Race/Ethnicity-specific Disparities in Hepatocellular Carcinoma Stage at Diagnosis and its Impact on Receipt of Curative Therapies

Ha, John; Yan, Melissa; Aguilar, María; Tana, Michele M.; Liu, Benny; Frenette, Catherine; Bhuket, Taft; Wong, Robert J.

doi:10.1097/mcg.0000000000000448

Cited by 66 publications

(75 citation statements)

References 34 publications

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“…As demonstrated in previous studies, compared to non-Hispanic Whites we found a poor survival in African Americans and a good survival in Asian patients [4, 7, 9, 12, 15, 16]. Our results demonstrate that increased presence of large tumor size was associated with poor survival in African Americans.…”

Section: Discussionsupporting

confidence: 88%

“…Tumor size is considered as an important prognostic determinant in several HCC staging systems such as the TNM classification [17], the Barcelona Clinic Liver Cancer (BCLC) staging system [18], and the Hong Kong Liver Cancer (HKLC) classification [19]. Although previous studies have reported the significant differences in tumor size in HCC patients stratified by race and proposed it as a predictor of prognosis for HCC patients [4, 7, 9, 12, 15, 16], our study has demonstrated that tumor presentation indeed is the dominant contributor to the poor OS of African Americans. Such a clear dominant factor could not be demonstrated for Hispanic-Whites and Asians.…”

Section: Discussionmentioning

confidence: 99%

“…Previous literature has reported that African American patients have a more advanced, and Asian patients a less advanced tumor stage at the moment of diagnosis, compared to non-Hispanic white patients [6, 7]. Obviously, more advanced disease at time of diagnosis may affect OS.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with ethnical disparity in overall survival for patients with hepatocellular carcinoma

Hansen

Peppelenbosch

et al. 2017

Oncotarget

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Hepatocellular carcinoma (HCC) is an important cause of cancer-related death worldwide. Ethnical disparity in overall survival has been demonstrated for HCC patients in the United States (U.S.). We aimed to evaluate the contributors to this survival disparity. The SEER database was used to identify HCC patients from 2004 to 2012. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate overall survival by ethnicity and the contributors to ethnical survival disparity. A total of 33 062 patients were included: 15 986 Non-Hispanic Whites, 6535 Hispanic Whites, 4842 African Americans, and 5699 Asians. Compared to Non-Hispanic Whites, African Americans had worse survival (HR, 1.18; 95%CI, 1.14–1.23), while Asians had a better survival (HR, 0.85; 95%CI, 0.82–0.89), and Hispanic Whites had a similar survival (HR, 1.01; 95%CI, 0.97–1.05). Multivariate Cox analysis identified that tumor presentation- and treatment-related factors significantly contributed to the ethnical survival disparity. Especially, tumor size was the most important contributor (HR, 1.11; 95%CI, 1.07–1.16). There is no ethnical survival disparity in patients undergoing liver transplantation and sub-analysis of patients within the Milan criteria for liver transplantation demonstrated no significant survival disparity between African Americans and non-Hispanic Whites in transplantation adjustment analysis (HR, 1.23; 95%CI, 1.11–1.35 in non-adjustment analysis to HR, 1.05; 95%CI, 0.95–1.15 after adjustment). Finally, no important contributor to the superior overall survival in Asians was identified. In conclusion, poor tumor presentation at diagnosis, limited benefit from resection and restricted utilization of liver transplantation are important contributors to poorer survival of African Americans with HCC.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Factors associated with ethnical disparity in overall survival for patients with hepatocellular carcinoma

Hansen

Peppelenbosch

et al. 2017

Oncotarget

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“…Racial/ethnic disparities have been reported both in NAFLD and HCC: Hispanics tend to have a more progressive course in NAFLD; and have lower rates of curative therapies for HCC[13]. Our finding that Hispanic ethnicity was associated with a decreased risk of development of HCC within NAFLD is surprising and needs confirmation with a larger cohort of individuals with NASH and other etiologies of chronic liver disease.…”

Section: Discussionmentioning

confidence: 51%

Risk factors for hepatocellular carcinoma in cirrhosis due to nonalcoholic fatty liver disease: A multicenter, case-control study

Corey

Gawrieh

deLemos

et al. 2017

WJH

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AIMTo identify risk factors associated with hepatocellular carcinoma (HCC), describe tumor characteristics and treatments pursed for a cohort of individuals with nonalcoholic steatohepatitis (NASH) cirrhosis.METHODSWe conducted a retrospective case-control study of a well-characterized cohort of patients among five liver transplant centers with NASH cirrhosis with (cases) and without HCC (controls).RESULTSNinety-four cases and 150 controls were included. Cases were significantly more likely to be male than controls (67% vs 45%, P < 0.001) and of older age (61.9 years vs 58 years, P = 0.002). In addition, cases were more likely to have had complications of end stage liver disease (83% vs 71%, P = 0.032). On multivariate analysis, the strongest association with the presence of HCC were male gender (OR 4.3, 95%CI: 1.83-10.3, P = 0.001) and age (OR = 1.082, 95%CI: 1.03-1.13, P = 0.001). Hispanic ethnicity was associated with a decreased prevalence of HCC (OR = 0.3, 95%CI: 0.09-0.994, P = 0.048). HCC was predominantly in the form of a single lesion with regional lymph node(s) and distant metastasis in only 2.6% and 6.3%, respectively. Fifty-nine point three percent of individuals with HCC underwent locoregional therapy and 61.5% underwent liver transplantation for HCC.CONCLUSIONMale gender, increased age and non-Hispanic ethnicity are associated with HCC in NASH cirrhosis. NASH cirrhosis associated HCC in this cohort was characterized by early stage disease at diagnosis and treatment with locoregional therapy and transplant.

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“…However, racially diverse, socioeconomically disadvantaged patients represent a difficult-to-reach population and are an important population to study given they experience health disparities, including higher HCC incidence and mortality rates 19, 33, 34 and lower HCC surveillance rates. 35-37 Outreach interventions would likely be equally, if not more, successful in other patient populations. Second, patients may have received HCC screening tests at outside institutions, although this is unlikely because many patients did not have insurance and would have out-of-pocket costs for outside testing.…”

Section: Discussionmentioning

confidence: 99%

Mailed Outreach Program Increases Ultrasound Screening of Patients With Cirrhosis for Hepatocellular Carcinoma

et al. 2017

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Background & Aims Surveillance of patients with cirrhosis increases early detection of hepatocellular carcinoma (HCC) and prolongs survival. However, its effectiveness is limited by underuse, particularly among racial/ethnic minorities and individuals of low socioeconomic status. We compared effectiveness of mailed outreach strategies, with and without patient navigation, in increasing the numbers of patients with cirrhosis undergoing surveillance for HCC in a racially diverse and socioeconomically disadvantaged cohort. Methods We performed a prospective study of patients with documented or suspected cirrhosis at a large safety-net health system from December 2014 through March 2016. Patients were randomly assigned (1:1:1) to groups that received mailed invitations for an ultrasound screening examination (n=600), mailed invitations for an ultrasound screening examination and patient navigation (barrier assessment and motivational education for patients who declined screening; n=600), or usual care (visit-based screening; n=600). Patients who did not respond to outreach invitations within 2 weeks received up to 3 reminder telephone calls. The primary outcome was completion of abdominal imaging within 6 months of randomization. Results Baseline characteristics were similar among groups. Cirrhosis was documented, based on ICD-9 codes, for 79.6% of patients and suspected, based on non-invasive markers of fibrosis, for 20.4%. In an intent to treat analysis, significantly greater proportions of patients who received the mailed invitation and navigation (47.2%) or the mailed invitation alone (44.5%) underwent HCC screening than patients who received usual care (24.3%) (P<0.001 for both comparisons). However, screening rates did not significantly differ between outreach the outreach groups (P=0.25). The effects of the outreach program were consistent in all subgroups, including Caucasian vs. non-Caucasian race, documented vs. suspected cirrhosis, Child Pugh A vs. B cirrhosis, and receipt of gastroenterology care. Conclusions In a prospective study, we found outreach strategies to double the percentage of patients with cirrhosis who underwent ultrasound screening for HCC. However, adding patient navigation to telephone reminders provided no significant additional benefit. ClinicalTrials.gov no: NCT02312817

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Race/Ethnicity-specific Disparities in Hepatocellular Carcinoma Stage at Diagnosis and its Impact on Receipt of Curative Therapies

Cited by 66 publications

References 34 publications

Factors associated with ethnical disparity in overall survival for patients with hepatocellular carcinoma

Factors associated with ethnical disparity in overall survival for patients with hepatocellular carcinoma

Risk factors for hepatocellular carcinoma in cirrhosis due to nonalcoholic fatty liver disease: A multicenter, case-control study

Mailed Outreach Program Increases Ultrasound Screening of Patients With Cirrhosis for Hepatocellular Carcinoma

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