Research Papers:
Factors associated with ethnical disparity in overall survival for patients with hepatocellular carcinoma
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Abstract
Juan Li1, Bettina E Hansen1, Maikel P. Peppelenbosch1, Robert. A. De Man1, Qiuwei Pan1,*, Dave Sprengers1,*
1Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
*These authors share senior authorship
Correspondence to:
Dave Sprengers, email: [email protected]
Keywords: hepatocellular carcinoma, ethnicity, overall survival, survival disparity, race
Received: October 07, 2016 Accepted: January 10, 2017 Published: January 20, 2017
ABSTRACT
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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