Race/ethnicity‐specific disparities in cancer incidence, burden of disease, and overall survival among patients with hepatocellular carcinoma in the United States

Abstract

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the fastest rising causes of cancer-related deaths in the United States, with disparities observed in cancer incidence and survival between ethnic groups. This report provides updated analyses on race-specific disparities in US HCC trends. METHODS: This large, population-based cohort study was conducted using Surveillance, Epidemiology, and End Results cancer registry data from 2003 to 2011 to investigate race-specific disparities in HCC incidence and survival. Survival was analyzed using Kaplan-Meier methods and multivariate Cox proportional-hazards models. RESULTS: From 2003 to 2011, Asians had the highest HCC incidence, followed by blacks, Hispanics, and non-Hispanic whites. During the same period, Hispanics had the greatest increase in HCC incidence (135.8%), whereas Asians experienced a 5.5% decrease. Although patients aged 65 years had the highest HCC incidence among all racial/ethnic groups, the higher HCC incidence in Asians was observed only for patients ages <50 and 65 years, whereas HCC incidence among patients ages 50 to 64 years was similar among Asians, blacks, and Hispanics. The overall 5-year HCC survival rate was highest among Asians (26.1%; 95% confidence interval [CI], 24.5%-27.6%) and lowest among blacks (21.3%; 95% CI, 19.5%-23.1%). On multivariate regression, Asians (hazard ratio, 0.83; 95% CI, 0.79-0.87; P < .001) and blacks (hazard ratio, 0.94; 95% CI, 0.89-0.99; P 5 .01) had significantly higher survival compared with non-Hispanic whites. CONCLUSIONS: Asians were the only group to demonstrate a declining HCC incidence in the form of a shift from advanced HCC to more localized HCC. These findings most likely reflect improved screening and surveillance efforts for this group. Cancer 2016;122:2512-23. V C 2016 American Cancer Society.KEYWORDS: incidence, liver cancer, racial differences, screening, Surveillance, Epidemiology, and End Results (SEER). INTRODUCTIONHepatocellular carcinoma (HCC) is a leading cause of cancer-related morbidity and mortality worldwide. [1][2][3] In the United States, the incidence of HCC has more than quadrupled, becoming the fastest rising cause of cancer-related deaths. 4,5 Although Asians have the highest overall HCC incidence, when stratified by race/ethnicity, the largest proportional increase in HCC incidence has been observed among Hispanics and blacks. 6,7 These observed differences in HCC trends may reflect race/ethnicity-specific differences in the underlying etiology of HCC, including chronic hepatitis C virus (HCV), chronic hepatitis B virus (HBV), nonalcoholic steatohepatitis, and alcoholic liver disease. 8 For example, the predominant etiology of HCC among Asians is HBV, and improved treatment of HBV over time may contribute to decreased incidence of HCC. In addition, race/ethnicity-specific differences in disease progression and HCC risk may occur even when the underlying liver disease etiology is the same. Disparities in disease progression and HCC risk may warrant more aggressive disease managem...

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

“…Patient knowledge, attitudes, and barriers of this population are particularly important to understand given increased HCC risk, lower surveillance rates, and worse prognosis among racial/ethnic minorities and patients of low SES. (4,23,24) Despite differences in patient populations, patients demonstrated high levels of basic knowledge regarding HCC risk, surveillance logistics, and prognosis. Most important, 90% of patients understood that cirrhosis is a high-risk state for HCC and that ultrasound-based surveillance should be performed every 6-12 months.…”

“…(3) Racial/ethnic minorities have higher rates of late-stage tumor detection as well as significantly lower stage-adjusted survival rates than non-Hispanic Caucasians. (4,5) Poor HCC clinical outcomes are, in part, attributed to underuse of surveillance among at-risk patients with cirrhosis. Several cohort studies have demonstrated that HCC surveillance is associated with higher rates of early tumor detection, curative treatment receipt, and overall survival (6) ; however, fewer than 20% of patients with cirrhosis in the United States undergo HCC surveillance.…”

Factors associated with ethnical disparity in overall survival for patients with hepatocellular carcinoma

“…Many efforts have been devoted to exploring the reasons behind this phenomenon [4, 14] for a better understanding of its contributors, which shall help us to determine which interventions could reduce this disparity.…”

Mailed Outreach Program Increases Ultrasound Screening of Patients With Cirrhosis for Hepatocellular Carcinoma

“…First, the study was conducted in a safety-net health system and results may not be generalized to other health systems. However, racially diverse, socioeconomically disadvantaged patients represent a difficult-to-reach population and are an important population to study given they experience health disparities, including higher HCC incidence and mortality rates 19, 33, 34 and lower HCC surveillance rates. 35-37 Outreach interventions would likely be equally, if not more, successful in other patient populations.…”