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Clinical Presentation and Survival of Asian and Non-Asian Patients with HCV-Related Hepatocellular Carcinoma

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Abstract

Background and Aim

Hepatitis C virus (HCV) is an important cause of hepatocellular carcinoma (HCC) in Asians; however, it is often overlooked due to the high prevalence of hepatitis B virus in Asians. This study examines HCV-related HCC in Asians.

Methods

We conducted a retrospective cohort study of 792 consecutive Asian (n = 220) and non-Asian (n = 572) patients with HCV-related HCC identified at Stanford University Medical Center using International Classification of Diseases-9 diagnosis between July 1996 and June 2012.

Results

Asian patients were much older [66 (38–88) vs. 56 (31–87) years, P < 0.0001] and more likely to be female (33 vs. 19 %, P < 0.0001). A larger proportion of Asians were diagnosed with HCC within 2 years of HCV diagnosis (35 vs. 20 %, P = 0.001). Asian patients were more likely to undergo palliative therapy (46 vs. 28 %) and less likely to be listed for liver transplantation (20 vs. 48 %, P < 0.001), despite similar rates of meeting Milan criteria (52 vs. 58 %, P = 0.16). Overall, there was a trend for higher median survival rates in Asians (30 vs. 21 months, P = 0.091). Asians had higher long-term survival with palliative therapy only (5-year survival: 28 vs. 10 %, P < 0.0001); however, survival was similar among patients listed for liver transplantation.

Conclusions

There were distinct differences in clinical presentations of Asian and non-Asian patients with HCV-related HCC. Asians with HCV-related HCC are less likely to undergo liver transplantation and more likely to have delayed HCV diagnosis. Improved strategies in HCV screening in Asians are needed, as it may lead to earlier diagnosis and treatment of HCV infection and possible prevention of HCC development.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

BCLC:

Barcelona clinic liver cancer

BMI:

Body mass index

CPT:

Child–Turcotte–Pugh

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HR:

Hazards ratio

ICD-9:

International Classification of Diseases-9

MELD:

Model for end-stage liver disease

OR:

Odds ratio

UCSF:

University of California, San Francisco

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Authors and Affiliations

  1. Medical School, Eastern Virginia Medical School, Norfolk, VA, 23507, USA

    Benjamin Yip

  2. Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA

    Benjamin Yip, Robert J. Wong, Aijaz Ahmed, Gabriel Garcia & Mindie H. Nguyen

  3. Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA

    James M. Wantuck

  4. Stanford University, Palo Alto, CA, 94304, USA

    Lily H. Kim

Authors
  1. Benjamin Yip
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  2. James M. Wantuck
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  3. Lily H. Kim
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  4. Robert J. Wong
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  5. Aijaz Ahmed
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  6. Gabriel Garcia
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  7. Mindie H. Nguyen
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Correspondence to Mindie H. Nguyen.

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Yip, B., Wantuck, J.M., Kim, L.H. et al. Clinical Presentation and Survival of Asian and Non-Asian Patients with HCV-Related Hepatocellular Carcinoma. Dig Dis Sci 59, 192–200 (2014). https://doi.org/10.1007/s10620-013-2948-7

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  • DOI: https://doi.org/10.1007/s10620-013-2948-7

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