Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012

Abstract

AIMTo describe racial/ethnic differences in treatment and survival among liver cancer patients in a population-based cancer registry.METHODSInvasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White (White, n = 12710), Hispanic (n = 8500), Chinese (n = 2723), non-Hispanic Black (Black, n = 2609), Vietnamese (n = 2063), Filipino (n = 1479), Korean (n = 1099), Japanese (n = 658), American Indian/Alaskan Native (AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian (n = 233), South Asian (n = 190), Hawai`ian/Pacific Islander (n = 172), Thai (n = 95), and Other Asian (n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.RESULTSAfter adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio (OR) = 0.30, 95%CI: 0.17-0.53], Cambodian (OR = 0.65, 95%CI: 0.45-0.96), AIAN (OR = 0.66, 95%CI: 0.46-0.93), Black (OR = 0.76, 95%CI: 0.67-0.86), and Hispanic (OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese (OR = 1.58, 95%CI: 1.42-1.77), Koreans (OR = 1.45, 95%CI: 1.24-1.70), Japanese (OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese (OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio (HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians (HR = 1.35, 95%CI: 1.16-1.58), and Blacks (HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese (HR = 0.82, 95%CI: 0.77-0.86), Filipinos (HR = 0.84, 95%CI: 0.78-0.90), Vietnamese (HR = 0.85, 95%CI: 0.80-0.90), Koreans (HR = 0.90, 95%CI: 0.83-0.97), and Hispanics (HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.CONCLUSIONDisaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.

Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma Are Not Explained by Differences in Comorbidities, Liver Disease Severity, or Tumor Burden

“…Despite this, Wong et al found that from 2009 to 2010, of those potentially eligible for liver transplantation, only 11% of black patients underwent transplantation compared to 20% of white patients. Furthermore, even after adjusting for factors such as tumor stage, age, sex, treatment type, and income, black patients remained significantly more likely than white patients to die from HCC.…”

“…(4) Analyses exploring racial disparities in HCC outcomes have failed to fully explain this disparity on multivariable analysis. (5)(6)(7) Contributing factors that have been explored include late presentation, as black patients have been shown in some cohorts to be more likely to present with advanced tumor burden than white patients. (4) Other analyses have suggested disparities in curative therapies contribute to the racial disparity in HCC mortality.…”

High frequency of the PNPLA3 rs738409 [G] single‐nucleotide polymorphism in Hmong individuals as a potential basis for a predisposition to chronic liver disease

“…HCC risk factors included waist circumference, BMI, blood pressure, cholesterol, smoking status, diabetes status, and HBV status. While the Hmong are a relatively small Asian group, their distinctiveness as the population experiencing the lowest liver cancer survival rates among all Californians, 8 means that adding a genetic dimension to our prior data on their considerable behavioral risk factors 9 for chronic liver disease expands our insights into contributing etiologies. Having these findings suggest that a high rate of the PNPLA3 SNV should be examined further.…”

“…8 Multiple risk factors including viral hepatitis have been identified for HCC pathogenesis. There are different risk factors for NAFLD.…”

“…7 According to an analysis of 33,270 cases of HCC diagnosed from 1988 to 2012 and reported to the California Cancer Registry, Laotian/Hmong experienced the highest risk of cause-specific mortality (hazard ratio, 1.50; 95% confidence interval, 1.29-1.73) among all 15 racial/ethnic groups. 8 Multiple risk factors, including viral hepatitis, have been identified for HCC pathogenesis. There are different risk factors for NAFLD.…”