Clin Mol Hepatol.  2022 Apr;28(2):242-253. 10.3350/cmh.2021.0355.

Cause of death and cause-specific mortality for primary liver cancer in South Korea: A nationwide population-based study in hepatitis B virus-endemic area

• Kim BH
• Lee D
• Jung KW
• Won YJ
• Cho H

• KMID: 2528253
• DOI: http://doi.org/10.3350/cmh.2021.0355

Abstract

Background/Aims
Primary liver cancer is one of the leading causes of cancer mortality worldwide. However, the causes of death have not been studied in detail in patients with liver cancer.
Methods
The causes of death and cause-specific mortality risks in patients with primary liver cancer, diagnosed during 2000–2016, were investigated using the nationwide population-based cancer registry data in South Korea (n=231,388). The cumulative incidence function and Fine-Gray models were used to estimate the cause-specific mortality under the competing risks. Risks of non-cancer deaths relative to the general population were compared by standardized mortality ratios (SMRs).
Results
Among 179,921 total deaths, 92.4%, 1.7%, and 6.0% of patients died of primary liver cancer, cancer from other sites, and non-cancer illnesses, respectively. Proportionate mortality from liver cancer remained high. The 5-year competing risks probability of death from liver cancer varied by tumor stage, from 42% to 94%, and it remained high 10 years after the diagnosis (61–95%). Competing mortality from other causes has continuously increased. The most common non-cancer causes of death were underlying liver diseases (SMR, 15.6; 95% confidence interval [CI], 15.1–16.1) and viral hepatitis (SMR, 46.5; 95% CI, 43.9–49.2), which demonstrated higher mortality risks compared to the Korean general population. Higher mortality risks of suicide (SMR, 2.6; 95% CI, 2.4–2.8) was also noted.
Conclusions
Patients with liver cancer are most likely to die from liver cancer and related liver disease, even 10 years after the diagnosis, highlighting a need for specialized long-term follow-up care.

Keyword

Liver neoplasms; Mortality; Cause of death; Survival; Competing risks