Among U.S. veterans with hepatitis B, researchers found that the risk for hepatocellular carcinoma was higher among Asian-Pacific Islanders than Caucasians and African-Americans, increased with the presence of cirrhosis, and significantly increased among those without cirrhosis after age 40 regardless of race.
“Our results have important implications for HCC surveillance in HBV in the U.S.,” Sahil Mittal, MD, MS, from Baylor College of Medicine, Houston, and colleagues wrote. “We found that the annual risk of HCC was high in all patients with cirrhosis, ranging from 0.94% in [African-Americans] to as high as 3.4% in [Asian-Pacific Islanders]. These data provide support to the guidelines recommending HCC surveillance in all HBV infected individuals with underlying cirrhosis.”
Of the 8,329 veteran patients included in the study, 3,498 were Caucasian, 3,248 were African-American, 659 were Asian-Pacific Islander, and 924 were of unknown ethnicity. During 7 years of follow-up, 303 patients developed HCC for an incidence rate of 0.51 per 100 person-years.
The annual incidence rates of HCC per 100 person-years were 0.65 among Asian-Pacific Islanders, 0.57 among Caucasians and 0.4 among African-Americans. By age, the annual incidence rates of HCC per 100 person-years were 0.13 in patients aged 40 years or younger, 0.37 in patients aged 40 years to 49 years, 0.6 in patients aged 50 years to 59 years, and 0.9 in patients aged 60 years or older.
After adjusting for clinical and viral factors, the researchers observed a significantly higher risk for HCC in Asian-Pacific Islanders compared with Caucasians (HR = 2.04; 95% CI, 1.31-3.17), patients with cirrhosis (HR = 3.69; 95% CI, 2.82-4.82), patients who received antiviral treatment (HR = 1.75; 95% CI, 1.33-2.29), and patients with a history of alcohol abuse (HR = 1.37; 95% CI, 1.05-1.8).
Compared with patients younger than 40 years, the risk for HCC increased significantly among those aged 40 years to 49 years (HR = 1.97; 95% CI, 0.99-3.87), those aged 50 years to 59 years (HR = 3; 95% CI, 1.55-5.81), and those aged 60 years or older (HR = 4.02; 95% CI, 2.03-7.94). The risks for HCC by age were independent of race.
Additional findings included a lower annual incidence rate of HCC (0.04 vs. 0.54 per 100 person-years) and a significantly lower risk for HCC (HR = 0.14; 95% CI, 0.02-0.98) among women compared with men. – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.