Hepatocellular Carcinoma in Pacific Islanders vs. Whites

Pacific Islanders (PI) have amongst the highest incidences of hepatocellular carcinoma (HCC), but large studies characterizing this population are limited. This study explores potential disparities in treatment and outcome by comparison of PIs and Whites with HCC treated at a single center. A prospectively collected database of 1608 patients diagnosed with HCC from 1993-2022 at the only liver disease/transplant center in Hawai'i identified 252 PI and 338 White patients. Demographic, medical history, laboratory, tumor characteristics, treatment, survival data were collected. Chi-square, t-test, univariate logistic regression analyses and Kaplan-Meier survival analysis were conducted. Compared to Whites, PIs were younger, had lower educational attainment, and were more likely to be born outside the US. PIs also had a 4-fold higher likelihood of Hepatitis B (HBV) infection and higher rates of metabolic comorbidities. In contrast, Whites were 3 times more likely to have Hepatitis C infection, with higher likelihood of history of high-risk behavior (illicit drugs, incarceration, tattoos) and higher rates of presentation with cirrhosis. Of patients with screenable diseases, PIs were less than half as likely to be diagnosed through screening and presented with larger tumors and more advanced disease. Both groups were equally likely to receive treatment (including surgical treatment). Survival was similar between groups. Disparities in HCC screening and presentation seen in PIs may be attributed to high rates of occult HBV infection in this group. Initiatives to further improve outcomes for HCC in PIs should concentrate on expanding screening for chronic viral hepatitis and addressing barriers to care delivery following diagnosis.