American College of Gastroenterology Annual Meeting

American College of Gastroenterology Annual Meeting

October 26, 2016
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Advanced HCC prevalent in blacks vs. non-Hispanic whites

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LAS VEGAS — Black patients presented with more advanced hepatocellular carcinoma compared with non-Hispanic white patients at Alameda Health System, Highland Hospital — a safety-net hospital — in Oakland, Calif., per data presented at ACG 2016.

“While HCC incidence in the U.S. appears to have stabilized, overall survival from HCC remains to be poor,” Jonathan Chan, MD, of the Alameda Health System, Highland Hospital, said during his presentation in a liver plenary. “Racial and ethnic disparities of HCC incidence reflect differences … including ideology of liver disease. Racial and ethnic disparities of HCC survival are also affected by stage of HCC diagnosis which affects treatment options. To evaluate [these] disparities in HCC tumor stage, diagnosis was the aim of this study at a safety-net hospital population.”

Chan and colleagues retrospectively evaluated 191 adults with HCC enrolled at Highland Hospital between July 2014 and May 2016, to identify differences in HCC tumor stage at diagnosis. Of these, 80.6% were men and the mean age at HCC diagnosis was 57.8. The cohort included 44.2% of adults who were Asian, 23.9% were black, 17.2% were white and 12.3% were Hispanic.

“Comparisons of HCC stage between groups used chi square testing and multivariate logistic regression models adjusted for sex, race, etiology of HCC, cirrhosis, ascites and provider type,” Chan said.

Forty-four percent of patients had extrahepatic metastatic disease at diagnosis and 73% had HCC outside Milan criteria, per Chan’s presentation.

The rate of HCC within Milan criteria at diagnosis were similar between groups, however there was evidence of significant disparities in the presence of metastatic disease: non-Hispanic white patients: 36.4%; black patients: 67.6%; Hispanic patients: 37.5%; and Asian patients: 33.3%; P < .01).

Multivariate regression analysis showed black patients were less likely to have HCC within Milan criteria at diagnosis (OR = 0.2; 95% CI, 0.04-0.96), as well as more likely to have metastatic disease (OR = 3.89; 95% CI, 1.1-13.76) vs. non-Hispanic white patients.

When HCC was diagnosed by a gastrointestinal provider, patients were more likely to have HCC within Milan criteria (OR = 2.65; 95% CI, 1.04-6.79) compared with diagnosis by a non-gastrointestinal provider.

Chan concluded: “Compared to non-Hispanic whites with HCC, African Americans with HCC were nearly four times more likely to have metastatic disease at diagnosis and five times more likely to have HCC outside Milan criteria.” – by Melinda Stevens

Reference:

Chan J, et al. Abstract #50. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 14-19, 2016; Las Vegas, NV.

Disclosure: Chan reports no relevant financial disclosures. One researcher reports receiving grant support/research and serving on the advisory committee for Gilead Sciences.