title: Liver cancer in Malaysia: epidemiology and clinical presentation in a multiracial Asian population.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) is an important cancer in Malaysia. This study aimed to determine the epidemiological characteristics and clinical presentations of patients in a multiracial population consisting of three major Asian races: Malays, Chinese and Indians.
  
  
  METHODS
  Consecutive patients with HCC were prospectively studied from 2006 to 2009. HCC was diagnosed principally on multiphasic computed tomography and magnetic resonance imaging scans of the liver. The tumor was staged according to the Barcelona Clinic Liver Cancer (BCLC) classification.
  
  
  RESULTS
  Altogether, 348 patients were diagnosed with HCC. There were 239 (68.7%) Chinese patients, 71 (20.4%) Malays and 38 (10.9%) Indians, with the median age of 62.5 years and the male to female ratio of 3.4:1. The predominant etiology in Malay and Chinese patients was hepatitis B virus infection (>60%) and in Indian patients was alcohol intake (26.3%) and cryptogenic cause (29.0%). Hepatitis C was seen in 18.3% of Malays, but less than 10% in Chinese and Indians. BCLC staging was: Stage A, 120 (34.5%); Stage B, 75 (21.6%); Stage C, 84 (24.1%); and Stage D, 69 (19.8%). A larger proportion of Indian than Chinese and Malays patients (44.7%) presented with stage D disease. Portal vein invasion was noted in 124 patients (35.6%) and extrahepatic metastases in 68 (19.5%). Surgical resection and radiofrequency ablation with curative intent was carried out in >90% of stage A patients and transarterial chemoembolization in 49.3% and 21.4% of stages B and C patients, respectively.
  
  
  CONCLUSIONS
  HCC is most common among Chinese, followed by Malays and Indians in Malaysia. The etiology of HCC shows a peculiar racial pattern.
authors.affiliation: Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Khean-Lee
authors.initials: KL
authors.lastname: Goh
authors.forename: Hamizah
authors.initials: H
authors.lastname: Razlan
authors.forename: Juanda Leo
authors.initials: JL
authors.lastname: Hartono
authors.forename: Choon-Seng
authors.initials: CS
authors.lastname: Qua
authors.forename: Boon-Koon
authors.initials: BK
authors.lastname: Yoong
authors.forename: Peng-Soon
authors.initials: PS
authors.lastname: Koh
authors.forename: Basri Johan Jeet
authors.initials: BJ
authors.lastname: Abdullah
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology / Q000556:secondary / Q000628:therapy; D002681:China / Q000208:ethnology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007194:India / Q000208:ethnology; D008103:Liver Cirrhosis / Q000208:ethnology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology / Q000628:therapy; D008175:Lung Neoplasms / Q000453:epidemiology / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins
keywords: BCLC staging; Chinese; Indian; Malay; hepatocelluar carcinoma; multiracial Asian population