Treatment and Survival Disparities in Asian Americans With Hepatocellular Carcinoma: The Need to Disaggregate a...

Area of Science:

• Oncology
• Health Services Research
• Health Disparities

Background:

• Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality worldwide.
• The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population is often treated as a single group, masking significant internal diversity.
• Understanding treatment and survival differences within the AANHPI population is crucial for equitable cancer care.

Purpose of the Study:

• To investigate disparities in treatment modality and mortality among diverse subgroups of Asian American, Native Hawaiian, and Pacific Islander patients with early-stage hepatocellular carcinoma (HCC).
• To compare outcomes between disaggregated AANHPI patient subgroups and non-Hispanic White (NHW) patients.

Main Methods:

• Utilized the National Cancer Database (2004-2019) for patients with early-stage HCC eligible for liver transplantation (LT).
• Disaggregated AANHPI patients into East Asian (EA), Southeast Asian (SEA), South Asian (SA), and Native Hawaiian and other Pacific Islander (NHPI) subgroups.
• Employed chi-squared tests for categorical variables, Student t tests for continuous variables, and Kaplan-Meier estimates for survival analysis, with NHW as the reference group.

Main Results:

• The study included 3,039 AANHPI patients (8.5%) and 32,845 NHW patients (91.5%).
• AANHPI patients were less likely to receive LT but experienced lower overall mortality compared to NHW patients.
• Disaggregated analysis revealed South Asian patients had higher LT rates (HR: 2.70), while SEA (HR: 1.43) and NHPI (HR: 1.90) patients faced higher mortality risks compared to East Asian patients (all P<0.01).

Conclusions:

• While AANHPI individuals with early-stage HCC demonstrate improved survival as a collective cohort, significant disparities exist across distinct subgroups.
• These findings underscore the critical importance of recognizing and addressing the heterogeneity within the AANHPI population.
• Physicians, researchers, and policymakers must acknowledge these subgroup differences to develop targeted and equitable strategies for hepatocellular carcinoma management.