Risk Factors for Early-Onset and Late-Onset Hepatocellular Carcinoma in Asian Immigrants With Hepatitis B in the United States

Wan, David; Tzimas, Demetrios; Smith, Joshua A.; Kim, Sunnie S. Y.; Araujo, James L.; David, Ramoncito; Lobach, Iryna; Sarpel, Umut

doi:10.1038/ajg.2011.302

Cited by 31 publications

(50 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Factors such as alcohol intake, genetic predisposition and aflatoxin may also affect risks differences between groups. Fujianese immigrants appear more likely to develop HCC at an early age (56) for reasons that are still unclear, but are likely related to some of those factors. Risk stratification using a comprehensive scoring system that accounts for age, gender, HBV VL, HBeAg status, and family history of HCC and genotype (18) may potentially provide a better way to calculate disease burden in specific subgroups and more effectively target individuals at a greater risk for HCC and for whom treatments may bring the greatest benefit.…”

Section: Discussionmentioning

confidence: 99%

Chronic Hepatitis B and Liver Cancer Risks among Asian Immigrants in New York City: Results from a Large, Community-Based Screening, Evaluation, and Treatment Program

Pollack

Kwon

Wang

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

Background Hepatitis B virus (HBV) infection, the predominant cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects Asian Americans. Limited data exists on the variability and characteristics of infection that determine disease progression risk within US Asian ethnic subgroups. Methods Retrospective analyses were conducted on a large, community-based HBV screening and treatment program in New York City (NYC). From 2005-2008 the program enrolled 7,272 Asian-born individuals. Determinants of HBV seroprevalence were calculated and risk factors for HCC progression were compared across Asian subgroups. Results Among newly tested individuals, 13% were HBV positive. Seroprevalence varied significantly with age, gender, education, birthplace, and family history of infection. Chinese-born individuals, particularly from the Fujian province, had the highest seroprevalence (23.2% and 33.1%, respectively). Clinical and virologic characteristics placed HBV-infected individuals at significant risk for HCC. Significant differences in HCC risk existed among Asian subgroups in bivariate analysis, including age, gender, HBV viral load and HBeAg status. Differences in HBV genotype and family history of HCC may further HCC risk among subgroups. Conclusions Asian immigrants in NYC have a high prevalence of HBV infection and are at significant risk of disease progression and HCC. Although heterogeneity in HBV seroprevalence was found by Asian subgroups, HCC risk among infected individuals was primarily explained by age and gender differences. Country and province of birth, age, and gender may further explain seroprevalence differences. Impact Findings provide estimates of HBV burden in Asian ethnic subgroups and identify high risk groups to target for screening and treatment that can prevent HCC.

show abstract

Section: Discussionmentioning

confidence: 99%

Chronic Hepatitis B and Liver Cancer Risks among Asian Immigrants in New York City: Results from a Large, Community-Based Screening, Evaluation, and Treatment Program

Pollack

Kwon

Wang

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

show abstract

“…In addition, mortality from HCC is also higher in immigrant cohorts than their native-born counterparts [54,59]. Among immigrants with HBV, the onset of HCC tends to occur at a younger age than in the baseline population, and especially so among patients with a family history of HCC [60].…”

Section: Burden Of Chronic Liver Disease Among Migrantsmentioning

confidence: 99%

Immigration and viral hepatitis

Sharma

Carballo

Feld

et al. 2015

Journal of Hepatology

134

103

View full text Add to dashboard Cite

WHO estimates reveal that the global prevalence of viral hepatitis may be as high as 500 million, with an annual mortality rate of up to 1.3 million individuals. The majority of this global burden of disease is borne by nations of the developing world with high rates of vertical and iatrogenic transmission of HBV and HCV, as well as poor access to healthcare. In 2013, 3.2% of the global population (231 million individuals) migrated into a new host nation. Migrants predominantly originate from the developing countries of the south, into the developed economies of North America and Western Europe. This mass migration of individuals from areas of high-prevalence of viral hepatitis poses a unique challenge to the healthcare systems of the host nations. Due to a lack of universal standards for screening, vaccination and treatment of viral hepatitis, the burden of chronic liver disease and hepatocellular carcinoma continues to increase among migrant populations globally. Efforts to increase case identification and treatment among migrants have largely been limited to small outreach programs in urban centers, such that the majority of migrants with viral hepatitis continue to remain unaware of their infection. This review summarizes the data on prevalence of viral hepatitis and burden of chronic liver disease among migrants, current standards for screening and treatment of immigrants and refugees, and efforts to improve the identification and treatment of viral hepatitis among migrants.

show abstract

“…There was little difference between the 2 tumor-size groups and the liver function tests, but AFP mean values were much higher for the larger-tumor group (p < 0.0008). Platelets were also significantly different between the 2 groups (p < 0.0001) with only the small-tumor patients having thrombocytopenia, which has a much-cited association with HCC [12,13,14]. However, the means for the platelet counts in the larger-tumor group in our dataset were within the normal range.…”

Section: Resultsmentioning

confidence: 44%

“…An increase in the incidence of PVT with increased HCC size has been noted previously [23] and was a trend in our patients, as was elevated AFP levels and tumor size. We found that thrombocytopenia, which has previously been noted in association with cirrhosis and HCC [12,13,14,29,30], was significantly different between the 2 tumor-size groups and was unexpectedly more pronounced in patients with smaller tumors than in those with the larger ones.…”

Section: Discussionmentioning

confidence: 55%

Small Hepatocellular Carcinomas and Thrombocytopenia

Carr

Guerra

Giorgio³

et al. 2012

Oncology

View full text Add to dashboard Cite

Background: Clinical phenotypes of small and large hepatocellular carcinomas (HCCs) are not well characterized. Aim: To evaluate the characteristics of small HCCs diagnosed by screening. Method: A cohort of 430 small HCCs that were diagnosed through screening, were dichotomized according to a size of ≤3 cm or >3 cm maximum tumor diameter and compared for radiological and blood-test parameters. Results: There were 330 males and 100 females. A higher percent of females had smaller tumors. The majority of patients had single tumors, but 15% of those with larger tumors had portal vein thrombosis (PVT) compared to 5% of those with smaller tumors. Significant differences between the tumor-size groups included alpha-fetoprotein (AFP) values and platelet counts, with thrombocytopenia and elevated bilirubin levels being associated with smaller tumors. In comparing PVT-positive and PVT-negative patients, AFP levels and platelet counts were also significantly different between the 2 groups. A mean multinomial multiple logistic regression model was developed for maximum tumor diameter plus PVT. Conclusions: The finding of larger tumors being associated with normal platelets and bilirubin levels in comparison to smaller tumors having thrombocytopenia reveals 2 different patterns of HCC presentation.

show abstract

Risk Factors for Early-Onset and Late-Onset Hepatocellular Carcinoma in Asian Immigrants With Hepatitis B in the United States

Cited by 31 publications

References 28 publications

Chronic Hepatitis B and Liver Cancer Risks among Asian Immigrants in New York City: Results from a Large, Community-Based Screening, Evaluation, and Treatment Program

Chronic Hepatitis B and Liver Cancer Risks among Asian Immigrants in New York City: Results from a Large, Community-Based Screening, Evaluation, and Treatment Program

Immigration and viral hepatitis

Small Hepatocellular Carcinomas and Thrombocytopenia

Contact Info

Product

Resources

About