BOSTON — Liver cancer is the fastest growing malignancy in the United States, according to a preliminary report from the newly organized Liver Cancer Network.
The network includes six medical centers and has enrolled about 250 patients, Alex S. Befeler, M.D., reported at the annual meeting of the American Association for the Study of Liver Diseases.
Liver cancer is still relatively rare, but “what is striking is that it is the cancer most rapidly increasing in this country,” said Dr. Befeler of St. Louis University.
The primary purpose of the Liver Cancer Network is to track the incidence and mortality of hepatocellular carcinoma. There has been no way to document this until now, Dr. Befeler noted. A second objective is to assess the effectiveness of cancer staging systems, which vary widely across the United States.
“There has been a lot of enthusiasm for the Liver Cancer Network, especially since the meeting,” he later told this newspaper. “The main problem has been funding. At this point, the project is unfunded, and that has been a major obstacle.”
On patient enrollment, blood samples are collected, and demographic and risk factors for hepatocellular cancer and other liver diseases are documented. Tumor characteristics and treatment protocols are recorded.
The mean age of the report's patient group is 59 years, and 75% are male. Eighty percent are white, 10% are African American, 4% are East Asian, and 4% are Hispanic. In this preliminary report, mean follow-up is 6 months.
Overall, 87% of patients with hepatocellular cancer have had underlying liver disease; 52% have hepatitis C virus infection, and 11% have hepatitis B virus infection. One-fifth of patients with liver cancer have a history of alcohol abuse. Two percent have a history of hemochromatosis, Dr. Befeler reported.
Liver cancer is often asymptomatic when first diagnosed: 42% of the patients enrolled in the Liver Cancer Network were asymptomatic on presentation. Survival is “significantly better for those who are asymptomatic at presentation or who were candidates for liver transplantation,” he said.
Overall, 26% of the patients received no treatment, 18.5% got a liver transplant, 13% underwent surgical resection, 13% received chemoembolization, 10% had local ablation, 6% received chemotherapy, 5.6% underwent hepatic artery embolization, and 5% received radiation. Fewer than 5% of the patients received other treatments. Chemotherapy is generally ineffective in the treatment of liver cancer, and treatment modalities other than liver transplantation are also not highly successful, he said.
A major problem in the management of liver cancer has been that “oncologists and tumor registries have poor staging systems,” Dr. Befeler noted. He added that the systems frequently compete and conflict with each other.
“The UNOS [United Network for Organ Sharing] allocation system is best,” he said, adding that data from the Liver Cancer Network support that assertion. The tumor-node-metastasis staging system, in which patients are classified according to tumor size, “doesn't work very well.” And the original Okuda staging system, established in Japan, is ineffective, he said, as is the Barcelona Clinic Staging System.