Comparison of Hepatocellular Carcinoma in Hispanics and Non-Hispanics Patients

Abstract

Background: Hepatocellular carcinoma (HCC) is the fastest growing cancer in the United States. Studies have shown that compared to Blacks and non-Hispanic Whites, Hispanics have a higher HCC incidence and mortality rate. Most studies investigating HCC in Hispanics have been conducted utilizing data largely from the Western and Southern United States. These findings may, however, not be highly representative of Hispanics in the Northeast, given the nonhomogenous distribution and diversity of Hispanics across the United States.Methods: Some 148 HCC patients diagnosed between 1996 and 2012 were identified from a tertiary center in the northeastern United States. Hispanic patients were randomly matched to non-Hispanic White patients by year of diagnosis. Patient characteristics, HCC risk factors, treatment, and outcome were recorded. A Kaplan-Meier (KM) plot with log-rank tests was used for survival analysis.Results: Compared to non-Hispanic White patients (n=89), Hispanic HCC patients (n=59) were more likely to have chronic hepatitis C infection (69.5% vs. 38.2%, p < 0.01), alcoholic liver disease (37.3% vs. 21.4%, p = 0.04) and were less likely to have chronic hepatitis B infection (6.8% vs. 24.7%, p = 0.01), and private insurance (37.3% vs. 57.3%, p = 0.02). Hispanics were more likely to be diagnosed with an earlier stage disease (Barcelona Clinic Liver Cancer, BCLC stages A and B) compared to non-Hispanic patients (71.7% vs. 36.8%, p < 0.01) and were more likely to receive locoregional treatment. Although Hispanics trended towards improved overall survival, this finding did not hold when stratified by the BCLC stage. Conclusion:Risk factors for HCC in the northeastern Hispanic population are like those found among Hispanics in other US regions. Other research suggests Hispanics are at increased risk for hepatic injury and HCC. However, HCC in this northeastern Hispanic population appears to be less aggressive (earlier stage and trend towards better overall survival) than non-Hispanics. Further research may be needed to identify potential differences by ethnic group for HCC risk factors, presentation, and outcomes.

Prevalence and factors associated with liver fibrosis among first‐degree relatives of Mexican Americans with hepatocellular carcinoma

“…Mexican American probands with HCC in our cohort had a high prevalence of obesity, diabetes, hypertension and hypercholesterolemia, which corroborates previous studies characterising Hispanic Americans with HCC 2,4,26–28 . Several population‐based studies have indicated that there may a hereditary component of hepatic steatosis and fibrosis 29–32 .…”

“…Mexican American probands with HCC in our cohort had a high prevalence of obesity, diabetes, hypertension and hypercholesterolemia, which corroborates previous studies characterising Hispanic Americans with HCC. 2,4,[26][27][28] Several population-based studies have indicated that there may a hereditary component of hepatic steatosis and fibrosis. [29][30][31][32] Our group has also previously demonstrated an increased incidence of hepatic fibrosis in the first-degree relatives of patients with cirrhosis secondary to nonalcoholic fatty liver disease (NAFLD).…”

“…Hispanic Americans have a higher incidence rate of nonalcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC). [2][3][4][5][6][7] More specifically, Mexican Americans living in the southern region of Texas have one of the highest prevalence rates of NAFLD as well as the highest age-adjusted HCC incidence rate of any ethnic group in the United States, 8 representing a public health concern. 1 Hepatic fibrosis is a primary risk factor for liver-related events and HCC.…”

“…The Hispanic population is the largest ethnic group within the United States with a growing population estimated to be around 110 million by the year 2060, 1 necessitating the need to accurately evaluate health disparities that affect this population. Hispanic Americans have a higher incidence rate of nonalcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC) 2–7 . More specifically, Mexican Americans living in the southern region of Texas have one of the highest prevalence rates of NAFLD as well as the highest age‐adjusted HCC incidence rate of any ethnic group in the United States, 8 representing a public health concern 1…”