The changing characteristics of hepatocellular cancer in Hawaii over time

•We examine the different risk factors over a 20-year period in a large population of patients with hepatocellular cancer in Hawaii.•Fewer Asians, immigrants, and hepatitis B–related liver cancer were seen over time.•More hepatitis C and metabolic factors such as diabetes, hyperlipidemia, and obesity were evident in the recent eras.•The sensitivity of alpha-fetoprotein is decreasing in liver cancer that is not related to viral hepatitis.

BackgroundThe incidence of hepatocellular cancer (HCC) is increasing, and we sought to characterize the differences and trends in HCC over 2 decades in Hawaii.MethodsThis retrospective study of 821 HCC cases analyzed risk factors, diabetes, alpha-fetoprotein (AFP), tumor characteristics, and treatment, comparing 5-year eras (1993 to 2012).ResultsWith succeeding eras, there were fewer Asians, immigrants, and hepatitis B–related HCC. Hepatitis C, diabetes, hyperlipidemia, and body mass index have increased. Over time, more patients had normal AFP, and normal AFP was seen more often in nonviral HCC (49.6% vs 33.2%, P = .007). Over time, the proportion of patients who underwent resection or transplant was stable, but fewer patients underwent no therapy.ConclusionsCharacteristics of HCC are changing, and diagnosis may be more difficult as metabolic factors are becoming more important than viral factors. AFP seems to be a less important biomarker, and clearly, better diagnostic tools will be necessary to identify HCC in the future.