AIM: In the USA, Hawaii has the highest incidence of hepatocellular carcinoma (HCC) and a diverse population. It is an ideal place to characterize HCC in the context of ethnicity/risk factors. METHODS: A total of 262 cases of HCC (1992-2003) were retrospectively reviewed for demographics, ethnicity, birthplace, viral hepatitis, alcohol use, diabetes, smoking and risk factors for viral hepatitis such as intravenous drug abuse (IVDA), transfusions, tattoos and vertical transmission. Tumor stage, Child’s class, Cancer of the Liver Italian Program (CLIP) score,α-fetoprotein level, treatment and survival were recorded. RESULTS: Gender, age, viral hepatitis, alcohol, IVDA, and diabetes differed significantly in Asians, non-Asians and Pacific Islanders. There were also specific differences within Asian subgroups. Alpha-fetoprotein, smoking, transfusions, stage and resectability did not differ between groups. Asians were more likely to have hepatitis B, while non-Asians were more likely to have hepatitis C. Factors that decreased survival included hepatitis B, alcohol, elevated alpha-fetoprotein, CLIP >2 and increased Child’s class. When Asians were combined with Pacific Islanders, median survival (1.52 years vs 3.54 years), 1-and 3-year survival was significantly worse than those for non-Asians. After Cox regression analysis for hepatitis B and alcohol, there was no difference in survival by ethnicity. CONCLUSION: Various ethnicities have different risk factors for HCC. Hepatitis B, alcohol, and α-fetoprotein are more important factors for survival than ethnicity. AIM: In the USA, Hawaii has the highest incidence of hepatocellular carcinoma (HCC) and a diverse population. METHODS is A Histopathological Character of HCC in the Context of Ethnicity / Risk Factors. METHODS: A total of 262 cases of HCC (1992 2003) were retrospectively reviewed for demographics, ethnicity, birthplace, viral hepatitis, alcohol use, diabetes, smoking and risk factors for viral hepatitis such as intravenous drug abuse (IVDA), transfusions, tattoos and vertical transmission. Tumor stage, Child’s class, Cancer of the Liver Italian Program (CLIP) score, α-fetoprotein level, treatment and survival were recorded. RESULTS: Gender, age, viral hepatitis, alcohol, IVDA, and diabetes differed significantly in Asians, non-Asians and Pacific Islanders. There were also specific differences within Asian subgroups. Alpha-fetoprotein, smoking, transfusions, stage and resectability did not differ between groups. Asians were more likely to have hepatitis B, while non-Asians were more likely to ha When Asians were combined with Pacific Islanders, median survival (1.52 years vs. 3.54 years), 1-and 3- After Cox regression analysis for hepatitis B and alcohol, there was no difference in survival by ethnicity. CONCLUSION: Various ethnicities have different risk factors for HCC. Hepatitis B, alcohol, and α- fetoprotein are more important factors for survival than ethnicity.