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Clinical Features Associated with Survival Outcome in African-American Patients with Hepatocellular Carcinoma
Jacqueline Estevez1,2, Ju Dong Yang2, Jennifer Leong3
1Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
Insights
African-Americans with hepatocellular carcinoma (HCC) have poorer survival rates compared to Caucasians after 2010. Early diagnosis is crucial, as tumor stage, not ethnicity, predicts mortality.
Area of Science:
- Oncology
- Epidemiology
- Health Disparities
Background:
- African-Americans (AA) exhibit higher incidence and lower survival rates for hepatocellular carcinoma (HCC).
- This study investigates survival trends and clinical factors in AA versus Caucasian HCC patients over two decades.
Purpose of the Study:
- To compare survival rates and clinical characteristics between African-American and Caucasian patients with HCC.
- To identify factors influencing survival differences in HCC patients based on race and diagnosis period.
Main Methods:
- Retrospective analysis of 1156 HCC patients (578 AA, 578 Caucasian) matched by diagnosis year (1991-2016).
- Patients were grouped by diagnosis before or after 2010.
- Survival analysis and multivariate analysis were performed using chart review and National Death Index data.
Main Results:
- After 2010, AA patients showed poorer survival (35%) compared to Caucasians (44%).
- Caucasian survival improved post-2010, while AA survival remained stagnant.
- AA patients diagnosed after 2010 presented with more advanced Barcelona Clinic Liver Cancer (BCLC) stage C disease and received less treatment.
Conclusions:
- African-Americans with HCC face worse survival outcomes post-2010, presenting with more advanced disease.
- Tumor stage and liver function (Child's class) are independent predictors of mortality, not race.
- Enhanced early diagnosis and treatment strategies are necessary to improve HCC outcomes for African-Americans.
Background:
African-Americans (AA) have a higher incidence of hepatocellular carcinoma (HCC) and lower survival. We characterized survival rates and clinical features associated with survival in AA vs. Caucasians with HCC over the past two decades.
Methods:
HCC patients from three US medical centers were matched by year of diagnosis (1991-2016): AA (n = 578)/Caucasian (n = 578) and placed in one of two groups-HCC diagnosed prior to 2010 or 2010 and after. Data were obtained from chart review and the National Death Index. Multivariate and survival analysis controlling for key predictors were conducted.
Results:
Prior to 2010, there was no difference in survival between Caucasians and AA (p = 0.61). After 2010, AA patients had poorer survival compared to Caucasians (35% vs. 44%, respectively, p = 0.044). Over time, survival improved for Caucasians (32% before 2010 vs. 44% after 2010, p = 0.003), but not AA (36% vs. 35%, p = 0.50). AA on presentation (in the after 2010 cohort) were more likely to have BCLC (Barcelona Clinic Liver Cancer) stage C (24% vs. 15%, p = 0.010) and less likely to receive treatment (85% vs. 93%, p = 0.002) compared to matched Caucasians. BCLC beyond stage A (aHR: 1.75, 95% CI: 1.26-2.43, p = 0.001) and child's class C (aHR 2.05, 95% CI: 1.23-3.41, p = 0.006) were the strongest predictors of mortality, while race was not.
Conclusions:
African-Americans presented with more advanced HCC and had poorer survival compared to Caucasians after 2010. Tumor stage was an independent predictor of mortality, but ethnicity was not. Further efforts are needed to improve early HCC diagnosis for AA.
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