Ethnic differences determine liver cancer detection, outcomes
Researchers determined racial and ethnic differences that correlated with early detection of hepatocellular carcinoma and receipt of curative treatment, which could be used as intervention targets to improve patient outcomes.
“As with most malignancies, HCC tumor burden at diagnosis impacts both prognosis and treatment decisions,” Nicole E. Rich, MD, from the University of Texas Southwestern Medical Center, and colleagues wrote. “Understanding and quantifying potential differences is the first step to identify intervention targets and inform strategies to reduce existing disparities.”
Rich and colleagues retrospectively identified a cohort of 1,117 patients with HCC, of whom 35.9% were white, 34.4% were black and 29.7% were Hispanic.
Compared with white patients, black patients were more likely to have viral hepatitis (P < .001) and more likely to have Child-Pugh class A cirrhosis (P = .03), while Hispanic patients were more likely to have alcohol- or NASH-related cirrhosis (P < .001) and less likely to have Child-Pugh class A cirrhosis (P = .003).
Both Hispanic patients (OR = 0.75; 95% CI, 0.55-1) and black patients (OR = 0.74; 95% CI, 0.56-0.98) were less likely to have HCC detected at Barcelona-Clinic Liver Cancer (BCLC) stage 0/A than white patients. After adjusting for receipt of HCC surveillance, HCC detection at BCLC stage 0/A remained significantly less likely among Hispanic patients (OR = 0.7; 95% CI, 0.51-0.98).
Among 463 patients with early-stage HCC, white patients were more likely to undergo curative treatment compared with Hispanic patients (OR = 0.51; 95% CI, 0.37-0.7) and black patients (OR = 0.6; 95% CI, 0.44-0.81). After adjusting for BCLC stage, age and insurance status, curative treatment remained less likely among Hispanic patients compared with white patients (OR = 0.57; 95% CI, 0.39-0.85).
Median overall survival was 16.3 months among white patients, 14.4 months among Hispanic patients, and 10.6 months among black patients. After adjusting for Child-Pugh class, BCLC stage, treatment type and insurance status, the researchers observed a significant difference in overall survival between Hispanic and white patients (HR = 0.83; 95% CI, 0.74-0.94).
“Our data suggest interventions to improve early tumor detection and curative treatment receipt would likely improve HCC outcomes and reduce disparities,” the researchers concluded. “Our findings have important implications for health policy and highlight the need for further study on racial-ethnic disparities in HCC including identification of additional actionable intervention targets to reduce disparities in prognosis.” – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.