Shehwar Ahmed, Aamna Qasim, Gabriela Rojas, Shubham Madan, Helena Barbosa, Zainab Mustafa, and et al. 2025. "Ten-Year Trends in Hepatocellular Carcinoma Mortality: Examining the Interaction Between Fibrosis Score and Patient Age" Diseases 13, no. 8: 256. https://doi.org/10.3390/diseases13080256
APA StyleBangolo, A., Tran, H. H.-V., Alqinai, B., Goyal, R., Ahmed, S., Qasim, A., Rojas, G., Madan, S., Barbosa, H., Mustafa, Z., Waseem, R., Ingersoll, G., Khan, H., Guzzetti, A., Daniel, J., Parkar, S., Tiwari, A., Lafleur, S., Cingapagu, R., ... Weissman, S. (2025). Ten-Year Trends in Hepatocellular Carcinoma Mortality: Examining the Interaction Between Fibrosis Score and Patient Age. Diseases, 13(8), 256. https://doi.org/10.3390/diseases13080256