Trends in incidence rates of hepatocellular carcinoma and stage at diagnosis by demographics in the U.S. from 2004 to 2021: a joinpoint analysis of the SEER database

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Objectives Hepatocellular carcinoma (HCC) is the 13th most common cancer in the U.S., causing approximately 30,000 deaths annually. Incidence has risen substantially over recent decades. This study examines trends in age-adjusted HCC incidence from 2004 to 2021.Materials and Methods Incidence data for HCC (ICD-10 C22.0) from 2004 to 2021 were obtained from the Surveillance, Epidemiology and End Results (SEER) registry, representing 48% of the U.S. population. Rates were age-adjusted to the 2000 U.S. standard population and stratified by sex, race/ethnicity, age, and stage at diagnosis. Annual percentage changes (APCs) were calculated using Joinpoint regression with statistical significance set at p < 0.05.Results and conclusion From 2004 to 2015, overall HCC incidence increased (APC 3.16; p < 0.01), followed by a significant decline from 2015 to 2021 (APC −1.24; p < 0.01). Racial/ethnic subgroup trends varied: Hispanics, Non-Hispanic Blacks, and American Indian/Alaska Native populations showed rising incidence until 2015 with subsequent declines, while changes among Non-Hispanic Whites were less pronounced. After 2015, incidence declined among females (APC −0.27) and males (APC −1.85). Age-specific trends showed decreasing rates among individuals aged 35–49 and 50–64 years, with declines in those 65+ beginning in 2019. Localized-stage HCC incidence decreased after 2015, while regional trends fluctuated and distant-stage incidence continued to rise. Stage-specific patterns also differed by race. HCC incidence has declined overall since 2015, potentially reflecting improved hepatitis C therapy and risk-factor management. However, persistent or rising rates in specific demographic groups and increasing distant-stage diagnoses highlight ongoing disparities and the need for enhanced screening and early detection strategies.

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