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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Racial Diversity in Hepatocellular Carcinoma in a Predominately African-American Population at an Urban Medical
Brian Rutledge1, Jenny Jan2, Sindhuri Benjaram2
1Department of Gastroenterology, Wayne State University School of Medicine, 3990 John R St 6 Hudson Room 6938, Detroit, MI, 48201, USA. drbrianrutledge@gmail.com.
Insights
African-American (AA) populations have low hepatocellular carcinoma (HCC) surveillance rates. Routine APRI assessment can improve early tumor detection and survival for AA patients.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) surveillance, treatment, and outcomes in African-American (AA) populations are under-evaluated.
- HCC disproportionately affects certain demographics, necessitating targeted research.
Purpose of the Study:
- To evaluate demographics, surveillance, therapy, and outcomes for a predominantly AA population with HCC.
- To identify factors influencing HCC development and outcomes in AA individuals.
Main Methods:
- Retrospective analysis of 274 patients with HCC visits between 2010 and 2017.
- Tumor size defined by imaging (≤ 5 cm as 'small'); HCC surveillance defined by ultrasound (US).
Main Results:
- The study population was primarily AA (78%) and male (76%), with a mean age of 62.
- Hepatitis C virus (HCV) was a more significant risk factor for HCC in AA patients (92% vs. 67%).
- Surveillance rates were low (16% for AA vs. 7% for non-AA); APRI > 0.7 predicted HCC risk.
Conclusions:
- Low surveillance rates in AA populations require intervention, emphasizing the need for physician/patient education on surveillance US.
- Routine APRI assessment in AA patients is recommended for earlier tumor detection and improved survival.
- Race was not a significant factor in treatment or outcomes; most patients received tumor ablative treatment.
Purpose:
Surveillance, treatment, and outcomes for African-American (AA) populations with hepatocellular carcinoma (HCC) remain under evaluated. This study evaluated demographics, surveillance, therapy, and outcomes for a predominately AA population.
Methods:
The electronic medical records of a large health-care provider were used to identify 274 patients with visits for HCC between 2010 and 2017. Tumor size at diagnosis was defined by imaging with ≤ 5 cm being defined as "small." Surveillance for HCC was defined based on ultrasound (US) assessments.
Results:
Patients were primarily AA (78%) and male (76%) with an average age at diagnosis of 62 years. Hepatitis C virus (HCV) was more likely to be a risk factor for the development of HCC in AA as compared to non-AA (92% vs 67%; p < 0.005). Surveillance rates were low (16% for AA vs 7% for non-AA). An aspartate aminotransferase platelet ratio index (APRI) value > 0.7 within 2 years of tumor diagnosis was a strong predictor for the risk of the development of HCC (86% AA vs 79 % non-AA). In this study, race was not a factor in treatment or outcomes, and most patients received tumor ablative treatment.
Conclusion:
Given the low surveillance rates and the demonstrated increased survival for patients with small tumors, ways to increase surveillance must be initiated. The results of this study demonstrate the need for physician/patient education on the importance of surveillance US. Further, this study supports routine assessment of APRI in AA patients in an effort to identify patients in whom intensive surveillance will significantly improve earlier detection of tumors.
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