title: Clinical presentation and survival of Asian and non-Asian patients with HCV-related hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatitis C virus (HCV) is an important cause of hepatocellular carcinoma (HCC) in Asians; however, it is often overlooked due to the high prevalence of hepatitis B virus in Asians. This study examines HCV-related HCC in Asians.
  
  
  METHODS
  We conducted a retrospective cohort study of 792 consecutive Asian (n = 220) and non-Asian (n = 572) patients with HCV-related HCC identified at Stanford University Medical Center using International Classification of Diseases-9 diagnosis between July 1996 and June 2012.
  
  
  RESULTS
  Asian patients were much older [66 (38-88) vs. 56 (31-87) years, P < 0.0001] and more likely to be female (33 vs. 19 %, P < 0.0001). A larger proportion of Asians were diagnosed with HCC within 2 years of HCV diagnosis (35 vs. 20 %, P = 0.001). Asian patients were more likely to undergo palliative therapy (46 vs. 28 %) and less likely to be listed for liver transplantation (20 vs. 48 %, P < 0.001), despite similar rates of meeting Milan criteria (52 vs. 58 %, P = 0.16). Overall, there was a trend for higher median survival rates in Asians (30 vs. 21 months, P = 0.091). Asians had higher long-term survival with palliative therapy only (5-year survival: 28 vs. 10 %, P < 0.0001); however, survival was similar among patients listed for liver transplantation.
  
  
  CONCLUSIONS
  There were distinct differences in clinical presentations of Asian and non-Asian patients with HCV-related HCC. Asians with HCV-related HCC are less likely to undergo liver transplantation and more likely to have delayed HCV diagnosis. Improved strategies in HCV screening in Asians are needed, as it may lead to earlier diagnosis and treatment of HCV infection and possible prevention of HCC development.
authors.affiliation: Medical School, Eastern Virginia Medical School, Norfolk, VA, 23507, USA, byip.ucsd@gmail.com.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Yip
authors.forename: James M
authors.initials: JM
authors.lastname: Wantuck
authors.forename: Lily H
authors.initials: LH
authors.lastname: Kim
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
authors.forename: Gabriel
authors.initials: G
authors.lastname: Garcia
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000208:ethnology* / Q000401:mortality / Q000821:virology; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies