Risk Factors for Early-Onset and Late-Onset Hepatocellular Carcinoma in Asian Im

StephenW

Am J Gastroenterol. 2011 Sep 13. doi: 10.1038/ajg.2011.302. [Epub ahead of
print]

Risk Factors for Early-Onset and Late-Onset Hepatocellular Carcinoma in
Asian Immigrants With Hepatitis B in the United States.

Wan DW, Tzimas D, Smith JA, Kim S, Araujo J, David R, Lobach I, Sarpel U.

Source

Division of Gastroenterology, Department of Medicine, NYU Langone Medical
Center, New York, New York, USA.

Abstract

OBJECTIVES:

Routine screening for hepatocellular carcinoma (HCC) is recommended in
chronic hepatitis B (HBV) patients with cirrhosis and select non-cirrhotic
HBV populations including Asian males ages 40 and older and females ages 50
and older. However, many younger HBV patients develop HCC and there have
been few studies examining this group. Additionally, studies of HCC in the
Asian immigrant population in the United States have been limited. The
objective of this study was to determine the associated risk factors for
the development of early-onset (males and females under ages 40 and 50,
respectively) and late-onset HCC in immigrants with chronic HBV in the
United States.

METHODS:

Clinical, demographic, and laboratory data were retrospectively collected
on all Asian immigrants with HBV at Bellevue Hospital Center from 2003 to
2009. Patients with HCC were identified within this cohort. Features of
early-onset and late-onset HCC cases were compared with age-matched HBV
controls without HCC.

RESULTS:

We identified 168 cases of HCC in Asians with HBV. In all, 74% (124/168) of
cases were late-onset, and 26% (44/168) were early-onset. When comparing
the 124 late-onset HCC cases with 199 age-matched HBV controls, gender
(odds ratio (OR)=4.4; P<0.05) and cirrhosis (OR=9.6; P<0.05) or surrogate
labs (i.e., platelets, international normalized ratio, total bilirubin,
albumin) were found to be associated with HCC development. When comparing
the 44 early-onset HCC cases with 432 age-matched HBV controls, family
history of HCC (OR=2.7; P<0.05), and smoking history (OR=3.4; P<0.05) were
independently associated risk factors in addition to gender (OR=2.7;
P<0.05), and cirrhosis (OR=19.5; P<0.05) or surrogate labs. In all, 54.8%
of late-onset HCC cases were cirrhotic and 29.5% of early-onset HCC cases
were cirrhotic.

CONCLUSIONS:

HCC occurs in Asian immigrant HBV patients younger than currently
recommended screening guidelines. A large majority of these early-onset
patients did not have cirrhosis at the time of their HCC diagnosis;
therefore, factors other than cirrhosis need to be considered when
evaluating HCC risk in young patients. Factors associated with HCC
development across all ages include cirrhosis and male gender, while family
history and smoking history may identify younger Asian immigrant HBV
patients at risk for HCC. Prospective validation, including
cost-effectiveness evaluation, is necessary, but our results suggest that
younger Asian HBV patients, especially those with a smoking history or
family history of HCC, appear to have an increased risk for HCC and should
be considered for enrollment in early screening programs regardless of
their age.Am J Gastroenterol advance online publication, 13 September 2011;
doi:10.1038/ajg.2011.302.



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StephenW

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胃肠病学杂志。 2011年09月13日。作者：10.1038/ajg.2011.302。 [检索策略
打印]

早发和晚发性肝癌的风险因素
乙肝在美国的亚裔移民。

万德国之声，Tzimas ð，史密斯JA，金小号，阿劳霍J，大卫R，洛巴奇我，Sarpel U。

来源

肠胃科，医学系，纽约大学Langone医学
中心，纽约，纽约，美国。

摘要

目标：

肝细胞癌（HCC）的常规筛查，建议在
慢性乙型肝炎病毒（HBV）肝硬化患者，并选择非肝硬化
乙肝病毒的人群，包括亚洲男性年龄在40岁以上的女性年龄在50
以上。然而，许多年轻的乙肝患者发展肝癌和有
检查本组的研究很少。此外，在肝癌的研究
在美国的亚洲移民人口已有限。 “
这项研究的目的是要确定相关的危险因素
早发性（男性和女性在40岁和50岁的发展，
在慢性乙肝的移民）和迟发性肝癌
美国。

方法：

临床，人口和实验室资料进行回顾性收集
在Bellevue医院中心从2003年到乙肝病毒的所有亚洲移民
2009年。肝癌患者被确定在此队列中。功能
早发和晚发性肝癌宗相比，与年龄相匹配的乙肝病毒
控制无肝癌。

结果：

我们确定了在亚洲人168例肝癌与乙肝病毒。在所有，74％（168分之124）
例迟发性，和26％（一百六十八分之四十四）早发。当比较
199 HBV的年龄相匹配的控制，性别的124个迟发性肝癌病例
（比值比（OR）= 4.4，P <0.05）和肝硬化（OR = 9.6，P <0.05）或代理
实验室（即，血小板，国际标准化比值，总胆红素，
白蛋白）被发现与肝癌发展。当比较
早发44例肝癌432 HBV的年龄相匹配的控制，家庭
历史肝癌（OR = 2.7，P <0.05），吸烟史（OR = 3.4，P <0.05）
除了性别（OR = 2.7独立相关的危险因素;
P <0.05），肝硬化（OR = 19.5，P <0.05）或替代实验室。总之，54.8％
迟发性例肝癌肝硬化和早期发病的肝癌病例的29.5％
是肝硬化。

结论：

肝癌的发生比目前年轻亚裔移民的乙肝患者
建议筛选准则。大部分的这些早期发病
患者没有在其诊断肝癌的时间的肝硬化;
因此，比肝硬化的其他因素需要时要考虑的
年轻患者的肝癌风险评估。与肝癌的相关因素
在所有年龄段的发展，包括肝硬化和男性，而家庭
历史和吸烟史可识别年轻的亚洲移民乙肝病毒
患者在肝癌的风险。准验证，包括
成本效益评价，是必要的，但我们的结果表明，
年轻的亚洲乙肝患者，特别是那些与吸烟史或
肝癌家族史，出现肝癌的风险增加，并应
无论被认为是早期筛查方案的入学率
他们age.Am胃肠病学杂志提前在线出版，2011年9月13日;
作者：10.1038/ajg.2011.302。