In the Journals

Liver cancer diagnosis often late among African-American patients

African-American patients presented with more advanced stages of hepatocellular carcinoma and had worse five-year survival rates compared with Caucasian patients, according to a study published in American Journal of Gastroenterology.

“Long-term survival improved over time for Caucasians with HCC, but not for their African-American counterparts resulting in a survival difference between the two ethnic groups, though ethnicity was not a predictor of HCC mortality,” Jacqueline Estevez, MD, from Stanford University Medical Center in California, and colleagues wrote. “Rather it appears that staging of HCC was the most significant factor for survival.”

Estevez and colleagues performed a cohort study of HCC cases and analyzed the matched results of 578 African-American patients and 578 Caucasian patients. Patients were matched by year of HCC diagnosis and study site. Most cases presented between 2007 and 2014 with a median diagnosis year of 2010.

African-American patients were less likely to have cirrhosis (80% vs. 89%; P < .0001) or hepatic decompensation (59% vs. 75%; P < .0001) compared with Caucasian patients.

In contrast, African-American patients were more likely to have higher creatinine levels (1.21 vs. 0.99 mg/dL; P < .0001), multifocal tumors (39% vs. 32%; P = .014), vascular invasion (22% vs. 16%; P = .01) and a larger mean size of the largest tumor (P = .019) compared with Caucasian patients.

Additionally, African-American patients had a significantly higher proportion of patients with Barcelona Clinic Liver Cancer stage C compared with Caucasian patients (22% vs. 17%; P = .023) and higher average MELD scores (11.5 vs. 10.8; P = .029).

African-American patients were overall less likely to receive any HCC treatment compared with Caucasian patients (84% vs. 89%; P = .01) and less likely to receive either of the most common treatments in both ethnicity groups: transarterial chemoembolization or radiofrequency ablation (58% vs. 72%; P < .001).

While the researchers found no difference in 5-year survival rates between African-American and Caucasian patients overall (38% vs. 37%) or between African-American and Caucasian patients before 2010 (36% vs. 32%), African-American patients had worse 5-year survival rates than Caucasian patients after 2010 (35% vs. 44%; P = .044).

The researchers performed a multivariate analysis with HIV cases removed and found the significant mortality predictors included Child-Pugh class C (HR = 2.2; 95% CI, 1.32-3.68), Barcelona Clinic Liver Cancer higher than stage A (HR = 1.78; 95% CI, 1.26-2.53) and older age (HR = 1.03; 95% CI, 1.02-1.05). Surgical treatment (HR = 0.08; 95% CI, 0.04-0.16) and liver-directed therapy (HR = 0.17; 95% CI, 0.11-0.27) correlated significantly with decreased mortality.

“Discovering cancer at an earlier stage is a modifiable problem if HCC surveillance methods and/or adherence to HCC surveillance guidelines can be improved,” the researchers wrote. “However, there are barriers that must be overcome in order to improve surveillance.”

Estevez and colleagues noted that previous studies have found that African-Americans often have poor linkage to care which can lead to inadequate screening and surveillance for HCC. Additionally, HCC surveillance has been shown to be less vigorous in chronic hepatitis B patients, an infection that is common among African-Americans.

“To overcome these potential barriers to care, awareness of the risk factors for liver disease and its associated outcomes must be reinforced for practitioners while other surveillance methods must be applied to community settings to capture those most at risk for liver disease,” the researchers concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

African-American patients presented with more advanced stages of hepatocellular carcinoma and had worse five-year survival rates compared with Caucasian patients, according to a study published in American Journal of Gastroenterology.

“Long-term survival improved over time for Caucasians with HCC, but not for their African-American counterparts resulting in a survival difference between the two ethnic groups, though ethnicity was not a predictor of HCC mortality,” Jacqueline Estevez, MD, from Stanford University Medical Center in California, and colleagues wrote. “Rather it appears that staging of HCC was the most significant factor for survival.”

Estevez and colleagues performed a cohort study of HCC cases and analyzed the matched results of 578 African-American patients and 578 Caucasian patients. Patients were matched by year of HCC diagnosis and study site. Most cases presented between 2007 and 2014 with a median diagnosis year of 2010.

African-American patients were less likely to have cirrhosis (80% vs. 89%; P < .0001) or hepatic decompensation (59% vs. 75%; P < .0001) compared with Caucasian patients.

In contrast, African-American patients were more likely to have higher creatinine levels (1.21 vs. 0.99 mg/dL; P < .0001), multifocal tumors (39% vs. 32%; P = .014), vascular invasion (22% vs. 16%; P = .01) and a larger mean size of the largest tumor (P = .019) compared with Caucasian patients.

Additionally, African-American patients had a significantly higher proportion of patients with Barcelona Clinic Liver Cancer stage C compared with Caucasian patients (22% vs. 17%; P = .023) and higher average MELD scores (11.5 vs. 10.8; P = .029).

African-American patients were overall less likely to receive any HCC treatment compared with Caucasian patients (84% vs. 89%; P = .01) and less likely to receive either of the most common treatments in both ethnicity groups: transarterial chemoembolization or radiofrequency ablation (58% vs. 72%; P < .001).

While the researchers found no difference in 5-year survival rates between African-American and Caucasian patients overall (38% vs. 37%) or between African-American and Caucasian patients before 2010 (36% vs. 32%), African-American patients had worse 5-year survival rates than Caucasian patients after 2010 (35% vs. 44%; P = .044).

The researchers performed a multivariate analysis with HIV cases removed and found the significant mortality predictors included Child-Pugh class C (HR = 2.2; 95% CI, 1.32-3.68), Barcelona Clinic Liver Cancer higher than stage A (HR = 1.78; 95% CI, 1.26-2.53) and older age (HR = 1.03; 95% CI, 1.02-1.05). Surgical treatment (HR = 0.08; 95% CI, 0.04-0.16) and liver-directed therapy (HR = 0.17; 95% CI, 0.11-0.27) correlated significantly with decreased mortality.

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“Discovering cancer at an earlier stage is a modifiable problem if HCC surveillance methods and/or adherence to HCC surveillance guidelines can be improved,” the researchers wrote. “However, there are barriers that must be overcome in order to improve surveillance.”

Estevez and colleagues noted that previous studies have found that African-Americans often have poor linkage to care which can lead to inadequate screening and surveillance for HCC. Additionally, HCC surveillance has been shown to be less vigorous in chronic hepatitis B patients, an infection that is common among African-Americans.

“To overcome these potential barriers to care, awareness of the risk factors for liver disease and its associated outcomes must be reinforced for practitioners while other surveillance methods must be applied to community settings to capture those most at risk for liver disease,” the researchers concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.