Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma

Abstract

Despite improved screening and surveillance guidelines, significant race/ethnicity‐specific disparities in hepatocellular carcinoma (HCC) continue to exist and disproportionately affect minority and disadvantaged populations. This trend indicates that social determinants, genetic, and environmental factors are driving the epidemic at the population level. Race and geography had independent associations with risk of mortality among patients with HCC. The present review discusses the risk factors and issues related to disparities in HCC. The underlying etiologies for these disparities are complex and multifactorial. Some of the risk factors for developing HCC include hepatitis B (HBV) and hepatitis C (HCV) viral infection, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, smoking and alcohol consumption. In addition, population genetics; socioeconomic and health care access; treatment and prevention differences; and genetic, behavioral, and biological influences can contribute to HCC. Acculturation of ethnic minorities, insurance status, and access to health care may further contribute to the observed disparities in HCC. By increasing awareness, better modalities for screening and surveillance, improving access to health care, and adapting targeted preventive and therapeutic interventions, disparities in HCC outcomes can be reduced or eliminated.

Hepcidin Downregulation Correlates With Disease Aggressiveness And Immune Infiltration in Liver Cancers

“…Since alcohol consumption and chronic viral infection are common risk factors for liver cancers ( 40 ), we analyzed if hepcidin downregulation had any additional effect on the patient’s survival. Hepcidin downregulation (HAMP low group) had a significantly worsening effect on overall and disease-specific survival in patients without alcohol consumption.…”

Cell-Free DNA Analysis by Whole-Exome Sequencing for Hepatocellular Carcinoma: A Pilot Study in Thailand

“…In contrast, the mutation frequencies of ZNF814, ZNF492, and ADAMTS12 were much lower in HCC tissues than in cfDNA. However, different gene mutations can be present based on the race or ethnicity of patients [ 21 ]. Therefore, the mutations of ZNF814, ZNF492, and ADAMTS12 might be important for HCC patients from Thailand specifically.…”

Etiology of Hepatocellular Carcinoma: Special Focus on Fatty Liver Disease

“…Diabetes mellitus, a component of the metabolic syndrome has been shown to attribute about 7% of the HCC cases worldwide (5,42). Meta-analyses have shown that diabetes is associated with HCC independent of viral hepatitis in which diabetic patients show 2-3 fold greater risks in developing HCC compared with non-diabetic controls (43).…”

“…Meta-analyses have shown that diabetes is associated with HCC independent of viral hepatitis in which diabetic patients show 2-3 fold greater risks in developing HCC compared with non-diabetic controls (43). The pathophysiological conditions such as hyperglycemia, hyperinsulinemia, insulin resistance, and activation of insulin-like growth factor signaling pathways provide a strong association for diabetes to be the risk factor in the pathogenesis of HCC (5,44). Obesity, a pathological state characterized by insulin resistance, hyperinsulinemia, and inflammation is also closely associated with HCC (45).…”

“…HCC accounts for about 80% of the primary liver cancer while the other types include cholangiocarcinoma (10-20%) and angiosarcoma (1%) (3). There is a striking variation in HCC incidence rates across geographic regions and at the global level, each year over 800,000 people are diagnosed with liver cancer (4,5). HCC cases are highest in Eastern Asia and sub-Saharan Africa, followed by intermediate rates in Southern and Western European countries, North and Central America, and the lowest incidence rates are observed in and Northern Europe and South Central Asia (6,7).…”