Liver Cancer Has a Distinctive Profile in Black Patients: Current Screening Guidelines May Be Inadequate

Winters, Adam C.; Shaltiel, Tali; Sarpel, Umut; Branch, Andrea D.

doi:10.1002/hep4.1771

Cited by 8 publications

(11 citation statements)

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“…[34][35][36][37] Additional studies are needed to determine whether surveillance guidelines should be adjusted to account for the tendency of HCC to arise in African American patients with relatively well-preserved liver function. 38 Our findings confirmed data showing that insurance status (private vs. others), race, and socioeconomic status are associated with HCC surveillance. 9,10,28,39 After adjusting for gender and liver status, private insurance had ORs ranging from 2.5 to 2.7 in our study.…”

Section: Discussionsupporting

confidence: 89%

“…Black patients present with more advanced HCC than Whites, but are younger, have better liver function, and are less likely to have cirrhosis 34–37 . Additional studies are needed to determine whether surveillance guidelines should be adjusted to account for the tendency of HCC to arise in African American patients with relatively well‐preserved liver function 38 …”

Section: Discussionmentioning

confidence: 99%

“…34 , 35 , 36 , 37 Additional studies are needed to determine whether surveillance guidelines should be adjusted to account for the tendency of HCC to arise in African American patients with relatively well‐preserved liver function. 38 …”

Section: Discussionmentioning

confidence: 99%

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Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C

et al. 2022

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Background Hepatocellular carcinoma (HCC) incidence and mortality vary by race/ethnicity and both are higher in Black patients than in Whites. For HCC surveillance, all cirrhotic patients are advised to undergo lifelong twice‐annual abdominal imaging. We investigated factors associated with surveillance and HCC incidence in a diverse HCC risk group, cirrhotic patients recently cured of hepatitis C virus (HCV) infection. Methods In this observational cohort study, all participants (n = 357) had advanced fibrosis/cirrhosis and were cured of HCV with antiviral treatment. None had Liver Imaging Reporting and Data System (LI‐RADS) 2–5 lesions prior to HCV cure. Ultrasound, computed tomography, and/or magnetic resonance imaging were used for surveillance. Results At a median follow‐up of 40 months [interquartile range (IQR) = 28–48], the median percentage of time up‐to‐date with surveillance was 49% (IQR) = 30%–71%. The likelihood of receiving a first surveillance examination was not significantly associated with race/ethnicity, but was higher for patients with more advanced cirrhosis, for example, bilirubin [odds ratio (OR) = 3.8/mg/dL, p = 0.002], private insurance (OR = 3.4, p = 0.006), and women (OR = 2.3, p = 0.008). The likelihood of receiving two or three examinations was significantly lower for non‐Hispanic Blacks and Hispanics versus non‐Hispanic Whites (OR = 0.39, and OR = 0.40, respectively, p < 0.005 for both) and for patients with higher platelet counts (OR = 0.99/10,000 cells/µl, p = 0.01), but higher for patients with private insurance (OR = 2.8, p < 0.001). Incident HCC was associated with higher bilirubin (OR = 1.7, p = 0.02) and lower lymphocyte counts (OR = 0.16, p = 0.01). Conclusions Contrary to best practices, HCC surveillance was associated with sociodemographic factors (insurance status and race/ethnicity) among patients cured of HCV. Guideline‐concordant surveillance is needed to address healthcare disparities.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C

et al. 2022

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“…(2) organ failure (except liver); (3) a history of radiotherapy, chemotherapy, surgery, and antibiotic therapy within the first half of the year of admission; (4) severe cirrhosis with diffuse regenerative nodules or dysplastic nodules; (5) first underwent RFA at other hospitals; (6) underwent surgery as the primary treatment and RFA for recurrence; (7) patients were during pregnancy or lactation.…”

Section: Eligibility Criteriamentioning

confidence: 99%

“…are believed to be its predisposing factors [ 4 ]. Liver cancer is often deadly, but the chances of survival can be improved by early detection, thus opening the door for curative treatments, such as resection, liver transplantation, and radiofrequency ablation (RFA) [ 5 ]. RFA as the current mainstay for clinical liver cancer treatment still has limitations as it cannot provide complete removal of the tumor focus, with a possibility of disease relapse [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of MRI with Serum Lectin-Reactive Alpha-Fetoprotein for Liver Cancer Recurrence after Percutaneous Radiofrequency Ablation

Zhang

Yao

Lin

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To explore the predictive value of magnetic resonance imaging (MRI) with serum lectin-reactive alpha-fetoprotein (AFP-L3) for liver cancer recurrence after percutaneous radiofrequency ablation (RFA). Methods. This study included 94 liver cancer patients admitted for RFA treatment and 82 healthy subjects. MRI was performed to record the apparent diffusion coefficient (ADC). The serum concentrations of AFP-L3 were quantified in all participants. The correlation of the AFP-L3 serum level and ADC value with clinical efficacy following RFA was analyzed. Moreover, the prognostic factors affecting liver cancer recurrence were analyzed, as well as the predictive effect of the ADC value and AFP-L3 on liver cancer recurrence. Results. The serum AFP-L3 level was higher in liver cancer patients than the healthy controls with a lower ADC value. Besides, the patients with tumor residuals had lower ADC values and higher serum AFP-L3 levels than those with complete ablated tumor. The combined detection of the ADC value and serum AFP-L3 level had a sensitivity of 87.50% and a specificity of 87.18% for diagnosing complete ablation after RFA treatment. The number of tumor nodules, tumor diameter, AFP, AFP-L3, and the presence of liver cirrhosis are all independent risk factors for liver cancer recurrence within one year. Meanwhile, the combined detection of the ADC value and serum AFP-L3 level had a good predictive effect on liver cancer recurrence with the sensitivity of 92.86% and a specificity of 69.62%. Conclusion. The ADC values combined with serum AFP-L3 detection had good predictive effects on complete ablation and recurrence of liver cancer after RFA treatment.

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Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis

et al. 2023

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Background Successful treatment of hepatitis C reduces liver inflammation and fibrosis; however, patients remain at risk of developing hepatocellular carcinoma (HCC). Aims To identify risk factors for new‐onset HCC in patients cured of hepatitis C. Methods Imaging, histological, and clinical data on patients whose first HCC was diagnosed >12 months of post‐SVR were analyzed. Histology of 20 nontumor tissues was analyzed in a blinded manner using the Knodel/Ishak/HAI system for necroinflammation and fibrosis/cirrhosis stage and the Brunt system for steatosis/steatohepatitis. Factors associated with post‐SVR HCC were identified by comparison with HALT‐C participants who did not develop post‐SVR HCC. Results Hepatocellular carcinoma was diagnosed in 54 patients (45 M/9F), a median of 6 years of post‐SVR [interquartile range (IQR) =1.4‐10y] at a median age of 61 years (IQR, 59–67). Approximately one‐third lacked cirrhosis, and only 11% had steatosis on imaging. The majority (60%) had no steatosis/steatohepatitis in histopathology. The median HAI score was 3 (1.25–4), indicating mild necroinflammation. In a multivariable logistic regression model, post‐SVR HCC was positively associated with non‐Caucasian race (p = 0.03), smoking (p = 0.03), age > 60 years at HCC diagnosis (p = 0.03), albumin<3.5 g/dL (p = 0.02), AST/ALT>1 (p = 0.05), and platelets <100 × 103 cells/μL (p < 0.001). Alpha fetoprotein ≥4.75 ng/mL had 90% specificity and 71% sensitivity for HCC occurrence. Noncirrhotic patients had larger tumors (p = 0.002) and a higher prevalence of vascular invasion (p = 0.016) than cirrhotic patients. Conclusions One‐third of patients with post‐SVR HCC did not have liver cirrhosis; most had no steatosis/steatohepatitis. Hepatocellular carcinomas were more advanced in noncirrhotic patients. Results support AFP as a promising marker of post‐SVR HCC risk.

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Liver Cancer Has a Distinctive Profile in Black Patients: Current Screening Guidelines May Be Inadequate

Abstract: There is mounting evidence that Black patients develop more advanced liver cancers with less advanced liver disease. These findings have important implications for the future of liver cancer screening.

Cited by 8 publications

References 11 publications

Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C

Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C

Predictive Value of MRI with Serum Lectin-Reactive Alpha-Fetoprotein for Liver Cancer Recurrence after Percutaneous Radiofrequency Ablation

Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis

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