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Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States
Article first published online: 25 JAN 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 5, pages 1367–1377, 1 March 2010
How to Cite
Artinyan, A., Mailey, B., Sanchez-Luege, N., Khalili, J., Sun, C.-L., Bhatia, S., Wagman, L. D., Nissen, N., Colquhoun, S. D. and Kim, J. (2010), Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States. Cancer, 116: 1367–1377. doi: 10.1002/cncr.24817
- Issue published online: 18 FEB 2010
- Article first published online: 25 JAN 2010
- Manuscript Accepted: 5 JUN 2009
- Manuscript Revised: 4 JUN 2009
- Manuscript Received: 10 MAR 2009
- health disparity;
- hepatocellular carcinoma;
Racial, ethnic, and socioeconomic disparities in the survival of patients with hepatocellular carcinoma (HCC) continue to exist. The authors of this report hypothesized that these differences result from inequities in access to care and in response to therapy.
Patients with HCC (n = 20,920) were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and patients who underwent liver transplantation for HCC (n = 4735) were identified from the United Network for Organ Sharing (UNOS) database. Clinical and pathologic factors were compared after patients were stratified by race and ethnicity.
The survival of patients with HCC improved over time for all racial, ethnic, and income groups (P < .001). Black and low income individuals had the poorest long-term survival (P < .001). On multivariate analysis, black race was predictive of the poorest survival (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.09-1.22; P < .001), whereas Asian race was associated with the best survival (HR, 0.87; 95% CI, 0.83-0.91; P < .001). After liver transplantation, black patients had the worst graft survival and overall survival (median survival [MS], 30.5 months and 39.7 months, respectively; P < .001), whereas Hispanics had the best survival (MS, 83.4 months and 86.6 months, respectively; P < .001). In a multivariate analysis of transplantation patients, race and ethnicity were associated significantly with outcome.
Significant racial and ethnic disparities in the outcome of patients with HCC persist despite the receipt of comparable treatment. The authors concluded that further investigations are warranted to identify the reasons for the stark disparity in outcomes between black patients and Hispanic patients after liver transplantation for HCC. Cancer 2010. © 2010 American Cancer Society.