1053 Hepatocellular Carcinoma (HCC) Diagnosis, Treatment and Outcome in a Primarily African American Population

Abstract

INTRODUCTION: HCC is the most common primary liver cancer and five-year survival of HCC depends on the extent of disease and liver reserve. The objective of this study was to determine the impact of racial disparity in identification, treatment and outcome in HCC patients seen in a predominately African American (AA) population. METHODS: From a database of HCC patients diagnosed between 2009 and 2017, 227 patients had a sufficient number of visits to identify treatment and outcomes. Date of diagnosis was defined by definitive imaging or biopsy. Tumor size (small = < 5 cm) was used as a surrogate for calculating Child’s-Pugh score in these predominately Hepatitis C cirrhotic patients. Outcomes was determined as death or transfer to hospice, while survival was defined by death only. Patients being sent to transplant (9 AA and 1 Non-AA ) were excluded from the analysis since transplant was at a different institution. RESULTS: There were 194 AA and 33 non-AA patients and hepatitis C was the dominant risk factor (n = 192; 85%). Only 29 patients (13%) were diagnosed under even a minimal surveillance protocol defined as a normal ultrasound within 6-12 months prior to diagnosis. AA patients were more likely to have a large tumor burden as compared to non-AA (AA = 74% and Non-AA = 51 %; P < 0.01). A variety of treatments for the HCC were use in the 61% of patients who received treatment. The remaining 39% of patients either died in the hospital prior to treatment or were sent to hospice for palliative care. Median outcome was better for patients with a small tumor at diagnosis, treated patients and for non-HCV patients (Table 1). When survival was evaluated, results were similar (44 months for small tumors vs 10 months for large tumors P < 0.001). Race did not have a major impact on overall outcome (AA = 16 months vs Non-AA = 20 months, P = 0.33) or survival (20 months vs 34 months P = 0.35). CONCLUSION: Most patients diagnosed with HCC in this urban medical center presented with large tumors with AA patients likelier to have large tumor burden. Outcome was better for patients with small tumors or who were treated regardless of tumor size. However, overall outcome was similar regardless of race. Our study reaffirms the potential importance of surveillance of high-risk individuals to identify early HCC tumors and thus increase survival in our AA population. Moreover, addressing the major risk factor of HCV by treatment with highly effective DAA would also impact the development of HCC especially in our AA population.