Carr Jacquelyn, Cha Da Eun, Shaltiel Tali, Zheng Serena, Siderides Cleo, Golas Benjamin, Labow Daniel, Magge Deepa, Cohen Noah, Branch Andrea, Sarpel Umut
Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th St, 7th Floor, New York, NY, 10019, USA.
Division of Liver Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Immigr Minor Health. 2022 Apr;24(2):327-333. doi: 10.1007/s10903-021-01205-8. Epub 2021 Apr 27.
Guidelines recommend hepatitis B (HBV) testing in individuals from endemic areas, and if positive, screening for hepatocellular carcinoma (HCC). While screening programs are well established in the Asian immigrant population in New York City (NYC), less is known about the characteristics of HBV/HCC among the African immigrant community. A retrospective review was performed of HCC cases from 2005 to 2018 at our institution. Country of origin was not documented in the electronic medical record; therefore, African immigrant status was approximated using self-identified race/ethnicity, positive HBV status, and an online registry to determine country of origin based on last name. Surnames with the greatest prevalence or density in an African country were considered. Among 4400 patients with HCC, 472 identified as non-Hispanic Black; of these, 86 were HBV+. Based on surname, it was estimated that 33 individuals were likely immigrants from Africa. In this group, median age of HCC diagnosis was 48 years (IQR 43-55). In patients with an available date of HBV diagnosis (n = 24), 17 (71%) were unaware of their HBV status when they presented with HCC. Zero patients were diagnosed with HCC through routine screening, most patients (66%) were diagnosed upon imaging evaluation of symptoms. Twelve patients (36%) underwent resection or transplantation; the remaining 64% were ineligible for surgical treatment. Of the 26 patients with follow-up data, 18 (69%) died of disease or were critically ill at last encounter, and of these, 14 (77%) died within 1 year of HCC diagnosis. In conclusion, African immigrants in NYC with HBV/HCC are at high risk of HCC related mortality at a young age. Most were unaware of their hepatitis status at the time of HCC diagnosis. No patients were enrolled in routine HCC screening; the majority were diagnosed based on imaging obtained for symptoms. Most individuals presented with inoperable disease, and the majority died within months of diagnosis. Awareness of these findings may help healthcare providers improve patient outcomes.
指南建议对来自乙肝流行地区的个体进行乙肝（HBV）检测，若检测结果呈阳性，则需筛查肝细胞癌（HCC）。虽然纽约市（NYC）的亚洲移民群体中已经建立了完善的筛查项目，但对于非洲移民社区中HBV/HCC的特征了解较少。我们对本机构2005年至2018年的HCC病例进行了回顾性研究。电子病历中未记录患者的原籍国；因此，根据自我认定的种族/族裔、HBV阳性状态以及一个在线登记处，通过姓氏来确定原籍国，以此估算非洲移民身份。考虑姓氏在某个非洲国家中出现频率或密度最高的情况。在4400例HCC患者中，472例被认定为非西班牙裔黑人；其中，86例HBV检测呈阳性。根据姓氏估计，有33人可能是来自非洲的移民。在这组人群中，HCC诊断的中位年龄为48岁（四分位间距43 - 55岁）。在有HBV诊断日期的患者中（n = 24），17例（71%）在出现HCC时并不知道自己的HBV状态。没有患者通过常规筛查被诊断出HCC，大多数患者（66%）是在对症状进行影像学评估时被诊断出来的。12例患者（36%）接受了切除或移植手术；其余64%的患者不符合手术治疗条件。在有随访数据的26例患者中，18例（69%）死于疾病或在最后一次随访时病情危急，其中14例（77%）在HCC诊断后1年内死亡。总之，纽约市患有HBV/HCC的非洲移民在年轻时面临HCC相关死亡的高风险。大多数患者在HCC诊断时并不知道自己的肝炎状态。没有患者参加常规的HCC筛查；大多数患者是根据针对症状进行的影像学检查而被诊断出来的。大多数患者就诊时已患有无法手术治疗的疾病，并且大多数患者在诊断后的几个月内死亡。了解这些发现可能有助于医疗服务提供者改善患者的治疗结果。
