Hepatitis B and alcohol affect survival of hepatocellular carcinoma patients

Abstract

Aim: In the USA, Hawaii has the highest incidence of hepatocellular carcinoma (HCC) and a diverse population. It is an ideal place to characterize HCC in the context of ethnicity/risk factors.

Methods: A total of 262 cases of HCC (1992-2003) were retrospectively reviewed for demographics, ethnicity, birthplace, viral hepatitis, alcohol use, diabetes, smoking and risk factors for viral hepatitis such as intravenous drug abuse (IVDA), transfusions, tattoos and vertical transmission. Tumor stage, Child's class, Cancer of the Liver Italian Program (CLIP) score, alpha-fetoprotein level, treatment and survival were recorded.

Results: Gender, age, viral hepatitis, alcohol, IVDA, and diabetes differed significantly in Asians, non-Asians and Pacific Islanders. There were also specific differences within Asian subgroups. Alpha-fetoprotein, smoking, transfusions, stage and resectability did not differ between groups. Asians were more likely to have hepatitis B, while non-Asians were more likely to have hepatitis C. Factors that decreased survival included hepatitis B, alcohol, elevated alpha-fetoprotein, CLIP>2 and increased Child's class. When Asians were combined with Pacific Islanders, median survival (1.52 years vs 3.54 years), 1- and 3-year survival was significantly worse than those for non-Asians. After Cox regression analysis for hepatitis B and alcohol, there was no difference in survival by ethnicity.

Conclusion: Various ethnicities have different risk factors for HCC. Hepatitis B, alcohol, and alpha-fetoprotein are more important factors for survival than ethnicity.

Figure 1

Kaplan-Meier curves demonstrate that the presence of hepatitis B adversely affects survival (P = 0.023).

Figure 2

Kaplan-Meier curves demonstrate decreased survival with significant alcohol use (EtOH) (P = 0.005).

Figure 3

No difference in survival are noted when Kaplan-Meier curves are compared between Asians, Pacific Islanders and non-Asians.

Figure 4

Survival is decreased when Asians and Pacific Islanders are compared to non-Asians as demonstrated by Kaplan-Meier curves (P = 0.045).

Figure 5

Patients with normal AFP levels (<20 ng/dL) have improved survival compared with those with elevated AFP levels (P = 0.0013).

Figure 6

Patients with lower CLIP scores <2 have improved survival compared with those with CLIP score ≥ 2 as demonstrated by Kaplan-Meier curves (P<0.0001).

Figure 7

Increased Child’s class has progressively worse survival with Kaplan-Meier curves (P = 0.0055).