title: Role of ethnicity in risk for hepatocellular carcinoma in patients with chronic hepatitis C and cirrhosis.
abstract: OBJECTIVE
  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 (< or =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.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA 94305, USA.
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
authors.forename: Alice S
authors.initials: AS
authors.lastname: Whittemore
authors.forename: Ruel T
authors.initials: RT
authors.lastname: Garcia
authors.forename: Saraa A
authors.initials: SA
authors.lastname: Tawfeek
authors.forename: Jing
authors.initials: J
authors.lastname: Ning
authors.forename: Suzanna
authors.initials: S
authors.lastname: Lam
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Wright
authors.forename: Emmet B
authors.initials: EB
authors.lastname: Keeffe
mesh_terms: D001741:Black or African American; D000368:Aged; D001213:Asian; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000208:ethnology* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000208:ethnology* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000208:ethnology; D008113:Liver Neoplasms / Q000150:complications / Q000208:ethnology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States; D044465:White People