Ethnic differences in the behavior of hepatocellular carcinoma

BACKGROUND, The purpose of this study was to examine the clinical presentat ion, prognostic factors, and survival rates of patients with hepatocellular carcinoma (HCC) and to examine differences between Asian and non-Asian pat ients with HCC. METHODS. A review of the clinical characteristics and laboratory evaluation s for 76 patients in two different broad ethnic groups (Asians [Group 1] an d non-Asians [Group 2]) who underwent treatment for HCC from 1977-1995 was performed. Chi-square and Cox regression analyses were performed to assess factor interaction and association with survival. RESULTS. A total of 24 patients in Group 1 and 52 patients in Group 2 were reviewed. Of the clinical variables examined, a higher rate of a history of hepatitis B positivity was observed in Group 1 compared with Group 2 (32% vs. 6%; P = 0.001). Among the 76 patients with HCC, a 1-year survival estim ate of 41.4% was found. There was a borderline significant difference in su rvival between Group 1 and Group 2 with a 1-year survival estimate of 29.5% versus 46.9%, respectively (P = 0.08). Better overall survival was found i n patients who had tumors that were resectable (P = 0.0001), had an a-fetop rotein level < 10 ng/mL (P = 0.02), or were a younger age at the time of di agnosis (P = 0.01). There was a trend for Asian race (P = 0.08) to be assoc iated with poorer survival. When these risk factors were entered into a mul tivariate analysis, tumor resectability and non-Asian race were most predic tive of improved survival (model P Value = 0.007). When controlling for the multiple variables most often reported to be associated with HCC, Asians h ad a significantly lower survival than non-Asians (P < 0.01). CONCLUSIONS. In this study it appears that the outcome for Asian patients w ith hepatoma is worse than for non-Asian patients, even when controlling fo r factors commonly associated with HCC. Biologic or social factors that are not appreciated currently may be involved in Asian patients with HCC, cont ributing to a poorer clinical outcome. (C) 1999 American Cancer Society.