C. Akateh1, S. M. Black1 1Ohio State University,Surgery,Columbus, OH, USA
Introduction:
Hepatocellular carcinoma (HCC) remains a major leading cause of end-stage liver disease and cancer-related mortality in the United States. While advances in various treatment strategies have contributed to improved outcomes overall, surgical resection remains the preferred choice of therapy and in many cases the only hope of a cure. Despite improving outcomes, minority patients with HCC continue to have worse outcomes compared to non-minorities. The goal of this study is to identify underlying mechanisms for disparities in HCC outcomes.
Methods:
The Surveillance, Epidemiology and End Results (SEER) database was used to identify White and Black patients diagnosed with hepatocellular carcinoma between 2000-2014. Age, race, marital status, stage, and receipt of surgery were evaluated as predictors of disparate outcomes and mortality in multivariate analyses.
Results:
43,877 patients (75.6% White, 12.8% Black and 11.6% Other Races) were identified, 73% of whom were male, and 26% were female. Black patients were significantly younger at diagnosis compared to Whites (60 vs. 64 (p<0.001) and were slightly more likely to have the advanced/regional disease at presentation (18.8 vs. 21.2%, p<0.001), respectively. Overall, blacks were significantly less likely to undergo cancer-directed surgery, including liver transplantation (OR 0.84, 95% CI= 0.76-0.92). This decrease in odds of surgery persisted after adjusting for patient-level factors such as age, sex, marital status, and year of diagnosis (adjusted OR 0.80, 95% CI= 0.73-0.88). However, these odds of surgery were equivalent when adjusted for disease stage (adjusted OR 0.94, 95% CI= 0.82-1.10). The unadjusted hazard of mortality was 1.11 times higher in blacks compared to whites (p<0.001). However, these hazards disappeared when adjusted for disease stage (HR 0.99, p=0.908).
Conclusion:
Significant racial disparities in HCC outcomes are largely related to the advanced presentation at diagnosis and resulting underuse of cancer-directed surgery. It is therefore imperative to address barriers to care as receipt of appropriate care eliminates these disparities.