Objective: Micronesians are a rapidly growing population both in Hawaii and the US. Hepatitis B is prevalent in Micronesia, but the consequences in those migrating to the US are not clear. This study characterizes Hepatocellular Carcinoma (HCC) in Micronesians and compares them to other Pacific Islanders (PI) with HCC.
Methods: This is a retrospective evaluation from a prospectively collected database of 1206 patients with HCC from 1993-2017. We identified 40 Micronesians and 142 Non-Micronesian PI (NMPI) and compared risk factors, clinical presentation, tumor characteristics, and treatments.
Results: All Micronesians were born in Micronesia, but 81.5% of the NMPI were born in the US (p<0.0001). Micronesians were younger (52.0 vs 60.2 years, p<0.0001), had higher rates of Hepatitis B (80% vs 31.2%, p<0.0001), a family history of HCC (17.5% vs 4.4%, p=0.011), and more tumors <5 cm (64.1% vs 45.2%, p=0.046). NMPI had higher rates of Hepatitis C (48.6% vs 22.5%, p=0.004) and hypertension (61.7% vs 32.4%, p=0.002). Tumor stage, vascular invasion, rupture, meeting Milan criteria and underlying liver function did not differ significantly. Micronesians received more liver transplants (5% vs 0%, p=0.048) and had better 5-year survival rates (48% vs 16.7%, p=0.002).
Conclusion: HCC in Micronesians is primarily Hepatitis B-related compared to NMPI. Despite being relatively new to healthcare in the US, Micronesians were equally likely to have HCC found with screening, more likely to receive a liver transplant and had better survival. Our study emphasizes the need for hepatitis B screening and HCC surveillance in this population.