Clinical Presentation of Hepatocellular Carcinoma (HCC) in Asian-Americans Versus Non-Asian-Americans

Abstract

The incidence of HCC is rising worldwide. Studies on ethnicity-based clinical presentation of HCC remain limited. The aim is to compare the clinical presentation and stage of HCC between Asian-Americans and non-Asian-Americans. This retrospective study assessed ethnicity-based differences in HCC presentation, including demographics, laboratory results, diagnosis of underlying liver disease, and stage of HCC. Of 276 patients, 162 were Asian-Americans and 114 were non-Asian-Americans. Compared to non-Asian-Americans, Asian-Americans had a significantly higher incidence of history of hepatitis B virus (HBV) infection (55.0% vs. 4.9%, P < 0.001), family history of HBV infection (12.5% vs. 0.0%, P < 0.001) and HCC (15.2% vs. 2.9%, P = 0.002), but lower incidence of history of hepatitis C virus (HCV) infection (37.5% vs. 61.6%, P < 0.001). At diagnosis of HCC, Asian-American patients had a significantly lower frequency of hepatic encephalopathy (8.9% vs. 29.3%, P = 0.001), and ascites (26.7% vs. 57.3%, P < 0.001). Asian-Americans had lower Child-Pugh scores (class A: 62.0% vs. 31.4%, P < 0.001), and MELD scores (9.2 ± 4.4 vs. 12.0 ± 6.4, P = 0.02), and presented with a lower stage of HCC by Okuda staging (I: 43.8% vs. 22.8%, P = 0.001). Asian-American patients with HCC presented with a higher incidence of history and family history of HBV infection, lower incidence of hepatic decompensation, lower Child and MELD scores, and an early stage HCC disease.

Hepatitis B- and Hepatitis C-Related Hepatocellular Carcinomas in the United States: Similarities and Differences

“…Wong et al found that HCV patients, compared to HBV patients, have significantly greater rates of stigmata of portal hypertension/cirrhosis and worse liver function on presentation (39). This was evidenced by higher rates of ascites, encephalopathy, thrombocytopenia, increased AST/ALT ratio, and hypoalbuminemia.…”

Management of Chronic Hepatitis B: An Overview of Practice Guidelines for Primary Care Providers

“…For example, HCC risk is greater among Asian than among Western patients, particularly those with HBeAg-negative disease, 46 and even in the absence of cirrhosis. 47 The recommendations may also vary because of Liver cirrhosis C geographic differences in the perceptions of physicians as well as differences in publication dates. Another controversial issue concerning treatment eligibility is whether the current criteria adequately identify all patients with CHB who are at risk of liver disease progression.…”

Methodological assessment of HCC literature

“…ethnicity Ethnicity is a widely accepted risk factor for the development of HCC [31]. In particular, the prevalence of HCC is much higher in the Asian population, whose members are more commonly infected by HBV than in Western ones [32].…”

“…In particular, the prevalence of HCC is much higher in the Asian population, whose members are more commonly infected by HBV than in Western ones [32]. However, the existence of differences in mortality and other HCC-related factors between ethnic groups is still controversial [31].…”

“…In a retrospective study, Wong et al have assessed the potential ethnicity based differences in HCC presentation in a cohort of 276 patients, 162 of whom were Asian-Americans and 114 were non-Asian-Americans [31]. Overall, when compared with non-Asian-Americans, Asian-Americans presented a significantly higher incidence of HBV infection history and family history of HCC.…”