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

Abstract

Background: Chronic 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.

Methods: We 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.

Results: Of 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.

Conclusion: The 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.

Figure 1

Proportions of patients with HCC whose disease was associated with HCV or HBV by era of initial presentation. HBV⁺/HCV^- represents patients with HBsAg⁺/anti-HBc⁺/anti-HCV^- or HBsAg^-/anti-HBc⁺/anti-HCV^-. HCV⁺ ± HBV⁺ represents patients with anti-HCV⁺/HBsAg^-/anti-HBc^-, anti-HCV⁺/HBsAg^-/anti-HBc⁺, or anti-HCV⁺/HBsAg⁺/anti-HBc⁺.

Figure 2

Proportions of patients with HCC whose disease was associated with HCV or HBV by age group and era of presentation. HBV⁺/HCV^- represents patients with HBsAg⁺/anti-HBc⁺/anti-HCV^- or HBsAg^-/anti-HBc⁺/anti-HCV^-. HCV⁺ ± HBV⁺ represents patients with anti-HCV⁺/HBsAg^-/anti-HBc^-, anti-HCV⁺/HBsAg^-/anti-HBc⁺, or anti-HCV⁺/HBsAg⁺/anti-HBc⁺.

Figure 3

Kaplan-Meier survival curves for patients with HBV and HCV. HBV⁺/HCV^- represents patients with HBsAg⁺/anti-HBc⁺/anti-HCV^- or HBsAg^-/anti-HBc⁺/anti-HCV^-. HCV⁺ ± HBV⁺ represents patients with anti-HCV⁺/HBsAg^-/anti-HBc^-, anti-HCV⁺/HBsAg^-/anti-HBc⁺, or anti-HCV⁺/HBsAg⁺/anti-HBc⁺. Median survival is indicated.

Figure 4

Kaplan-Meier survival curves stratified by treatment exposure at M. D. Anderson Cancer Center. Median survival is indicated in parentheses.