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Sex, race determine major risk factors for HCC in older patients
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Factors that most influence hepatocellular carcinoma risk varied between sex and race among elderly patients, but diabetes and obesity had the greatest overall effect in a recent study.
Researchers compared 6,991 patients aged 68 years or older diagnosed with HCC between 1994 and 2007 with a random sample of 255,702 Medicare beneficiaries with no previous HCC diagnosis. The mostly male cohort (65.7%), collected from the SEER database, was 71% white, 12% Asian, 8% black and 4% Hispanic.
Nearly a quarter of participants (22.9%) had HCV infection and 6.9% had HBV. Prior alcohol-related liver disease was observed in 31.2% of participants, and 4.5% had rare metabolic disorders. Diabetes and/or obesity was present in 61.5% of patients. HCC risk was significantly increased by HCV (OR=39.89; 95% CI, 36.29-43.84), HBV (OR=11.17; 95% CI, 9.18-13.59), alcohol-related disease (OR=4.06; 95% CI, 3.82-4.32), metabolic disorders (OR=3.45; 95% CI, 2.97-4.02) and diabetes/obesity (OR=2.47; 95% CI 2.34-2.61).
Investigators determined an overall population attributable fraction (PAF) of 64.5% for all evaluated risk factors. Men had a higher overall PAF than women (65.6% vs. 62.2%). When assessed by race, blacks had the lowest PAF (52.4%) while Asians had the highest (70.1%).
Diabetes/obesity had the largest overall PAF among assessed factors (36.6%), followed by alcohol-related disorders (23.5%) and HCV infection (22.4%). Diabetes/obesity also had the largest PAF among men (36.4%) and women (36.7%), as well as white (38.9%) and Hispanic patients (38.1%). HCV infection had the highest PAF among Asians (35.4%) and blacks (34.9%), and the second-highest among women (28.1%).
“This is the first population-based case-control study to report PAFs for HCC risk factors in the United States,” the researchers wrote. “The results … indicate that the dominant risk factors for HCC … may differ by sex and race/ethnicity. Overall, however, eliminating diabetes and obesity could have a larger effect on reducing the incidence of HCC than the elimination of any other risk factor.”
Disclosure: See the study for a full list of relevant disclosures.