Etiology and Outcomes of Hepatocellular Carcinoma in an Ethnically Diverse Population: The Multiethnic Cohort

• Published in: Cancers Vol. 13; no. 14; p. 3476
• Main Authors: Barzi, Afsaneh, Zhou, Kali, Wang, Songren, Dodge, Jennifer L, El-Khoueiry, Anthony, Setiawan, Veronica Wendy
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 12.07.2021; MDPI
• Subjects: African Americans; Alcohol use; Body mass index; Codes; Cultural differences; Death; Diabetes; Ethnicity; Etiology; Fatty liver; HCV; Hepatitis B; Hepatitis C; Hepatocellular carcinoma; Hispanic Americans; Japanese Americans; Liver cancer; Liver diseases; Medicare; Minority & ethnic groups; Mortality; Multivariate analysis; NAFLD; Obesity; Population; Questionnaires; Race; racial disparities; Risk factors; steatosis; Womens health; Hawaii; United States > US; California; racial disparities; NAFLD; ethnicity; HCV; liver cancer; steatosis; medicare
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers13143476

HCC incidence varies by race/ethnicity. We characterized racial differences in underlying etiology, presentation, and survival in the linkage of Multiethnic Cohort Study with SEER and Medicare claims. HCC characteristics, treatment, and underlying etiology in participants were obtained. Deaths were ascertained using state death certificates and the National Death Index. Risk factors were collected via questionnaires. Cox models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for death. Among 359 cases, the average age at diagnosis was 75.1. The most common etiology was hepatitis C (HCV) (33%), followed by nonalcoholic fatty liver disease (NAFLD) (31%), and different by ethnicity ( < 0.0001). African Americans (AA) (59.5%) and Latinos (40.6%) were more likely to be diagnosed with HCV-related HCC. In Japanese Americans (33.1%), Native Hawaiians (39.1%), and whites (34.8%), NAFLD was the most common etiology. Receipt of treatment varied across ethnic groups ( = 0.0005); AA had the highest proportion of no treatment (50.0%), followed by Latinos (45.3%), vs. whites (15.2%). HCC (72.2%) was the most common cause of death. In a multivariate analysis, AA (HR = 1.87; 95% CI: 1.06-3.28) had significantly higher mortality compared to whites. We found significant ethnic differences in HCC underlying etiology, receipt of treatment, and outcome. The findings are important for reducing disparities.