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

[Guest guest]

Am J Gastroenterol. 2011 Sep 13. doi: 10.1038/ajg.2011.302. [Epub ahead of

print]

Risk Factors for Early-Onset and Late-Onset Hepatocellular Carcinoma in Asian

Immigrants With Hepatitis B in the United States.

Wan DW, Tzimas D, JA, Kim S, Araujo J, R, Lobach I, Sarpel U.

Source

Division of Gastroenterology, Department of Medicine, NYU Langone Medical

Center, New York, New York, USA.

Abstract

OBJECTIVES:

Routine screening for hepatocellular carcinoma (HCC) is recommended in chronic

hepatitis B (HBV) patients with cirrhosis and select non-cirrhotic HBV

populations including Asian males ages 40 and older and females ages 50 and

older. However, many younger HBV patients develop HCC and there have been few

studies examining this group. Additionally, studies of HCC in the Asian

immigrant population in the United States have been limited. The objective of

this study was to determine the associated risk factors for the development of

early-onset (males and females under ages 40 and 50, respectively) and

late-onset HCC in immigrants with chronic HBV in the United States.

METHODS:

Clinical, demographic, and laboratory data were retrospectively collected on all

Asian immigrants with HBV at Bellevue Hospital Center from 2003 to 2009.

Patients with HCC were identified within this cohort. Features of early-onset

and late-onset HCC cases were compared with age-matched HBV controls without

HCC.

RESULTS:

We identified 168 cases of HCC in Asians with HBV. In all, 74% (124/168) of

cases were late-onset, and 26% (44/168) were early-onset. When comparing the 124

late-onset HCC cases with 199 age-matched HBV controls, gender (odds ratio

(OR)=4.4; P<0.05) and cirrhosis (OR=9.6; P<0.05) or surrogate labs (i.e.,

platelets, international normalized ratio, total bilirubin, albumin) were found

to be associated with HCC development. When comparing the 44 early-onset HCC

cases with 432 age-matched HBV controls, family history of HCC (OR=2.7; P<0.05),

and smoking history (OR=3.4; P<0.05) were independently associated risk factors

in addition to gender (OR=2.7; P<0.05), and cirrhosis (OR=19.5; P<0.05) or

surrogate labs. In all, 54.8% of late-onset HCC cases were cirrhotic and 29.5%

of early-onset HCC cases were cirrhotic.

CONCLUSIONS:

HCC occurs in Asian immigrant HBV patients younger than currently recommended

screening guidelines. A large majority of these early-onset patients did not

have cirrhosis at the time of their HCC diagnosis; therefore, factors other than

cirrhosis need to be considered when evaluating HCC risk in young patients.

Factors associated with HCC development across all ages include cirrhosis and

male gender, while family history and smoking history may identify younger Asian

immigrant HBV patients at risk for HCC. Prospective validation, including

cost-effectiveness evaluation, is necessary, but our results suggest that

younger Asian HBV patients, especially those with a smoking history or family

history of HCC, appear to have an increased risk for HCC and should be

considered for enrollment in early screening programs regardless of their age.Am

J Gastroenterol advance online publication, 13 September 2011;

doi:10.1038/ajg.2011.302.

PMID: 21912436 [PubMed - as supplied by publisher]

[Guest guest]

Am J Gastroenterol. 2011 Sep 13. doi: 10.1038/ajg.2011.302. [Epub ahead of

print]

Risk Factors for Early-Onset and Late-Onset Hepatocellular Carcinoma in Asian

Immigrants With Hepatitis B in the United States.

Wan DW, Tzimas D, JA, Kim S, Araujo J, R, Lobach I, Sarpel U.

Source

Division of Gastroenterology, Department of Medicine, NYU Langone Medical

Center, New York, New York, USA.

Abstract

OBJECTIVES:

Routine screening for hepatocellular carcinoma (HCC) is recommended in chronic

hepatitis B (HBV) patients with cirrhosis and select non-cirrhotic HBV

populations including Asian males ages 40 and older and females ages 50 and

older. However, many younger HBV patients develop HCC and there have been few

studies examining this group. Additionally, studies of HCC in the Asian

immigrant population in the United States have been limited. The objective of

this study was to determine the associated risk factors for the development of

early-onset (males and females under ages 40 and 50, respectively) and

late-onset HCC in immigrants with chronic HBV in the United States.

METHODS:

Clinical, demographic, and laboratory data were retrospectively collected on all

Asian immigrants with HBV at Bellevue Hospital Center from 2003 to 2009.

Patients with HCC were identified within this cohort. Features of early-onset

and late-onset HCC cases were compared with age-matched HBV controls without

HCC.

RESULTS:

We identified 168 cases of HCC in Asians with HBV. In all, 74% (124/168) of

cases were late-onset, and 26% (44/168) were early-onset. When comparing the 124

late-onset HCC cases with 199 age-matched HBV controls, gender (odds ratio

(OR)=4.4; P<0.05) and cirrhosis (OR=9.6; P<0.05) or surrogate labs (i.e.,

platelets, international normalized ratio, total bilirubin, albumin) were found

to be associated with HCC development. When comparing the 44 early-onset HCC

cases with 432 age-matched HBV controls, family history of HCC (OR=2.7; P<0.05),

and smoking history (OR=3.4; P<0.05) were independently associated risk factors

in addition to gender (OR=2.7; P<0.05), and cirrhosis (OR=19.5; P<0.05) or

surrogate labs. In all, 54.8% of late-onset HCC cases were cirrhotic and 29.5%

of early-onset HCC cases were cirrhotic.

CONCLUSIONS:

HCC occurs in Asian immigrant HBV patients younger than currently recommended

screening guidelines. A large majority of these early-onset patients did not

have cirrhosis at the time of their HCC diagnosis; therefore, factors other than

cirrhosis need to be considered when evaluating HCC risk in young patients.

Factors associated with HCC development across all ages include cirrhosis and

male gender, while family history and smoking history may identify younger Asian

immigrant HBV patients at risk for HCC. Prospective validation, including

cost-effectiveness evaluation, is necessary, but our results suggest that

younger Asian HBV patients, especially those with a smoking history or family

history of HCC, appear to have an increased risk for HCC and should be

considered for enrollment in early screening programs regardless of their age.Am

J Gastroenterol advance online publication, 13 September 2011;

doi:10.1038/ajg.2011.302.

PMID: 21912436 [PubMed - as supplied by publisher]

[Guest guest]

Am J Gastroenterol. 2011 Sep 13. doi: 10.1038/ajg.2011.302. [Epub ahead of

print]

Risk Factors for Early-Onset and Late-Onset Hepatocellular Carcinoma in Asian

Immigrants With Hepatitis B in the United States.

Wan DW, Tzimas D, JA, Kim S, Araujo J, R, Lobach I, Sarpel U.

Source

Division of Gastroenterology, Department of Medicine, NYU Langone Medical

Center, New York, New York, USA.

Abstract

OBJECTIVES:

Routine screening for hepatocellular carcinoma (HCC) is recommended in chronic

hepatitis B (HBV) patients with cirrhosis and select non-cirrhotic HBV

populations including Asian males ages 40 and older and females ages 50 and

older. However, many younger HBV patients develop HCC and there have been few

studies examining this group. Additionally, studies of HCC in the Asian

immigrant population in the United States have been limited. The objective of

this study was to determine the associated risk factors for the development of

early-onset (males and females under ages 40 and 50, respectively) and

late-onset HCC in immigrants with chronic HBV in the United States.

METHODS:

Clinical, demographic, and laboratory data were retrospectively collected on all

Asian immigrants with HBV at Bellevue Hospital Center from 2003 to 2009.

Patients with HCC were identified within this cohort. Features of early-onset

and late-onset HCC cases were compared with age-matched HBV controls without

HCC.

RESULTS:

We identified 168 cases of HCC in Asians with HBV. In all, 74% (124/168) of

cases were late-onset, and 26% (44/168) were early-onset. When comparing the 124

late-onset HCC cases with 199 age-matched HBV controls, gender (odds ratio

(OR)=4.4; P<0.05) and cirrhosis (OR=9.6; P<0.05) or surrogate labs (i.e.,

platelets, international normalized ratio, total bilirubin, albumin) were found

to be associated with HCC development. When comparing the 44 early-onset HCC

cases with 432 age-matched HBV controls, family history of HCC (OR=2.7; P<0.05),

and smoking history (OR=3.4; P<0.05) were independently associated risk factors

in addition to gender (OR=2.7; P<0.05), and cirrhosis (OR=19.5; P<0.05) or

surrogate labs. In all, 54.8% of late-onset HCC cases were cirrhotic and 29.5%

of early-onset HCC cases were cirrhotic.

CONCLUSIONS:

HCC occurs in Asian immigrant HBV patients younger than currently recommended

screening guidelines. A large majority of these early-onset patients did not

have cirrhosis at the time of their HCC diagnosis; therefore, factors other than

cirrhosis need to be considered when evaluating HCC risk in young patients.

Factors associated with HCC development across all ages include cirrhosis and

male gender, while family history and smoking history may identify younger Asian

immigrant HBV patients at risk for HCC. Prospective validation, including

cost-effectiveness evaluation, is necessary, but our results suggest that

younger Asian HBV patients, especially those with a smoking history or family

history of HCC, appear to have an increased risk for HCC and should be

considered for enrollment in early screening programs regardless of their age.Am

J Gastroenterol advance online publication, 13 September 2011;

doi:10.1038/ajg.2011.302.

PMID: 21912436 [PubMed - as supplied by publisher]

[Guest guest]

Am J Gastroenterol. 2011 Sep 13. doi: 10.1038/ajg.2011.302. [Epub ahead of

print]

Risk Factors for Early-Onset and Late-Onset Hepatocellular Carcinoma in Asian

Immigrants With Hepatitis B in the United States.

Wan DW, Tzimas D, JA, Kim S, Araujo J, R, Lobach I, Sarpel U.

Source

Division of Gastroenterology, Department of Medicine, NYU Langone Medical

Center, New York, New York, USA.

Abstract

OBJECTIVES:

Routine screening for hepatocellular carcinoma (HCC) is recommended in chronic

hepatitis B (HBV) patients with cirrhosis and select non-cirrhotic HBV

populations including Asian males ages 40 and older and females ages 50 and

older. However, many younger HBV patients develop HCC and there have been few

studies examining this group. Additionally, studies of HCC in the Asian

immigrant population in the United States have been limited. The objective of

this study was to determine the associated risk factors for the development of

early-onset (males and females under ages 40 and 50, respectively) and

late-onset HCC in immigrants with chronic HBV in the United States.

METHODS:

Clinical, demographic, and laboratory data were retrospectively collected on all

Asian immigrants with HBV at Bellevue Hospital Center from 2003 to 2009.

Patients with HCC were identified within this cohort. Features of early-onset

and late-onset HCC cases were compared with age-matched HBV controls without

HCC.

RESULTS:

We identified 168 cases of HCC in Asians with HBV. In all, 74% (124/168) of

cases were late-onset, and 26% (44/168) were early-onset. When comparing the 124

late-onset HCC cases with 199 age-matched HBV controls, gender (odds ratio

(OR)=4.4; P<0.05) and cirrhosis (OR=9.6; P<0.05) or surrogate labs (i.e.,

platelets, international normalized ratio, total bilirubin, albumin) were found

to be associated with HCC development. When comparing the 44 early-onset HCC

cases with 432 age-matched HBV controls, family history of HCC (OR=2.7; P<0.05),

and smoking history (OR=3.4; P<0.05) were independently associated risk factors

in addition to gender (OR=2.7; P<0.05), and cirrhosis (OR=19.5; P<0.05) or

surrogate labs. In all, 54.8% of late-onset HCC cases were cirrhotic and 29.5%

of early-onset HCC cases were cirrhotic.

CONCLUSIONS:

HCC occurs in Asian immigrant HBV patients younger than currently recommended

screening guidelines. A large majority of these early-onset patients did not

have cirrhosis at the time of their HCC diagnosis; therefore, factors other than

cirrhosis need to be considered when evaluating HCC risk in young patients.

Factors associated with HCC development across all ages include cirrhosis and

male gender, while family history and smoking history may identify younger Asian

immigrant HBV patients at risk for HCC. Prospective validation, including

cost-effectiveness evaluation, is necessary, but our results suggest that

younger Asian HBV patients, especially those with a smoking history or family

history of HCC, appear to have an increased risk for HCC and should be

considered for enrollment in early screening programs regardless of their age.Am

J Gastroenterol advance online publication, 13 September 2011;

doi:10.1038/ajg.2011.302.

PMID: 21912436 [PubMed - as supplied by publisher]