Black race is independently associated with underutilization of transplantation for clinical T1 hepatocellular carcinoma
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Updated: Oct 11, 2025
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Kavin Sugumar1, Sarah C Markt2, Jonathan J Hue1
1Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Insights
Black patients with early hepatocellular carcinoma (HCC) are less likely to receive a liver transplant but more likely to undergo resection compared to White patients. These racial disparities in operative management require further investigation and intervention.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Health disparities research
Background:
- Hepatocellular carcinoma (HCC) is a significant cause of cancer-related mortality globally.
- Current operative management for early-stage HCC includes ablation, surgical resection, and liver transplantation.
- Understanding racial variations in treatment is crucial for addressing health inequities.
Purpose of the Study:
- To compare the operative management of early-stage hepatocellular carcinoma (HCC) across different racial groups.
- To identify potential racial disparities in the utilization of liver resection and transplantation for HCC.
Main Methods:
- Utilized the National Cancer Database (2004-2016) to identify patients with cT1 HCC and low comorbidity (Charlson-Deyo score 0-1).
- Compared operative versus non-operative management, and specific surgical interventions (resection vs. transplantation) by race.
- Employed marginal standardization of logistic regression models, adjusting for clinico-demographic factors, to estimate treatment probabilities in specific patient subgroups (e.g., <70 years, insured).
Main Results:
- A total of 25,029 patients were analyzed (20,410 White, 4,619 Black).
- Black race was independently associated with a lower overall likelihood of operative intervention (OR 0.89, p=0.009).
- Black patients showed a higher likelihood of resection (OR 1.23, p<0.001) and a lower likelihood of transplantation (OR 0.60, p<0.001).
- Marginal standardization confirmed Black race was linked to increased resection probability (especially in patients >50 years with private insurance/Medicare) and decreased transplantation probability across age and insurance groups.
Conclusions:
- Racial disparities exist in the surgical management of early hepatocellular carcinoma (HCC).
- Black patients are disproportionately favored for liver resection and disfavored for liver transplantation compared to White patients.
- The multifactorial etiology of these disparities necessitates targeted interventions to ensure equitable care for all HCC patients.
Background:
Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality. Operative management of early disease includes ablation, resection, and transplantation. We compared the operative management of early-stage HCC in patients stratified by race.
Methods:
We identified patients with cT1 HCC and Charlson-Deyo score 0-1 in the National Cancer Database (2004-2016). We compared operative/non-operative management by race, adjusting for clinicodemographic variables. We performed marginal standardization of logistic regression to ascertain adjusted probabilities of resection or transplantation in patients under 70 years of age with insurance.
Results:
A total of 25,029 patients were included (White = 20,410; Black = 4619). After adjusting for clinico demographic variables, Black race was associated with a lower likelihood of undergoing operative intervention (OR 0.89,p = 0.009). Black patients were more likely to undergo resection (OR 1.23,p < 0.001) and less likely to undergo transplantation (OR 0.60,p < 0.001). Marginal standardization models demonstrated Black race was associated with increased probability of resection in patients >50yrs, with private insurance/Medicare, and lower probability of transplantation regardless of age or insurance payor.
Conclusion:
Black race is associated with lower rates of hepatic transplantation and higher rates of hepatic resection for early HCC regardless of age or insurance payor. The etiology of these disparities is multifactorial and correcting the root causes represents a critical area for improvement.
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