Journal of Immigrant and Minority Health

, Volume 15, Issue 6, pp 1023–1029 | Cite as

Both HCV and HBV are Major Causes of Liver Cancer in Southeast Asians

  • Hillary Lin
  • Nghiem B. Ha
  • Aijaz Ahmed
  • Walid Ayoub
  • Tami J. Daugherty
  • Glen A. Lutchman
  • Gabriel Garcia
  • Mindie H. Nguyen
Original Paper


The incidence of hepatocellular carcinoma (HCC) is higher in Asian Americans than in other ethnicities. While hepatitis B virus (HBV) is common, hepatitis C virus (HCV) is more prevalent in some subgroups. Our goal was to determine the etiology of liver disease associated with HCC in subgroups of Asian Americans. This was an analysis of 510 Asian HCC patients at a US medical center. Patients were identified using ICD9 diagnosis. Multivariate logistic regression was used to study predictors of HCV as the cause of HCC. Patients were Southeast Asian, Chinese, and Korean, with similar gender, age, and foreign-born status. Southeast Asians had a similar proportion of HBV- and HCV-related HCC, while Chinese and Korean patients had a higher proportion of HBV-related HCC. HCC was usually associated with HBV in Chinese and Korean patients, but both HCV and HBV were important associations in Southeast Asians.


Hepatocellular carcinoma Asians Asian Americans Hepatitis C Hepatitis B 



Hepatocellular carcinoma


Hepatitis B virus


Hepatitis C virus


Alanine aminotransferase


Aspartate aminotransferase


Alpha fetoprotein


Tumor, node, and metastasis stage


Barcelona clinic liver cancer stage


Nonalcoholic fatty liver disease


Model for end-stage liver disease


Child-Turcotte Pugh


  1. 1.
    McGlynn KA, Tsao L, Hsing AW, et al. International trends and patterns of primary liver cancer. Int J Cancer. 2001;94:290–6.PubMedCrossRefGoogle Scholar
  2. 2.
    El-Serag HB. Hepatocellular carcinoma: recent trends in the United States. Gastroenterology. 2004;127:S27–34.PubMedCrossRefGoogle Scholar
  3. 3.
    Hassan MM, Frome A, Patt YZ, El-Serag HB. Rising prevalence of hepatitis C virus infection among patients recently diagnosed with hepatocellular carcinoma in the United States. J Clin Gastroenterol. 2002;35:266–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Nordenstedt H, White DL, El-Serag HB. The changing pattern of epidemiology in hepatocellular carcinoma. Dig Liver Dis. 2010;42(Suppl 3):S206–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Di Bisceglie AM, Lyra AC, Schwartz M, et al. Hepatitis C-related hepatocellular carcinoma in the United States: influence of ethnic status. Am J Gastroenterol. 2003;98:2060–3.PubMedGoogle Scholar
  6. 6.
    Lauderdale DS, Huo D. Cancer death rates for older Asian-Americans: classification by race versus ethnicity. Cancer Causes Control. 2008;19:135–46.PubMedCrossRefGoogle Scholar
  7. 7.
    Bates JH, Hofer BM, Parikh-Patel A. Cervical cancer incidence, mortality, and survival among Asian subgroups in California, 1990–2004. Cancer. 2008;113:2955–63.PubMedCrossRefGoogle Scholar
  8. 8.
    Kwong SL, Chen MS Jr, Snipes KP, et al. Asian subgroups and cancer incidence and mortality rates in California. Cancer. 2005;104:2975–81.PubMedCrossRefGoogle Scholar
  9. 9.
    Frederick WH, Leinbach TR, Augustyn A, et al. Southeast Asia. Encyclopædia Britannica Online. Retrieved July 10, 2013 from
  10. 10.
    Kwong SL, Stewart SL, Aoki CA, Chen MS Jr. Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988 to 2007. Cancer Epidemiol Biomarkers Prev. 2010;19:2747–57.PubMedCrossRefGoogle Scholar
  11. 11.
    Fassio E. Hepatitis C and hepatocellular carcinoma. Ann Hepatol. 2010;9(Suppl):119–22.PubMedGoogle Scholar
  12. 12.
    Szalay F. Hepatitis C virus infection and hepatocarcinogenesis. Orv Hetil. 2010;151:1524–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Lui WY, Lin HL, Chau GY, et al. Male predominance in hepatocellular carcinoma: new insight and a possible therapeutic alternative. Med Hypotheses. 2000;55:348–50.PubMedCrossRefGoogle Scholar
  14. 14.
    Nguyen NH, VuTien P, Trinh HN, et al. Risk factors, genotype 6 prevalence, and clinical characteristics of chronic hepatitis C in Southeast Asian Americans. Hepatol Int. 2010;4:523–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Ho EY, Ha NB, Ahmed A, et al. Prospective study of risk factors for hepatitis C virus acquisition by Caucasian, Hispanic, and Asian American patients. J Viral Hepat. 2012;19:e105–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Wong LL, Limm WM, Tsai N, Severino R. Hepatitis B and alcohol affect survival of hepatocellular carcinoma patients. World J Gastroenterol. 2005;11:3491–7.PubMedGoogle Scholar
  17. 17.
    Tong MJ, Chavalitdhamrong D, Lu DS, et al. Survival in Asian Americans after treatments for hepatocellular carcinoma: a seven-year experience at UCLA. J Clin Gastroenterol. 2010;44:e63–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Okuno H, Xie ZC, Lu BY, et al. A low prevalence of anti-hepatitis C virus antibody in patients with hepatocellular carcinoma in Guangxi Province, southern China. Cancer. 1994;73:58–62.PubMedCrossRefGoogle Scholar
  19. 19.
    Zhang JY, Dai M, Wang X, et al. A case-control study of hepatitis B and C virus infection as risk factors for hepatocellular carcinoma in Henan, China. Int J Epidemiol. 1998;27:574–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Gao JD, Shao YF, Xu Y, et al. Tight association of hepatocellular carcinoma with HBV infection in North China. Hepatobiliary Pancreat Dis Int. 2005;4:46–9.PubMedGoogle Scholar
  21. 21.
    Kim SR, Kudo M, Hino O, et al. Epidemiology of hepatocellular carcinoma in Japan and Korea. A review. Oncology. 2008;75(Suppl 1):13–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Chemin I. Evaluation of a hepatitis B vaccination program in Taiwan: impact on hepatocellular carcinoma development. Future Oncol. 2010;6:21–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Chang MH, Chen CJ, Lai MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med. 1997;336:1855–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Lee CL, Ko YC. Hepatitis B vaccination and hepatocellular carcinoma in Taiwan. Pediatrics. 1997;99:351–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Chen DS. Hepatocellular carcinoma in Taiwan. Hepatol Res. 2007;37(Suppl 2):S101–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Khin LW, Teo CJ, Guan R. Seroprevalence of hepatitis B and C viral markers in patients with primary hepatocellular carcinoma in Singapore. Singapore Med J. 1996;37:492–6.PubMedGoogle Scholar
  27. 27.
    El-Serag HB, Marrero JA, Rudolph L, Reddy KR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology. 2008;134:1752–63.PubMedCrossRefGoogle Scholar
  28. 28.
    Gomez SL, Clarke CA, Shema SJ, et al. Disparities in breast cancer survival among Asian women by ethnicity and immigrant status: a population-based study. Am J Public Health. 2010;100:861–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Gomez SL, Quach T, Horn-Ross PL, et al. Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status. Am J Public Health. 2010;100(Suppl 1):S125–31.PubMedCrossRefGoogle Scholar
  30. 30.
    Rossing MA, Schwartz SM, Weiss NS. Thyroid cancer incidence in Asian migrants to the United States and their descendants. Cancer Causes Control. 1995;6:439–44.PubMedCrossRefGoogle Scholar
  31. 31.
    Hedeen AN, White E, Taylor V. Ethnicity and birthplace in relation to tumor size and stage in Asian American women with breast cancer. Am J Public Health. 1999;89:1248–52.PubMedCrossRefGoogle Scholar
  32. 32.
    Raz DJ, Gomez SL, Chang ET, et al. Epidemiology of non-small cell lung cancer in Asian Americans: incidence patterns among six subgroups by nativity. J Thorac Oncol. 2008;3:1391–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Hillary Lin
    • 1
  • Nghiem B. Ha
    • 2
    • 3
  • Aijaz Ahmed
    • 2
  • Walid Ayoub
    • 2
  • Tami J. Daugherty
    • 2
  • Glen A. Lutchman
    • 2
  • Gabriel Garcia
    • 2
  • Mindie H. Nguyen
    • 2
  1. 1.Stanford University School of MedicineStanfordUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of MedicineStanford University Medical CenterStanford, Palo AltoUSA
  3. 3.UC Davis School of MedicineSacramentoUSA

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