Hepatitis C‐positive Black patients develop hepatocellular carcinoma at earlier stages of liver disease and present with a more aggressive phenotype

Abstract

Background In the United States, mortality after a diagnosis of hepatocellular carcinoma (HCC) is higher in patients who are Black than in patients of other racial groups. The objective of this study was to clarify factors contributing to this disparity by analyzing liver and tumor characteristics in patients with HCC who have a history of hepatitis C virus (HCV) infection. Methods Records of patients with HCV and HCC at the authors' institution from 2003 to 2018 were retrospectively reviewed. Race and ethnicity were self‐identified. Imaging, laboratory, and pathologic features were compared between Black and non‐Black cohorts. Results Among 1195 individuals with HCC, 390 identified as Black. At the time of HCC diagnosis, Black patients had better liver function, as measured by Child‐Pugh score, Model of End‐Stage Liver Disease score, histology of nontumor tissue, and fibrosis‐4 (FIB‐4) score (all P < .05). FIB‐4 scores were <3.25 in 31% of Black patients. In addition, Black patients had less early stage HCC (20.2% vs 32.3%; P < .05), larger tumors (median [interquartile range]: 3.5 cm [2.2‐6.2 cm] vs 3.1 cm [2.1‐5.1 cm]; P < .01), more multiple tumors (median, [interquartile range]: 1 tumor [1‐3 tumors] vs 1 tumor [1‐2 tumors]; P = .03), more poorly differentiated tumors (30.3% vs 20.5%; P < .05), and more microvascular invasion (67.2% vs 56.5%; P < .05). Conclusions Black patients with HCV exposure develop HCC at earlier stages of liver disease than members of other racial groups. Nearly one‐third would not qualify for HCC screening using the common FIB‐4 cirrhosis threshold. Practice guidelines that stress HCC surveillance for cirrhotic patients with HCV may need to be revised to be more inclusive for Black patients. In addition, tumors in Black patients carry worse prognostic features, and molecular studies are needed to characterize their biologic properties.

Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C

“…Patients with private insurance and White patients were more likely to receive two or three surveillance tests than Black patients, even though Black patients are more likely to present with advanced HCC and to die from it. [34][35][36][37] Unlike a prior study, which showed a greatly reduced risk of post-SVR HCC in Black patients (HR = 0.52), 21 we found an increased risk (OR = 1.53). This finding suggests that the HCC risk in Black patients cured of HCV may be higher than reported, although our findings were not statistically significant and warrant further investigation.…”

Effects of surgery, chemotherapy, and radiation on hepatocellular carcinoma patients: A SEER-based study

“…This is not fully understood; however, it is probably multifactorial and may include socioeconomic factors and healthcare access variances [ 18 , 19 ]. Shaltiel et al showed that at HCC diagnosis, in Black patients with a history of HCV infection, the liver fibrosis was significantly less advanced; however, their tumors were more advanced in stage and had worse pathologic prognostic features compared to non-Black patients [ 20 ]. Regarding the stages, similar to our results, several studies previously reported lower survival rates in regional and distant stages compared to the localized stage [ 21 , 22 ].…”

Liver Cancer Has a Distinctive Profile in Black Patients: Current Screening Guidelines May Be Inadequate

“…Finally, a small study of patients with various liver diseases (but not with HCV infection) conducted at Mount Sinai also suggested that HCC in Black patients has a distinctive profile of better compensated liver disease yet more aggressive liver cancer, with significantly larger median tumor size, higher rates of vascular invasion, and a lower proportion presenting within Milan criteria. ( 9 )…”

“…In the United States, Black patients are both more likely to develop hepatocellular carcinoma (HCC) and more likely to die because of it. A recent publication in the March 2021 issue of Cancer ( 1 ) by our group at the Icahn School of Medicine at Mount Sinai adds important new evidence that HCC has a distinctive profile in Black individuals. ( 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 )…”

“…A recent publication in the March 2021 issue of Cancer ( 1 ) by our group at the Icahn School of Medicine at Mount Sinai adds important new evidence that HCC has a distinctive profile in Black individuals. ( 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 )…”