Hepatocellular cancer: risk factors and survival in Pacific Islanders compared to Caucasians in Hawaii

Abstract

Background: Hepatocellular cancer (HCC) is increasing in the United States. Although studies indicate that Asian and Pacific Islanders have an especially high incidence, no study has characterized HCC in the subgroup of Pacific Islanders (PI) alone.

Objective: To describe risk factors/survival of HCC in PI compared to Caucasians in Hawaii.

Patients: Of 523 HCC patients referred 1993-2008, 72 PI patients were compared to 85 Caucasian patients.

Measurements: In this retrospective-cohort study, data collected included demographics, risk factors, tumor characteristics, laboratory studies, treatment and survival. Chi-square analyses and t-tests identified difference between groups. Cox-proportional hazards model determined regression analysis of survival data.

Results: Mean age and sex distribution were not significantly different between groups. PI were more likely to have hepatitis B (36% vs 6%, P<.05), symptoms at presentation (60% vs 40%, P=.003), and larger tumors (P=.02). Caucasians were more likely to have hepatitis C (65% vs 43%, P=.01) and encephalopathy. Mean survival was significantly different between PI and Caucasians (10.9 months vs 43.3 months, P=.01). Multivariate-regression analysis showed late stage III/IV, increased Childs score, hepatitis B infection, and alcohol history associated with decreased survival. PI ethnicity was independently associated with increased hazard ratio. Treatment regardless of modality reduced hazard ratio for survival.

Conclusion: PI with HCC were more likely to have hepatitis B, symptoms and larger tumors, though they were just as likely to have their HCC found upon screening. PI ethnicity independently affected survival. Better education of the community/physicians on detection of hepatitis B and recognizing this risk for HCC in PI is needed.