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. 2019 Apr 3;14(4):e0214721.
doi: 10.1371/journal.pone.0214721. eCollection 2019.

Factors associated with favorable survival outcomes for Asians with hepatocellular carcinoma: A sequential matching cohort study

Zhensheng Wang  1 , Xiangjun Gu  1 , Aaron P Thrift  1   2
Affiliations

Factors associated with favorable survival outcomes for Asians with hepatocellular carcinoma: A sequential matching cohort study

Zhensheng Wang et al. PLoS One. .

Abstract

Background: Overall 5-year survival rates for patients diagnosed with hepatocellular carcinoma (HCC) are poor, but vary by race/ethnicity. We undertook a comprehensive assessment of underlying contributing factors to the favorable survival outcomes of HCC among Asians compared with non-Hispanic whites (NHW).

Methods: We identified 1,284 Asian and 7,072 NHW patients newly diagnosed with HCC between 1994 and 2011 in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. We used a novel three-step sequential matching approach to identify demographic, presentation and treatment factors that may explain survival differences between Asians and NHWs. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for the association between Asian race and risk of HCC-related mortality were estimated using Cox proportional hazards models.

Results: The absolute difference in 5-year survival rates between Asians and NHWs was 8.4% (95% CI: 4.6%-12.0%) in the demographics match analysis. The disparity remained unchanged after additionally matching on stage, grade and comorbidities in the presentation match analysis. However, in the treatment match analysis, which accounts for differences in demographic, presentation and treatment factors, the absolute difference in 5-year survival rates was reduced to 5.8% (95% CI: 2.6%-9.3%). Treatment differences explained more of survival disparity in Asian and NHW patients with localized disease than for those with regional or distant stage HCC.

Conclusions: Asian patients with HCC continue to have more favorable survival outcomes than NHWs with HCC. This persistent disparity seems to be more related to treatment differences than to differences in presentation characteristics including stage.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram showing included non-Hispanic white and Asian Hepatocellular carcinoma patients from SEER-Medicare datasets.
Fig 2
Fig 2. Kaplan-Meier plot for Hepatocellular carcinoma survival for Asian patients and three matched non-Hispanic white populations.
See this image and copyright information in PMC

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