Ethnic differences in the behavior of hepatocellular carcinoma

Chin, Philip L.; Chu, David Z. J.; Clarke, Ken G.; Odom‐Maryon, Tamara; Yen, Yun; Wagman, Lawrence D.

doi:10.1002/(sici)1097-0142(19990501)85:9<1931::aid-cncr8>3.0.co;2-o

Cited by 25 publications

(7 citation statements)

References 25 publications

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“…Only 11% of the patients in our study had surgical resection; in contrast, in the study of Wong et al [18], 54% of patients had stage I or II disease, and 24% of patients underwent liver resection and 7% liver transplantation. This supports the notion that patients with earlier-stage disease treated with surgical treatment options have more favorable survival outcomes [14,15]. Similarly, in a study of 255 HCC patients by Barazani et al [16] in which 18% of patients with HBV-associated HCC had liver transplantation, the 1-year survival rate was 85%, significantly higher than our 1-year survival rate of approximately 40%.…”

Section: Discussionsupporting

confidence: 89%

“…Tumor resectability has been shown to be an independent predictor of improved survival among patients with HCC [14]. However, most patients with HCC are diagnosed at a late stage and are not candidates for radical, curative therapies [15]; they are treated instead with palliative treatments such as systemic chemotherapy, arterial chemoembolism, or hormonal therapy.…”

Section: Introductionmentioning

confidence: 99%

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Survival and hepatitis status among Asian Americans with hepatocellular carcinoma treated without liver transplantation

Hwang

Hassan

2009

BMC Cancer

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BackgroundChronic hepatitis B virus (HBV) and hepatitis C virus (HCV) are established causes of HCC. HCC patients are often diagnosed late and receive palliative therapies, however, the survival of Asian American patients with HCC treated without transplantation has not been well studied. We reviewed our institution's experience to determine predictors and rates of survival in Asian American HCC patients treated without transplantation.MethodsWe identified Asian American patients with HCC referred to M. D. Anderson Cancer Center. Patients were tested for HBV and HCV. Survival curves were generated by Kaplan-Meier method. Multivariate Cox proportional hazards regression was used to test the relationship between prognostic factors and survival.ResultsOf 82 Asian American HCC patients, most had advanced disease (65%) and received treatment (68%); however, only 11% had surgical resection. 94% had positive anti-HBc and 61% had positive HBsAg. 20% had positive anti-HCV. There were no significant changes in the rates of HBV and HCV over time. Male gender, high alpha-fetoprotein levels, and stage IV disease were associated with shorter survival Overall median survival was 9.2 months (95% CI 6.5–11.9), and the survival of HCV and HBV patients was not statistically different.ConclusionThe survival rate of Asian American patients with advanced HCC, for whom transplantation was not available, was low. Timely hepatitis screening and interventions by primary care physicians may be the most logical solution to reduce the burden of hepatitis-associated HCC among Asian Americans.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Survival and hepatitis status among Asian Americans with hepatocellular carcinoma treated without liver transplantation

Hwang

Hassan

2009

BMC Cancer

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“…In Asia, this is mainly due to chronic hepatitis B virus (HBV) infection [8–10]. Therefore liver-specific HRQOL measurement could be more relevant for these patients.…”

Section: Introductionmentioning

confidence: 99%

Prognostic values of EORTC QLQ-C30 and QLQ-HCC18 index-scores in patients with hepatocellular carcinoma – clinical application of health-related quality-of-life data

Li¹,

Mo²,

Chan³

et al. 2017

BMC Cancer

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BackgroundHealth-related quality-of-life (HRQOL) assessment with EORTC QLQ-C30 was prognostic for overall survival (OS) in patients with advance-stage hepatocellular carcinoma (HCC), but no data existed for early-stage patients. The HCC-specific QLQ-HCC18 has not been evaluated for prognostic value in HCC patients. Utilization of raw HRQOL data in clinical setting has been impractical and non-meaningful. Therefore we developed index scores of QLQ-C30 and QLQ-HCC18 in an attempt to enable clinical utilization of these HRQOL measurements. This study investigates the prognostic significance of QLQ-C30, QLQ-HCC18 and C30/HCC18 index-scores in patients with newly diagnosed HCC which encompasses all stages.MethodsFrom 2007–2011, 517 patients were prospectively recruited. HRQOL was assessed at diagnosis using QLQ-C30 and QLQ-HCC18; C30 and HCC18 index-scores were calculated from raw HRQOL data. Cox regression was performed using continuous, dichotomized QLQ-C30 and QLQ-HCC18 variables, or index-scores, together with clinical factors to identify independent factors for OS. Various multivariate models were validated with c-index and bootstrapping for 1000 replications.ResultsFour hundred and seventy two patients had complete HRQOL data. Their median OS was 8.6 months. In multivariate analysis, independent prognostic HRQOL variables for OS were QLQ-C30 pain (HR 1.346 [1.092–1.661], p = 0.0055), QLQ-C30 physical functioning (HR 0.652 [0.495–0.860], p = 0.0024); QLQ-HCC18 pain (HR 1.382 [1.089–1.754], p = 0.0077) and QLQ-HCC18 fatigue (HR 1.441 [1.132–1.833], p = 0.0030). C30 index-score (HR 2.143 [1.616–2.841], p < 0.0001) and HCC18 index-score (HR 1.957 [1.411–2.715], p < 0.0001) were highly significant factors for OS. The median OS of patients with C30 index-score of 0–20, 21–40, 41–60, 61–100 were 16.4, 7.3, 3.1, 1.8 months respectively (p < 0.0001); while for HCC18 index-score: 16.4, 6.0, 2.8, 1.8 months respectively (p < 0.0001). All the multivariate models were validated, with mean optimism <0.01. The bootstrap validated c-index was 0.78.ConclusionsQLQ-C30 and QLQ-HCC18 were prognostic for OS in patients with newly diagnosed HCC irrespective of stage. Both C30 and HCC18 index-scores were highly significant prognostic factors for OS in newly diagnosed HCC patients. Index-scoring provides an effective way to summarize, analyze and interpret raw HRQOL data, and renders QLQ-C30 and QLQ-HCC18 meaningful and communicable in clinical practice. Index-scores could potentially serve as a standardized tool for future HRQOL research.

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“…However, in a registry review of five metropolitan areas in the United States (West Coast, Atlanta, Detroit), increased survival was noted in Asians compared to Whites, Hispanics, and Blacks [14]. In contrast, a study from Southern California reported worse clinical outcomes of HCC in Asian patients than in non-Asian patients [15]. Thus, further studies are needed to address these issues.…”

Section: Introductionmentioning

confidence: 99%

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

Wong

Xia

Imagawa

et al. 2010

J Immigrant Minority Health

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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.

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Ethnic differences in the behavior of hepatocellular carcinoma

Cited by 25 publications

References 25 publications

Survival and hepatitis status among Asian Americans with hepatocellular carcinoma treated without liver transplantation

Survival and hepatitis status among Asian Americans with hepatocellular carcinoma treated without liver transplantation

Prognostic values of EORTC QLQ-C30 and QLQ-HCC18 index-scores in patients with hepatocellular carcinoma – clinical application of health-related quality-of-life data

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

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