The changing characteristics of hepatocellular cancer in Hawaii over time

• Published in: The American journal of surgery Vol. 210; no. 1; pp. 146 - 152
• Main Authors: Wong, Linda L., M.D, Ogihara, Makoto, M.D, Ji, Junfang, Ph.D, Tsai, Naoky, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Body mass index; Diabetes; Ethnicity; Family medical history; Female; Hawaii - epidemiology; Hepatitis; Hepatocellular cancer; Humans; Hypertension; Incidence; Laboratories; Liver cancer; Liver diseases; Liver Neoplasms - diagnosis; Liver Neoplasms - epidemiology; Liver Neoplasms - therapy; Liver resection; Liver transplant; Male; Medical imaging; Metabolic factors; Middle Aged; Mortality; Obesity; Retrospective Studies; Risk Factors; Studies; Surgery; Surveillance; Time Factors; Ultrasonic imaging; Viral hepatitis; Young Adult; Hawaii; United States > US; Liver transplant; Viral hepatitis; Liver resection; Metabolic factors; Hepatocellular cancer
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2014.06.036

Abstract Background The incidence of hepatocellular cancer (HCC) is increasing, and we sought to characterize the differences and trends in HCC over 2 decades in Hawaii. Methods This retrospective study of 821 HCC cases analyzed risk factors, diabetes, alpha-fetoprotein (AFP), tumor characteristics, and treatment, comparing 5-year eras (1993 to 2012). Results With succeeding eras, there were fewer Asians, immigrants, and hepatitis B–related HCC. Hepatitis C, diabetes, hyperlipidemia, and body mass index have increased. Over time, more patients had normal AFP, and normal AFP was seen more often in nonviral HCC (49.6% vs 33.2%, P  = .007). Over time, the proportion of patients who underwent resection or transplant was stable, but fewer patients underwent no therapy. Conclusions Characteristics of HCC are changing, and diagnosis may be more difficult as metabolic factors are becoming more important than viral factors. AFP seems to be a less important biomarker, and clearly, better diagnostic tools will be necessary to identify HCC in the future.