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Published on: September 30, 2021
The Effect of Race on Outcomes in Veterans With Hepatocellular Carcinoma at a Single Center
Jackson Reynolds1, Sarah Hashimi1, Ngan Nguyen1
1The University of Tennessee Health Science Center, Memphis.
Insights
Black and White veterans with hepatocellular carcinoma (HCC) had similar overall survival (OS). However, Black veterans received less treatment, including surgical options, despite no significant differences in diagnosis or survival outcomes.
Area of Science:
- Hepatocellular Carcinoma (HCC) research
- Cancer disparities in veterans
- Oncology treatment outcomes
Background:
- Hepatocellular carcinoma (HCC) exhibits higher incidence and mortality in Black patients compared to White patients in many analyses.
- This study investigates potential disparities in HCC diagnosis, treatment, and survival among veterans at the Memphis Veterans Affairs Medical Center (VAMC).
Purpose of the Study:
- To determine if racial disparities exist in stage at diagnosis, therapy received, and overall survival (OS) for veterans with HCC.
- To analyze treatment patterns and survival outcomes for Black versus White veterans diagnosed with hepatocellular carcinoma.
Main Methods:
- Retrospective review of 227 patients (132 White, 95 Black) treated for HCC between 2009 and 2021.
- Evaluation of overall survival (OS) based on age, sex, comorbidities, tumor stage, treatment type, and other clinical factors.
- Kaplan-Meier analysis for OS and hazard ratios; Cox regression for multivariate analysis of discrepancies.
Main Results:
- No significant difference in overall survival (OS) was observed between Black and White veterans with HCC.
- White veterans were more likely to receive any form of treatment, including surgical resection and transplant, compared to Black veterans (P < .001).
- No significant differences were found in age, stage at diagnosis, receipt of systemic therapy, or common comorbidities.
Conclusions:
- Black veterans with HCC at Memphis VAMC received less treatment, including surgical options, than White veterans.
- Despite treatment disparities, the difference in treatment received did not significantly impact overall survival (OS) between racial groups.
Background:
Black patients have a higher incidence and mortality associated with hepatocellular carcinoma (HCC) compared with that of White patients in many retrospective analyses. This study sought to determine whether veterans treated for HCC at the Memphis Veterans Affairs Medical Center (VAMC) in Tennessee showed similar disparities in terms of stage at diagnosis, type of therapy received, and overall survival (OS).
Methods:
A retrospective review evaluated 132 White and 95 Black patients treated for HCC between 2009 and 2021. We evaluated the impact on OS of age, sex, comorbidities, tumor stage, α-fetoprotein level, method of diagnosis, first-line treatment, systemic treatment, and surgical options offered. Kaplan-Meier analysis was used to investigate differences in OS and cumulative hazard ratio for death. Cox regression multivariate analysis evaluated discrepancies among investigated variables.
Results:
The study found no significant difference in OS between Black and White veterans with HCC. Significant differences were found in who received surgical treatment and systemic therapy. More White veterans received any form of treatment compared with Black veterans (P < .001), and White veterans were more likely to undergo surgical resection and transplant (P = .052). There was no significant difference between age or stage at diagnosis, receipt of systemic therapy, alcohol, tobacco or drug use, HIV coinfection, or cirrhosis.
Conclusions:
Black veterans with HCC at the Memphis VAMC were less likely to receive any form of treatment, surgical resection, or transplant compared with White veterans, but this did not have a statistically significant effect on OS.
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