The Changing pathogenesis of liver cancer in Hawaii over three decades.

Background: Worldwide trends support the increasing contribution of hepatic steatosis on the incidence of hepatocellular carcinoma (HCC). This study investigates if similar changes are seen in Hawaii, where the incidence of HCC is higher than most of the United States. Methods; This is a retrospective study of 1651 patients diagnosed with HCC (1991-2023) that includes 60-70% of Hawaii's HCC cases. We evaluated changes in patient demographics, risk factors, and disease etiology over the three decades.

Results: From 1991-2023, there were significant increases in the proportion of HCC cases attributable to metabolic-associated steatotic liver disease(MASLD), coinciding with a rise in the prevalence of metabolic risk factors including obesity, diabetes, hyperlipidemia, and hypertension. Cases with a history of smoking also increased through 2020. Conversely, HCC cases presenting with cirrhosis alone decreased. HCV-associated cases increased through 2015 and then tapered, while HBV-associated cases decreased through 2020. There was no significant change in the proportion of alcohol-associated cases.

Conclusions: While HBV continues to be a major contributor to HCC in Hawaii, HCV-related HCC cases have tapered, while metabolic risk factors for HCC and cases attributable to MASLD have increased over time, parallelling overall trends observed in the United States. Efforts are needed to manage these metabolic factors to address the burden of HCC. Impact; Although Hawaii continues to have a large burden of viral hepatitis related HCC, metabolic factors and MASLD have affected the pathogenesis of liver cancer in Hawaii over the past the past 3 decades.