Racial and Ethnic Differences in Presentation and Outcomes of Hepatocellular Carcinoma.
Black
Disparities
Early Detection
Hispanic
Liver Cancer
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
03
12
2017
revised:
26
04
2018
accepted:
24
05
2018
pubmed:
4
6
2018
medline:
1
4
2020
entrez:
4
6
2018
Statut:
ppublish
Résumé
Racial and ethnic minorities are reported to have higher mortality related to hepatocellular carcinoma (HCC) than non-Hispanic whites. However, it is not clear whether differences in tumor characteristics or liver dysfunction among racial or ethnic groups affect characterization of causes for this disparity. We aimed to characterize racial and ethnic differences in HCC presentation, treatment, and survival. We performed a retrospective study of patients diagnosed with HCC from January 2008 through July 2017 at 2 large health systems in the United States. We used multivariable logistic regression and Cox proportional hazard models to identify factors associated with receipt of curative therapy and overall survival. Among 1117 patients with HCC (35.9% white, 34.3% black, 29.7% Hispanic), 463 (41.5%) were diagnosed with early stage HCC (Barcelona Clinic Liver Cancer stage 0/A) and 322 (28.8%) underwent curative treatment. Hispanic (odds ratio [OR], 0.75; 95% CI, 0.55-1.00) and black patients (OR, 0.74; 95% CI, 0.56-0.98) were less likely to be diagnosed with early stage HCC than white patients. Among patients with early stage HCC, Hispanics were less likely to undergo curative treatment than whites (OR, 0.58; 95% CI, 0.36-0.91). Black patients with early stage HCC were also less likely to undergo curative treatment than white patients, but this difference was not statistically significant (OR, 0.66; 95% CI, 0.43-1.03). Black and Hispanic patients had shorter median survival times than white patients (10.6 and 14.4 mo vs 16.3 mo). After adjusting for type of medical insurance, Child-Pugh class, Barcelona Clinic Liver Cancer stage, and receipt of HCC treatment, black patients had significantly higher mortality (hazard ratio, 1.12; 95% CI, 1.10-1.14) and Hispanic patients had lower mortality (hazard ratio, 0.83; 95% CI, 0.74-0.94) than white patients. In a retrospective study of patients diagnosed with HCC, we found racial/ethnic differences in outcomes of HCC to be associated with differences in detection of tumors at early stages and receipt of curative treatment. These factors are intervention targets for improving patient outcomes and reducing disparities.
Sections du résumé
BACKGROUND & AIMS
Racial and ethnic minorities are reported to have higher mortality related to hepatocellular carcinoma (HCC) than non-Hispanic whites. However, it is not clear whether differences in tumor characteristics or liver dysfunction among racial or ethnic groups affect characterization of causes for this disparity. We aimed to characterize racial and ethnic differences in HCC presentation, treatment, and survival.
METHODS
We performed a retrospective study of patients diagnosed with HCC from January 2008 through July 2017 at 2 large health systems in the United States. We used multivariable logistic regression and Cox proportional hazard models to identify factors associated with receipt of curative therapy and overall survival.
RESULTS
Among 1117 patients with HCC (35.9% white, 34.3% black, 29.7% Hispanic), 463 (41.5%) were diagnosed with early stage HCC (Barcelona Clinic Liver Cancer stage 0/A) and 322 (28.8%) underwent curative treatment. Hispanic (odds ratio [OR], 0.75; 95% CI, 0.55-1.00) and black patients (OR, 0.74; 95% CI, 0.56-0.98) were less likely to be diagnosed with early stage HCC than white patients. Among patients with early stage HCC, Hispanics were less likely to undergo curative treatment than whites (OR, 0.58; 95% CI, 0.36-0.91). Black patients with early stage HCC were also less likely to undergo curative treatment than white patients, but this difference was not statistically significant (OR, 0.66; 95% CI, 0.43-1.03). Black and Hispanic patients had shorter median survival times than white patients (10.6 and 14.4 mo vs 16.3 mo). After adjusting for type of medical insurance, Child-Pugh class, Barcelona Clinic Liver Cancer stage, and receipt of HCC treatment, black patients had significantly higher mortality (hazard ratio, 1.12; 95% CI, 1.10-1.14) and Hispanic patients had lower mortality (hazard ratio, 0.83; 95% CI, 0.74-0.94) than white patients.
CONCLUSIONS
In a retrospective study of patients diagnosed with HCC, we found racial/ethnic differences in outcomes of HCC to be associated with differences in detection of tumors at early stages and receipt of curative treatment. These factors are intervention targets for improving patient outcomes and reducing disparities.
Identifiants
pubmed: 29859983
pii: S1542-3565(18)30571-8
doi: 10.1016/j.cgh.2018.05.039
pmc: PMC6274621
mid: NIHMS972301
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
551-559.e1Subventions
Organisme : NCI NIH HHS
ID : R01 CA222900
Pays : United States
Organisme : NIMHD NIH HHS
ID : R01 MD012565
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK007745
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001105
Pays : United States
Informations de copyright
Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.
Références
Clin Gastroenterol Hepatol. 2015 Apr;13(4):791-8.e1
pubmed: 25019694
Liver Transpl. 2014 May;20(5):528-35
pubmed: 24415542
J Surg Res. 2017 Apr;210:253-260
pubmed: 28457336
Hepatobiliary Surg Nutr. 2016 Feb;5(1):43-52
pubmed: 26904556
Breast Cancer Res Treat. 2013 Jun;139(2):515-27
pubmed: 23657404
Gastroenterology. 2012 May;142(6):1264-1273.e1
pubmed: 22537432
Gastroenterology. 2017 Mar;152(4):812-820.e5
pubmed: 27889576
Gastroenterology. 2017 Jun;152(8):1954-1964
pubmed: 28283421
Cancer Prev Res (Phila). 2012 Sep;5(9):1124-30
pubmed: 22846843
Am J Gastroenterol. 2008 Jan;103(1):120-7
pubmed: 18005365
Cancer Control. 2015 Jan;22(1):95-101
pubmed: 25504283
J Natl Cancer Inst. 2002 Mar 6;94(5):334-57
pubmed: 11880473
J Natl Med Assoc. 2006 Dec;98(12):1934-9
pubmed: 17225837
Hepatology. 2017 Mar;65(3):875-884
pubmed: 27531684
Arch Surg. 2004 Sep;139(9):992-6
pubmed: 15381619
Arch Surg. 2010 Dec;145(12):1158-63
pubmed: 21173289
JAMA. 2002 Apr 24;287(16):2106-13
pubmed: 11966385
World J Gastroenterol. 2016 Oct 14;22(38):8584-8595
pubmed: 27784971
Cancer. 2016 Aug 15;122(16):2512-23
pubmed: 27195481
Genome Res. 2002 Jun;12(6):844-50
pubmed: 12045138
Am J Med. 2017 Sep;130(9):1099-1106.e1
pubmed: 28213044
Arch Intern Med. 2007 Oct 8;167(18):1983-9
pubmed: 17923599
J Natl Compr Canc Netw. 2015 May;13(5):543-9
pubmed: 25964640
Cancer. 2010 Mar 1;116(5):1367-77
pubmed: 20101732
J Gen Intern Med. 2012 Jul;27(7):861-7
pubmed: 22215266
Am J Med. 2015 Jan;128(1):90.e1-7
pubmed: 25116425
CA Cancer J Clin. 2015 Mar;65(2):87-108
pubmed: 25651787
Cancer. 2018 Feb 15;124(4):743-751
pubmed: 29072773
J Clin Oncol. 2016 Aug 20;34(24):2874-80
pubmed: 27325865
Aliment Pharmacol Ther. 2013 Oct;38(7):703-12
pubmed: 23957569
Gastroenterology. 2017 Feb;152(3):608-615.e4
pubmed: 27825963
Cancer. 2014 Dec 1;120(23):3683-90
pubmed: 25081065
Ann Surg Oncol. 2014 Apr;21(4):1287-95
pubmed: 24318095
J Natl Compr Canc Netw. 2013 Sep 1;11(9):1101-8
pubmed: 24029125