Role of ethnicity in risk for hepatocellular carcinoma in patients with chronic hepatitis C and cirrhosis

Background & Aims: In the United States, hepatocellular carcinoma (HCC) is more common among Asians and African Americans than Caucasians, with chronic hepatitis C virus (HCV) infection accounting for up to half of the patients. Our study examined ethnicity as a potential risk factor for HCC among patients with chronic hepatitis C. Methods: We conducted a case-control study of 464 patients with chronic hepatitis C and cirrhosis (207 cancer patients and 257 controls) using medical records and pathology records at 4 medical centers. We estimated odds ratios with 95% confidence intervals by using conditional logistic regression on case-control sets, matched within study centers and study period on sex and age groups (≤45, 46–55, 56–65, >65 yr). To control for potential confounding caused by severity of cirrhosis and residual confounding caused by age, we also included Child-Turcotte-Pugh (CTP) scores and age (continuous variable) in all regression analyses. Results: Compared with Caucasians, the cancer risk was increased significantly among Asians (adjusted odds ratio, 4.3; 95% confidence interval, 2.1–9.0 for men, and 4.6; 1.2–18.5 for women) and somewhat increased among African-American men (adjusted odds ratio, 2.4; 95% confidence interval, 0.9–6.3). Conclusions: This study suggests that, among patients with chronic hepatitis C and cirrhosis, liver cancer risk is increased 4-fold in Asians and may be doubled in African-American men, compared with Caucasians. These results need confirmation in larger studies from racially diverse populations, but, if confirmed, these results point to high-risk populations that should be targeted for screening and preventive efforts. Background & Aims: In the United States, hepatocellular carcinoma (HCC) is more common among Asians and African Americans than Caucasians, with chronic hepatitis C virus (HCV) infection accounting for up to half of the patients. Our study examined ethnicity as a potential risk factor for HCC among patients with chronic hepatitis C. Methods: We conducted a case-control study of 464 patients with chronic hepatitis C and cirrhosis (207 cancer patients and 257 controls) using medical records and pathology records at 4 medical centers. We estimated odds ratios with 95% confidence intervals by using conditional logistic regression on case-control sets, matched within study centers and study period on sex and age groups (≤45, 46–55, 56–65, >65 yr). To control for potential confounding caused by severity of cirrhosis and residual confounding caused by age, we also included Child-Turcotte-Pugh (CTP) scores and age (continuous variable) in all regression analyses. Results: Compared with Caucasians, the cancer risk was increased significantly among Asians (adjusted odds ratio, 4.3; 95% confidence interval, 2.1–9.0 for men, and 4.6; 1.2–18.5 for women) and somewhat increased among African-American men (adjusted odds ratio, 2.4; 95% confidence interval, 0.9–6.3). Conclusions: This study suggests that, among patients with chronic hepatitis C and cirrhosis, liver cancer risk is increased 4-fold in Asians and may be doubled in African-American men, compared with Caucasians. These results need confirmation in larger studies from racially diverse populations, but, if confirmed, these results point to high-risk populations that should be targeted for screening and preventive efforts. Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are the major risk factors for hepatocellular carcinoma (HCC).1Szilagyi A. Alpert L. Clinical and histopathological variation in hepatocellular carcinoma.Am J Gastroenterol. 1995; 90: 15-23PubMed A. of hepatocellular carcinoma in the United A. factors for hepatocellular carcinoma among patients with chronic liver J of the of the In the United States, the HCC increased from and to and with the of among patients and of age in to in to the of of hepatocellular carcinoma in the United J factors for the of liver cancer in the United carcinoma and hepatitis C in the may be a common liver in patients with hepatocellular carcinoma in the United in the of hepatocellular carcinoma in the United the of infection in the United States, HCC is to be a major in the carcinoma and hepatitis C in the of hepatitis C in the United of high-risk patients among with may of and patients may the from screening and C. in of patients with hepatocellular carcinoma and in the United of hepatocellular and for hepatocellular Gastroenterol. C. A. and of HCC in age, more liver and are to be with increased risk for HCC in patients with chronic liver chronic hepatitis A. of risk factors for hepatocellular a of patients with and study of hepatitis B and C and factors with HCC risk in J A. and risk factors for hepatocellular carcinoma in patients with of factors the of hepatocellular carcinoma in patients with chronic hepatitis C study the results and and as potential risk factors for HCC study of hepatitis B and C and factors with HCC risk in J A. and risk factors for hepatocellular carcinoma in patients with of factors the of hepatocellular carcinoma in patients with chronic hepatitis C study C virus and risk of hepatocellular C virus infection and risk of hepatocellular carcinoma among of risk of hepatocellular carcinoma in patients with hepatitis C J Gastroenterol. A. A. A. C and risk of hepatocellular carcinoma in a A. A. study on hepatitis C virus (HCV) as a risk factor for hepatocellular the of and the with hepatitis B virus and HCC J A. and in the of hepatocellular J C. factors for of hepatocellular carcinoma among with hepatitis a case-control J C. C virus and risk of hepatocellular carcinoma in a case-control C. C virus infection in and 1995; L. C virus and and hepatocellular carcinoma in the United J Gastroenterol. A. A. L. A. on C virus and in patients with cirrhosis C at centers in C. C. C. C virus to of hepatocellular carcinoma and A. carcinoma in with with hepatitis C J L. L. A. of hepatitis C virus and of hepatitis C factors for hepatocellular of with hepatitis and In the United States, HCC and also in African Americans and of hepatocellular carcinoma in the United J in the of hepatocellular studies to examined ethnicity as a potential HCC risk factor in patients with chronic hepatitis C. of Asians in the United HCC risk in Asians with chronic hepatitis B risk also patients with chronic hepatitis C chronic hepatitis are compared with groups with chronic hepatitis C is of hepatitis B in J L. A. hepatocellular carcinoma in the United of J Gastroenterol. B the of hepatocellular carcinoma for and compared to in J of hepatitis B and C in and patients with hepatocellular carcinoma in the United of and ethnicity as a potential HCC risk factor in patients with chronic hepatitis we conducted a case-control study of patients with chronic hepatitis C and cirrhosis from 4 medical centers. we medical and pathology records for of chronic hepatitis cirrhosis, and HCC at the period from to at the from to at the of in from to and at the from to ethnicity by We age, Child-Turcotte-Pugh in liver and of the for J at a as the of for patients and as the of and studies for patients and control patients chronic hepatitis C and cirrhosis by liver of as and of of and of infection with we HCC by by liver for at A. L. Clinical of hepatocellular carcinoma of the of for of hepatocellular carcinoma in patients with hepatitis C and in of for of hepatocellular carcinoma in for of hepatocellular in patients with chronic liver of and of in patients for screening hepatocellular A. of in the screening of patients with chronic liver in study in for hepatocellular carcinoma in patients with chronic hepatitis in the United of control we the of HCC by studies and of C. for hepatocellular carcinoma in chronic of hepatitis B and of hepatocellular carcinoma in a 1995; A. factors and of hepatocellular carcinoma and 1995; studies with at at the if was than with studies than a of HCC and of for of hepatocellular carcinoma in patients with hepatitis C and a of patients with chronic hepatitis C and be as patients of and patients with ethnicity than African and also study included the 464 patients with chronic hepatitis C and patients and 257 study was by the at and of estimated odds ratios with 95% confidence intervals by using conditional logistic regression on case-control sets, matched within study centers and study and sex and age (≤45, 46–55, 56–65, >65 yr). To control for potential confounding caused by cirrhosis severity and residual confounding caused by age, we also included scores and age (continuous variable) in all was as a of than using the of by patients more than to be and to be as men, patients also more than to be as African of Clinical by and African in a was among patients. African-American patients more to compared with Caucasians, and Americans and in the is a for larger and in African Americans by in a factors for hepatocellular carcinoma in hepatitis C virus odds ratios for study age, and Asians more than to HCC ratio, 4.3; 95% confidence interval, 2.1–9.0 for odds ratio, 4.6; 95% confidence interval, 1.2–18.5 for was also a increased HCC risk in African-American men ratio, 2.4; 95% confidence interval, to on and by for severity of liver and age (continuous African African for severity of liver and age (continuous in a study that, among patients with cirrhosis to chronic hepatitis Asians and African Americans a risk for HCC than Caucasians. was for age, and severity of liver Americans 4 more to HCC than from a HCC than the from A. A. L. A. C virus and in patients with cirrhosis C at in A. of risk factors for hepatocellular a of patients with and study on risk factors for hepatocellular carcinoma among patients with liver J study of patients with and cirrhosis a HCC of to A. A. L. A. C virus and in patients with cirrhosis C at in the studies of patients with and cirrhosis a HCC of up to to if the of these patients also liver in to A. of risk factors for hepatocellular a of patients with and study on risk factors for hepatocellular carcinoma among patients with liver J for the increased HCC risk in Asians may of of in to the patients with of be by in liver of A. of hepatocellular carcinoma in the United also may infection from medical and of hepatitis B in J at the age, patients may with for than of may the infection the of In compared with the of and the 4 study centers are more and Asians in the study This may be to to and in also be to the that at of the study centers of in and also patients from of and may be more and Asians than in the study to patients with cirrhosis to infection to on the common of HCC in the United and to the of confounding by case-control in of infection and cirrhosis, of the HCC risk We to potential confounding by and for these and HCC that is of of liver and severity of cirrhosis is studies these patients liver patients with liver of severity in the control study of hepatitis B and C and factors with HCC risk in J A. and risk factors for hepatocellular carcinoma in patients with of factors the of hepatocellular carcinoma in patients with chronic hepatitis C study A. A. study on hepatitis C virus (HCV) as a risk factor for hepatocellular the of and the with hepatitis B virus and HCC J A. and in the of hepatocellular J C. factors for of hepatocellular carcinoma among with hepatitis a case-control J factors for hepatocellular of with hepatitis and increased odds ratios with ethnicity if from that a of Caucasians, from that a racially diverse of patients. To we matched all case-control within study centers and study in to for severity of liver cirrhosis in all study that, among patients with cirrhosis, the HCC risk is 4-fold in Asians than and also may be increased in African-American These results need confirmation in larger studies in racially diverse populations if confirmed, point to high-risk populations that be targeted for screening and preventive efforts. Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are the major risk factors for hepatocellular carcinoma (HCC).1Szilagyi A. Alpert L. Clinical and histopathological variation in hepatocellular carcinoma.Am J Gastroenterol. 1995; 90: 15-23PubMed A. of hepatocellular carcinoma in the United A. factors for hepatocellular carcinoma among patients with chronic liver J of the of the In the United States, the HCC increased from and to and with the of among patients and of age in to in to the of of hepatocellular carcinoma in the United J factors for the of liver cancer in the United carcinoma and hepatitis C in the may be a common liver in patients with hepatocellular carcinoma in the United in the of hepatocellular carcinoma in the United the of infection in the United States, HCC is to be a major in the carcinoma and hepatitis C in the of hepatitis C in the United of high-risk patients among with may of and patients may the from screening and C. in of patients with hepatocellular carcinoma and in the United of hepatocellular and for hepatocellular Gastroenterol. C. A. and of HCC in age, more liver and are to be with increased risk for HCC in patients with chronic liver chronic hepatitis A. of risk factors for hepatocellular a of patients with and study of hepatitis B and C and factors with HCC risk in J A. and risk factors for hepatocellular carcinoma in patients with of factors the of hepatocellular carcinoma in patients with chronic hepatitis C study the results and and as potential risk factors for HCC study of hepatitis B and C and factors with HCC risk in J A. and risk factors for hepatocellular carcinoma in patients with of factors the of hepatocellular carcinoma in patients with chronic hepatitis C study C virus and risk of hepatocellular C virus infection and risk of hepatocellular carcinoma among of risk of hepatocellular carcinoma in patients with hepatitis C J Gastroenterol. A. A. A. C and risk of hepatocellular carcinoma in a A. A. study on hepatitis C virus (HCV) as a risk factor for hepatocellular the of and the with hepatitis B virus and HCC J A. and in the of hepatocellular J C. factors for of hepatocellular carcinoma among with hepatitis a case-control J C. C virus and risk of hepatocellular carcinoma in a case-control C. C virus infection in and 1995; L. C virus and and hepatocellular carcinoma in the United J Gastroenterol. A. A. L. A. on C virus and in patients with cirrhosis C at centers in C. C. C. C virus to of hepatocellular carcinoma and A. carcinoma in with with hepatitis C J L. L. A. of hepatitis C virus and of hepatitis C factors for hepatocellular of with hepatitis and In the United States, HCC and also in African Americans and of hepatocellular carcinoma in the United J in the of hepatocellular studies to examined ethnicity as a potential HCC risk factor in patients with chronic hepatitis C. of Asians in the United HCC risk in Asians with chronic hepatitis B risk also patients with chronic hepatitis C chronic hepatitis are compared with groups with chronic hepatitis C is of hepatitis B in J L. A. hepatocellular carcinoma in the United of J Gastroenterol. B the of hepatocellular carcinoma for and compared to in J of hepatitis B and C in and patients with hepatocellular carcinoma in the United of and ethnicity as a potential HCC risk factor in patients with chronic hepatitis we conducted a case-control study of patients with chronic hepatitis C and cirrhosis from 4 medical centers. we medical and pathology records for of chronic hepatitis cirrhosis, and HCC at the period from to at the from to at the of in from to and at the from to ethnicity by We age, Child-Turcotte-Pugh in liver and of the for J at a as the of for patients and as the of and studies for patients and control patients chronic hepatitis C and cirrhosis by liver of as and of of and of infection with we HCC by by liver for at A. L. 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To control for potential confounding caused by cirrhosis severity and residual confounding caused by age, we also included scores and age (continuous variable) in all was as a of than using ethnicity as a potential HCC risk factor in patients with chronic hepatitis we conducted a case-control study of patients with chronic hepatitis C and cirrhosis from 4 medical centers. we medical and pathology records for of chronic hepatitis cirrhosis, and HCC at the period from to at the from to at the of in from to and at the from to ethnicity by We age, Child-Turcotte-Pugh in liver and of the for J at a as the of for patients and as the of and studies for patients and control patients chronic hepatitis C and cirrhosis by liver of as and of of and of infection with we HCC by by liver for at A. L. 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L. Clinical of hepatocellular carcinoma of the of for of hepatocellular carcinoma in patients with hepatitis C and in of for of hepatocellular carcinoma in for of hepatocellular in patients with chronic liver of and of in patients for screening hepatocellular A. of in the screening of patients with chronic liver in study in for hepatocellular carcinoma in patients with chronic hepatitis in the United of control we the of HCC by studies and of C. for hepatocellular carcinoma in chronic of hepatitis B and of hepatocellular carcinoma in a 1995; A. factors and of hepatocellular carcinoma and 1995; studies with at at the if was than with studies than a of HCC and of for of hepatocellular carcinoma in patients with hepatitis C and We a of patients with chronic hepatitis C and be as patients of and patients with ethnicity than African and also study included the 464 patients with chronic hepatitis C and patients and 257 study was by the at and of estimated odds ratios with 95% confidence intervals by using conditional logistic regression on case-control sets, matched within study centers and study and sex and age (≤45, 46–55, 56–65, >65 yr). To control for potential confounding caused by cirrhosis severity and residual confounding caused by age, we also included scores and age (continuous variable) in all was as a of than using We estimated odds ratios with 95% confidence intervals by using conditional logistic regression on case-control sets, matched within study centers and study and sex and age (≤45, 46–55, 56–65, >65 yr). To control for potential confounding caused by cirrhosis severity and residual confounding caused by age, we also included scores and age (continuous variable) in all was as a of than using the of by patients more than to be and to be as men, patients also more than to be as African of Clinical by and African in a was among patients. African-American patients more to compared with Caucasians, and Americans and in the is a for larger and in African Americans by in a factors for hepatocellular carcinoma in hepatitis C virus odds ratios for study age, and Asians more than to HCC ratio, 4.3; 95% confidence interval, 2.1–9.0 for odds ratio, 4.6; 95% confidence interval, 1.2–18.5 for was also a increased HCC risk in African-American men ratio, 2.4; 95% confidence interval, to on and by for severity of liver and age (continuous African African for severity of liver and age (continuous in a the of by patients more than to be and to be as men, patients also more than to be as African of Clinical by and African in a was among patients. African-American patients more to compared with Caucasians, and Americans and in the is a for larger and in African Americans by in a the of by patients more than to be and to be as men, patients also more than to be as African was among patients. 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C virus and in patients with cirrhosis C at in the studies of patients with and cirrhosis a HCC of up to to if the of these patients also liver in to A. of risk factors for hepatocellular a of patients with and study on risk factors for hepatocellular carcinoma among patients with liver J for the increased HCC risk in Asians may of of in to the patients with of be by in liver of A. of hepatocellular carcinoma in the United also may infection from medical and of hepatitis B in J at the age, patients may with for than of may the infection the of In compared with the of and the 4 study centers are more and Asians in the study This may be to to and in also be to the that at of the study centers of in and also patients from of and may be more and Asians than in the study to patients with cirrhosis to infection to on the common of HCC in the United and to the of confounding by case-control in of infection and cirrhosis, of the HCC risk We to potential confounding by and for these and HCC that is of of liver and severity of cirrhosis is studies these patients liver patients with liver of severity in the control study of hepatitis B and C and factors with HCC risk in J A. and risk factors for hepatocellular carcinoma in patients with of factors the of hepatocellular carcinoma in patients with chronic hepatitis C study A. A. study on hepatitis C virus (HCV) as a risk factor for hepatocellular the of and the with hepatitis B virus and HCC J A. and in the of hepatocellular J C. factors for of hepatocellular carcinoma among with hepatitis a case-control J factors for hepatocellular of with hepatitis and increased odds ratios with ethnicity if from that a of Caucasians, from that a racially diverse of patients. To we matched all case-control within study centers and study in to for severity of liver cirrhosis in all study that, among patients with cirrhosis, the HCC risk is 4-fold in Asians than and also may be increased in African-American These results need confirmation in larger studies in racially diverse populations if confirmed, point to high-risk populations that be targeted for screening and preventive efforts. study that, among patients with cirrhosis to chronic hepatitis Asians and African Americans a risk for HCC than Caucasians. was for age, and severity of liver Americans 4 more to HCC than from a HCC than the from A. A. L. A. C virus and in patients with cirrhosis C at in A. of risk factors for hepatocellular a of patients with and study on risk factors for hepatocellular carcinoma among patients with liver J study of patients with and cirrhosis a HCC of to A. A. L. A. C virus and in patients with cirrhosis C at in the studies of patients with and cirrhosis a HCC of up to to if the of these patients also liver in to A. of risk factors for hepatocellular a of patients with and study on risk factors for hepatocellular carcinoma among patients with liver J for the increased HCC risk in Asians may of of in to the patients with of be by in liver of A. of hepatocellular carcinoma in the United also may infection from medical and of hepatitis B in J at the age, patients may with for than of may the infection the of In compared with the of and the 4 study centers are more and Asians in the study This may be to to and in also be to the that at of the study centers of in and also patients from of and may be more and Asians than in the We study to patients with cirrhosis to infection to on the common of HCC in the United and to the of confounding by case-control in of infection and cirrhosis, of the HCC risk We to potential confounding by and for these and HCC that is of of liver and severity of cirrhosis is studies these patients liver patients with liver of severity in the control study of hepatitis B and C and factors with HCC risk in J A. and risk factors for hepatocellular carcinoma in patients with of factors the of hepatocellular carcinoma in patients with chronic hepatitis C study A. A. study on hepatitis C virus (HCV) as a risk factor for hepatocellular the of and the with hepatitis B virus and HCC J A. and in the of hepatocellular J C. factors for of hepatocellular carcinoma among with hepatitis a case-control J factors for hepatocellular of with hepatitis and increased odds ratios with ethnicity if from that a of Caucasians, from that a racially diverse of patients. To we matched all case-control within study centers and study in to for severity of liver cirrhosis in all study that, among patients with cirrhosis, the HCC risk is 4-fold in Asians than and also may be increased in African-American These results need confirmation in larger studies in racially diverse populations if confirmed, point to high-risk populations that be targeted for screening and preventive efforts.