Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, USA.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, USA.
J Natl Med Assoc. 2021 Aug;113(4):396-404. doi: 10.1016/j.jnma.2021.02.001. Epub 2021 Feb 27.
The African American (AA) community in Washington DC is at an elevated risk for hepatocellular carcinoma (HCC) that has a dismal prognosis. The recent rapid increase in the incidence and diagnosis of HCC and liver metastases (LM) in DC prompted us to evaluate the past six decades of this incidence and some of its underlying causes using a single institutional cohort in a hospital located in the center of the city. Electronic medical and pathology records of 454 liver cancer patients from 1959 to 2013 at Howard University Hospital (HUH) were reviewed. Demographic, clinical and pathology characteristics were examined, and statistical analysis was performed using Wilcoxon rank-sum test. Incidence of HCC rose substantially between 1959 and 2013, increasing eight-fold from 1.05 to 8.0 per 100,000 AAs. The rate of increase in the last decade was highest at 550%. Cases were disproportionately male (67.2%), and median age at diagnosis was 57 years. Towards the last decade, the most common etiology for HCC was nonalcoholic fatty liver disease (NAFLD) followed by NAFLD/HCV combination. Liver cancer was clustered in the eastern region of DC in wards 4, 5, 7, and 8. Cases of liver metastases clinically diagnosed and confirmed by biopsies increased 96.4% from 1959 to 1968 to 2009-2013. This study confirms that HCC incidence has been increasing (initially driven by HCV, and NAFLD in the latter decades) more rapidly in DC than previously believed, highlighting the impact of case definitions especially regarding NAFLD in the context of changing diagnostic approaches including the revised ICD10. The rising burden, disproportionate population distribution, and low survival rate among AAs emphasize the importance of prevention and early detection as a public health imperative.
华盛顿特区的非裔美国人（AA）群体患肝细胞癌（HCC）的风险较高，而 HCC 的预后较差。最近，DC 肝癌和肝转移（LM）的发病率和诊断率迅速上升，促使我们利用位于市中心医院的单一机构队列，评估过去六十年的 HCC 发病率和一些潜在病因。回顾了霍华德大学医院（HUH） 1959 年至 2013 年间 454 例肝癌患者的电子病历和病理记录。检查了人口统计学、临床和病理学特征，并使用 Wilcoxon 秩和检验进行了统计分析。1959 年至 2013 年间，HCC 的发病率大幅上升，从每 10 万 AA 中 1.05 例增加到 8.0 例，增加了 8 倍。过去十年的增长率最高，为 550%。病例中男性比例偏高（67.2%），诊断时的中位年龄为 57 岁。在过去十年中，HCC 的最常见病因是非酒精性脂肪性肝病（NAFLD），其次是 NAFLD/HCV 联合。肝癌集中在 DC 的东部地区，包括第 4、5、7 和 8 病房。临床诊断和活检证实的肝转移病例从 1959 年至 1968 年增加了 96.4%，达到 2009 年至 2013 年。这项研究证实，HCC 的发病率在 DC 比之前认为的增长更快（最初由 HCV 驱动，而在最近几十年则由 NAFLD 驱动），突出了病例定义的影响，尤其是在包括 ICD10 修订版在内的诊断方法改变的情况下。非裔美国人的负担不断增加、人口分布不均以及生存率低，强调了预防和早期检测作为公共卫生当务之急的重要性。
