Hepatocellular Carcinoma in Micronesians, a Growing Pacific Islander Population in the U.S.

Abstract

Background: Micronesians are a rapidly growing population in Hawaii and the continental U.S. Hepatitis B is prevalent in Micronesia, but the consequences in those migrating to the U.S. are unclear. This study characterizes hepatocellular carcinoma in Micronesians with comparisons to other Pacific Islanders. Methods: A retrospective evaluation was undertaken of 40 Micronesian and 142 Non-Micronesian Pacific hepatocellular carcinoma patients diagnosed in a large clinical practice in Hawaii from 1993-2017. Results: All Micronesians were born outside of the U.S. Micronesians were younger at diagnosis (52.0 vs. 60.2 years), had higher rates of hepatitis B (80% vs. 31.2%), a family history of hepatocellular carcinoma (17.5% vs. 4.4%) and more tumors <5 cm (64.1% vs. 45.2%). Non Micronesian Pacific Islanders had higher rates of Hepatitis C (48.6% vs. 22.5%) and hypertension (61.7% vs. 32.4%). There was no difference in the proportions of screen-detected tumors, those meeting Milan criteria, tumor stage, or liver function. Micronesians had better 5-year survival rates (48% vs. 16.7%). Conclusion: Hepatocellular carcinoma in Micronesians is primarily Hepatitis B-related. Micronesians were equally likely to have hepatocellular carcinoma found with screening, undergo transplant and had better survival. Our study emphasizes the need for hepatitis B screening and hepatocellular carcinoma surveillance in Micronesians.