24 In addition, social factors, such as income, education, employment, and access to health care, may contribute to disparities in survival. For example, a U.S. study of area-level median household income found better survival among treated HCC patients from high- versus low-income counties.19 In this study, the proportion of HCC diagnoses that were histologically confirmed decreased with time. Possible reasons could include changes in etiology or comorbidities of HCC cases.24 Histologic confirmation is also likely to be affected by guidelines 5-Fluoracil price affirming the use of noninvasive diagnostic5 and clinical management procedures under specified circumstances.5,

8 This study had strengths, including availability of trend data for stage and treatment as well as HCC survival data with sufficient counts to estimate survival within race and treatment subgroups. Caution is, however, recommended when interpreting the findings because of limited information on the method of diagnosis, as well as patient comorbidities, HCC etiology, and treatment. Though the favorable survival associated with curative therapy selleck in this report is thought to be meaningful, lead-time bias resulting from earlier diagnosis should not be dismissed as a contributory factor.25 Furthermore, the SEER-13

registries include only 14% of the U.S. population, with racial and economic attributes that differ in several meaningful ways from those of the entire nation. For example, large Asian or Pacific 上海皓元医药股份有限公司 Islander populations are found in the Hawaii, Seattle, and California registries of SEER-13, whereas Hispanic populations in Florida and Texas are not. The SEER-13 population is more urban than the United States. Although SEER-13 contains 14% of the nation’s population, it contains 22% of U.S. liver transplant centers.26 Despite these limitations, the

findings suggest that HCC diagnosis and management are changing in the SEER-13 population, with favorable results on stage, treatment, and survival. In summary, the detection of early stage HCC among at-risk persons may enable the use of potentially curative therapies. This is likely to contribute to the improving survival described in this report. The small percentage of cases receiving either liver surgery or ablation therapy (22%) suggests that the potential exists for further improvement in survival, with ongoing implementation of the HCC control efforts already improving the prognoses of HCC cases. We thank Carol Johnson, Leon Sun, Kathleen Cronin, Carol Kosary, Lynn Ries, Jennifer Ruhl, Susan Devesa, Nadia Howlader (critical review), Neil Neyman (coding), the U.S. Census Bureau (population data), SEER registries (population-based surveillance) and IMS, Inc. (data file).