title: The changing characteristics of hepatocellular cancer in Hawaii over time.
abstract: BACKGROUND
  The incidence of hepatocellular cancer (HCC) is increasing, and we sought to characterize the differences and trends in HCC over 2 decades in Hawaii.
  
  
  METHODS
  This retrospective study of 821 HCC cases analyzed risk factors, diabetes, alpha-fetoprotein (AFP), tumor characteristics, and treatment, comparing 5-year eras (1993 to 2012).
  
  
  RESULTS
  With succeeding eras, there were fewer Asians, immigrants, and hepatitis B-related HCC. Hepatitis C, diabetes, hyperlipidemia, and body mass index have increased. Over time, more patients had normal AFP, and normal AFP was seen more often in nonviral HCC (49.6% vs 33.2%, P = .007). Over time, the proportion of patients who underwent resection or transplant was stable, but fewer patients underwent no therapy.
  
  
  CONCLUSIONS
  Characteristics of HCC are changing, and diagnosis may be more difficult as metabolic factors are becoming more important than viral factors. AFP seems to be a less important biomarker, and clearly, better diagnostic tools will be necessary to identify HCC in the future.
authors.affiliation: Department of Surgery, John A. Burns School of Medicine, University of Hawaii, 550 South Beretania Street, Suite 403, Honolulu, Hawaii 96813, USA; Transplant Center, Queens Medical Center, Honolulu, HI, USA; Cancer Center, University of Hawaii, Honolulu, HI, USA. Electronic address: hepatoma@aol.com.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wong
authors.affiliation: Department of Surgery, John A. Burns School of Medicine, University of Hawaii, 550 South Beretania Street, Suite 403, Honolulu, Hawaii 96813, USA; Transplant Center, Queens Medical Center, Honolulu, HI, USA.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ogihara
authors.affiliation: Cancer Center, University of Hawaii, Honolulu, HI, USA.
authors.forename: Junfang
authors.initials: J
authors.lastname: Ji
authors.affiliation: Liver Center, Queens Medical Center, Honolulu, HI, USA.
authors.forename: Naoky
authors.initials: N
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Hepatocellular cancer; Liver resection; Liver transplant; Metabolic factors; Viral hepatitis