Abstract
Background: Hepatocellular Carcinoma (HCC) is the 6th most common cancer and the 2nd leading cause of cancer-related mortality in the world. Sub-Saharan Africa and Eastern Asia are regions endemic for viral hepatitis, accounting for 80% of all HCC cases worldwide. A recent hospital-based study assessing the frequency of hepatitis B (HBV), hepatitis C (HCV), and HCC among Somali immigrants seen at Mayo Clinic determined the adjusted frequency for HBsAg positivity was 10-fold higher and anti-HCV positivity was 3-fold higher as compared to non-Somali residents of Olmsted County, Minnesota. Furthermore, HCV infection was identified as the leading contributor to HCC development among Somalis. The overall goal of this study is to determine the risk factors, surveillance, treatment options, and outcomes of Somalis with HCC seen at Mayo Clinic.
Methods: The Mayo Clinic Unified Data Platform Advanced Cohort Explorer (ACE) query tool was used to identify Somali patients seen at Mayo Clinic from March 1, 1998 to March 31, 2015. Clinical notes were searched in ACE using conjunction and disjunction combinations: the terms Somali, Somalia or Somalian were linked with the terms HCC, Hepatocellular Carcinoma or Liver Cancer. Diagnosis was validated using histopathology and/or imaging reports from the electronic medical record (EMR). To confirm the ethnicity of identified patients, names were screened by author HMA who is of Somali heritage. Variables abstracted from the EMR include demographics, etiology of HCC, diagnosis date, date of death or last contact, Child-Turcotte-Pugh class, Barcelona Clinic Liver Cancer (BCLC) stage, comorbid conditions, initial and subsequent treatments, HCC surveillance, cirrhosis and other malignancies.
Results: 54 Somali patients diagnosed with HCC were seen at Mayo Clinic from March 1, 1998 to March 31, 2015. The mean age was 63±16.3 and 36 (67%) individuals were male. Thirty-eight (70%) of the 54 HCC patients had HCV, 14 (26%) had HBV, 1 (2%) had non-alcoholic steatohepatitis (NASH), and 1 (2%) had unknown etiology for HCC. Of those with known HCV genotypes, the most common were genotype 4 (45%) and 3 (35%). At the time of HCC diagnosis, 16 (32%) presented with BCLC stage A, 5 (10%) with stage B, 17 (34%) with stage C, and 12 (24%) with stage D. Of the 54 patients, 43 (80%) had cirrhosis, 15 (28%) had vascular invasion, and 10 (19%) had metastatic HCC. Regarding treatment, 12 (22%) patients received curative treatment while 42 (78%) received palliative treatment. Orthotopic liver transplantation (OLT) was received by 3 (6%) of Somali patients compared to 19% of non-Somali HCC patients seen at Mayo Clinic between 2007 and 2009. HCC was detected during surveillance in 11 (20%) Somali HCC patients; of the 11, 2 (4%) received semiannual surveillance.
Conclusions: These findings provide a starting point to address liver cancer disparities among Somalis. HCV genotype 4 was most commonly associated with HCC development among the study population. Due to low surveillance rates, more Somalis presented with end-stage liver disease. Furthermore, advanced stage HCC was disproportionately found among Somalis compared to the general North American population. A recent study demonstrated that 11% of North American HCC patients seen at 4 major medical centers presented with stage D. By contrast, our study found 25% of Somalis had Stage D HCC. As a result, Somalis are more likely to receive palliative rather than curative treatments. Improving the identification of individuals with chronic HBV or HCV who are at increased risk for HCC and implementing more comprehensive HCC surveillance is likely to reduce the burden of HCC among this population.
Citation Format: Hawa M. Ali, Nasra H. Giama, Hager Ahmed Mohammed, Essa A. Mohamed, Ju Dong Yang, Abdirashid M. Shire, Lewis R. Roberts. Hepatocellular carcinoma characteristics and outcomes among Somali immigrants. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B64.
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