美国肝细胞癌发病率的性别及种族/族裔比值收窄，1992-2022年

Background: Temporal trends in hepatocellular carcinoma (HCC) incidence in the U.S. have not been uniform across all adult populations. Most national analyses have focused on absolute rates within demographic groups rather than changes in incidence rate ratios (IRRs) over time. Because IRRs directly quantify relative disparities, evaluating their temporal trends can clarify how sex- and race/ethnicity-specific differences are evolving. We examined long-term trends in HCC incidence and IRRs using three decades of SEER data. Methods: We analyzed HCC cases diagnosed from 1992 to 2022 in the SEER 12 registry. Age-adjusted incidence rates (per 100,000; 2000 U.S. standard) were calculated overall and by sex, race/ethnicity, and age group (<50 vs ≥50 years). Sex ratios were estimated with women as the reference group, while race/ethnicity ratios were estimated with non-Hispanic White (NHW) individuals as the reference group. Temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average APC (AAPC) with 95% confidence intervals (CIs). Results: 68,023 total HCC cases were identified. Annual cases increased from 840 in 1992 to 2,846 in 2022. Age-adjusted incidence rose from 4.27 to 7.84 per 100,000 (AAPC, 2.03%). Incidence increased during 1992-2009 (APC, 4.72%), was stable from 2009-2015, and declined during 2015-2022 (APC, 3.41%). Incidence remained higher in men, increasing from 6.97 to 12.24 per 100,000 (AAPC, 2.38%), compared with 2.13 to 3.95 per 100,000 in women (AAPC, 2.45%). However, the male-to-female IRR declined from 3.29 to 3.11, with an inflection in 2012; the IRR increased before 2012 (APC, 0.51%) and decreased thereafter (APC, -1.64%). Across racial/ethnic groups, incidence was highest among NH Asian or Pacific Islander (NHAPI) (14.27 per 100,000), followed by Hispanic (12.12), NH Black (NHB) (9.30), and NHW (4.37). AAPCs were highest for NHW (3.12%) and Hispanic (2.54%), intermediate for NHB (2.37%), and negative for NHAPI (-0.93%). Segment-specific APCs differed by group: NHW rates increased during 1992-2013 and declined thereafter; NHB and Hispanic rates increased during early periods and declined or stabilized in later years; NHAPI incidence increased modestly until 2007 and decreased thereafter. Similarly, the NHAPI:NHW IRR declined from 5.8 to 1.9 (AAPC, -3.93%); the NHB:NHW IRR declined from 2.0 to 1.4 (AAPC, -0.73%); and the Hispanic:NHW IRR decreased slightly from 2.7 to 2.4 (AAPC, -0.57%). Conclusion: HCC incidence increased through the early 2010s but has declined since 2015. Sex- and race/ethnicity-specific IRRs narrowed across the study period, driven by declining rates among NHAPI and NHB populations and slower increases among Hispanic individuals relative to NHW. These 30-year trends demonstrate substantial shifts in the demographic distribution of HCC incidence in the U.S. and may reflect changes in etiology.