Survival in Asian Americans after treatments for hepatocellular carcinoma: a seven-year experience at UCLA.
BACKGROUND
Hepatocellular carcinoma (HCC) is a common malignancy in Asians and is related to the high incidence of chronic viral hepatitis in this ethnic population. The aims of this study were to examine the tumor characteristics and liver disease status in HCC patients of Asian ancestry and determine their survival after treatments for HCC.


RESULTS
Between September 2000 and December 2007, 278 patients, mean age 61.5 years, presented with HCC to the University of California Los Angeles (UCLA) Liver Cancer Center. Hepatitis B (HBV) infection was detected in up to 68% of Chinese, Korean, and Vietnamese patients, whereas 60% of Japanese patients had Hepatitis C (HCV) infection. Compared with HCC patients who presented with symptoms, those detected by surveillance had more tumors within the Milan and University of California, San Francisco (UCSF) criteria and more patients in Child-Turcotte-Pugh class A. On the basis of a predefined UCLA treatment algorithm, 83% of patients received surgical and/or loco-regional therapies. Compared with other treatments, orthotopic liver transplantation (OLT), and radiofrequency ablation had the highest overall patient survival (P<0.0001) and OLT has the highest disease free survival rates (P<0.0001). Independent baseline predictors for: (1) patient survival were HBV [hazard ratio (HR) 0.62, P=0.005], UCSF criteria (HR 0.46, P<0.0001), Child Turcotte Pugh class A (HR 0.57, P=0.005), alphafetoprotein per log10 increase (HR 1.26, P=0.0012), and alkaline phosphatase per log10 increase (HR 2.32, P=0.02); and for (2) disease free survival were UCSF criteria (HR 0.66 P=0.007), aspartate aminotransferase per log10 increase (HR 1.50, P=0.04), and age per year increase (HR=1.02, P=0.04). The 4 Asian subgroups had similar survival rates.


CONCLUSIONS
HBV and Hepatitis C were associated with over 90% of HCC cases in Asian Americans. HCC detected by surveillance identified more patients eligible for surgical and loco-regional therapies, which improved the overall and disease free survival.
Tong
Myron J
MJ
The Dumont-UCLA Liver Cancer Center, Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. myrontong@hmri.org
Chavalitdhamrong
Disaya
D
Lu
David S K
DS
Raman
Steven S
SS
Gomes
Antoinette
A
Duffy
John P
JP
Hong
Johnny C
JC
Busuttil
Ronald W
RW
D000368:Aged; D000465:Algorithms; D001213:Asian; D002140:California / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D017115:Catheter Ablation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate