Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb;5(1):43-52.
doi: 10.3978/j.issn.2304-3881.2015.08.05.

Racial disparities in treatment and survival of patients with hepatocellular carcinoma in the United States

Affiliations

Racial disparities in treatment and survival of patients with hepatocellular carcinoma in the United States

Li Xu et al. Hepatobiliary Surg Nutr. 2016 Feb.

Abstract

Background: While the incidence and mortality of hepatocellular carcinoma (HCC) continue to increase across the United States (US), disparities may exist relative to treatment modality and survival. The objective of the present study was to determine the factors associated with racial differences in survival among patients with HCC in the US.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with HCC between 1998 and 2012 in the US. Multivariable logistic regression analysis was performed to examine associations between type of therapy and race, while a multivariable Cox proportional hazards model was built to determine the effect of race on survival.

Results: A total of 58,186 patients with HCC were identified. Over two-thirds of patients were white (n=39,223, 67.4%), while 18.3% were Asian (n=10,665), 13.1% black (n=7,620) and 1.2% native American (n=678). In comparison to other racial groups, Asian patients with HCC tended to be older [white vs. black vs. native American vs. Asian: median age: 63 years, interquartile range (IQR), 55-73 vs. 59 years, IQR, 53-66 vs. 59 years, IQR, 53-69 vs. 64 years, IQR, 55-73, P<0.001] and were diagnosed with larger tumors (white vs. black vs. native American vs. Asian: median tumor size: 4.8 cm, IQR, 3.0-8.0 vs. 5.1 cm, IQR, 3.1-8.7 vs. 4.8 cm, IQR, 3.0-7.3 vs. 5.5 cm, IQR, 3.1-9.0, P<0.001). Asian patients were also less likely to present with concomitant cirrhosis (white vs. black vs. native American vs. Asian: 81.8% vs. 77.7% vs. 83.2% vs. 69.1%, P<0.001) while elevated levels of alpha-fetoprotein more were often noted among black patients (white vs. black vs. native American vs. Asian: 25.5% vs. 14.9% vs. 22.2% vs. 21.8%, P<0.001). Compared to other racial groups, Asian patients were most likely to receive any form of treatment (white vs. black vs. native American vs. Asian: 29.2% vs. 25.2% vs. 27.6% vs. 34.4%, P<0.001). In particular, after controlling for potential confounders, Asian patients demonstrated the greatest odds of undergoing surgery (OR: 1.48, 95% CI, 1.13-1.95, P=0.01). The median overall survival (OS) was 11 months with the worst prognosis noted among black patients. After accounting for disease and patient factors, Asian patients demonstrated the lowest risk for death [hazard ratio (HR): 0.76, 95% CI, 0.66-0.87, P<0.001] while no differences were noted in the risk of death among other racial groups (all P>0.05).

Conclusions: Significant racial differences were noted in presentation, treatment and survival among patients with HCC. Further research is necessary to better understand socio-demographic and biological factors driving racial disparities in care. Future policies should aim to improve access to care among racial/ethnic minorities.

Keywords: Hepatocellular carcinoma (HCC); race; survival; therapy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Proportion of different treatments for hepatocellular carcinoma stratified by race across different time periods examined.
Figure 2
Figure 2
Kaplan-Meier curves for patients with hepatocellular carcinoma by race, stratified by stage of disease and type of treatment. (A) Localized disease; (B) metastatic disease; (C) surgical therapy; (D) non-surgical therapy.

References

    1. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917. - PubMed
    1. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012;379:1245-55. - PubMed
    1. Cancer Fact Sheets. Available online: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx (accessed August 9, 2015).
    1. Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol 2009;27:1485-91. - PMC - PubMed
    1. Altekruse SF, Henley SJ, Cucinelli JE, et al. Changing hepatocellular carcinoma incidence and liver cancer mortality rates in the United States. Am J Gastroenterol 2014;109:542-53. - PMC - PubMed