Introduction Hepatocellular carcinoma (HCC) is a major cause cancer-related mortality, world wide. In particular, HCC is associated with chronic hepatitis B infection (CHB) in Africa and South East Asia. Most published data relating to the natural history of CHB and HCC originates from South East Asia; however due to differences in HBV genotype and potential environmental and genetic factors, it is not clear whether this data are applicable to the African population. Therefore, to explore this issue we have compared the characteristics and outcomes of patients with CHB and HCC according to ethnic origin.
Methods Patients with HCC complicating CHB, managed at King's College Hospital London, were identified from our clinic databases. Demographic information, laboratory parameters, initial tumour staging and outcome data, including HBe-antigen status, viral load and genotype, were collated where available. Comparison was performed between Black patients and patients of South East Asian origin.
Results In total, 295 patients with HCC and CHB were identified. Median age at the diagnosis of tumour was 37 years and 85% of patients were male. Ethnicity was classified as Black in 27% of patients and South East Asian in 21% of these patients. Cirrhosis was present in 81% whereas 8% were non-cirrhotic at diagnosis of HCC; data were unavailable in the remaining 11% of patients. 18% were HBe-antigen positive and 7% hepatitis C antibody positive. The distribution of HBV genotypes varied according to ethnic group, with genotypes A and E restricted to Black patients and genotypes B and C to South East Asian patients. On comparing these two groups, there were no differences in gender, the presence of cirrhosis, co-factors for liver disease, laboratory parameters or tumour stage, as assessed by the BCLC staging system. However, Black patients were significantly younger (median age: 44 vs 61 years, p<0.001). Although not significant, there was a trend towards a greater frequency of HBe-antigen positivity in the Black patients. No difference in viral load was observed. There was an increased probability of death within the follow-up period in the Black group (66% vs 39%, p=0.004). Comparison of Kaplan–Meier survival curves for the two groups demonstrated decreased survival following diagnosis of HCC in the Black group (log rank: p=0.31).
Conclusion In our cohort, we have observed that Black patients present at a younger age and have poorer length of survival in comparison to South East Asian patients. This may represent a more aggressive HCC phenotype that is associated with HBV genotypes A and E although there are potentially multiple confounding factors. Further research is required to determine the cause of this apparent inequality.
Competing interests None declared.
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