Faculty Collaboration Database

Racial/ethnic disparities in access to care and survival for patients with early-stage hepatocellular carcinoma. Arch Surg 2010 Dec;145(12):1158-63

Date

12/22/2010

Pubmed ID

21173289

DOI

10.1001/archsurg.2010.272

Scopus ID

2-s2.0-78650774178 (requires institutional sign-in at Scopus site)   114 Citations

Abstract

OBJECTIVE: To determine whether controlling for differences in the use of invasive therapy affects racial/ethnic differences in survival of early-stage hepatocellular carcinoma (HCC).

DESIGN: A retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) HCC data. Invasive therapy was defined as tumor ablation, hepatectomy, or liver transplant. Race/ethnicity was defined as white, black, Asian, Hispanic, or other. Racial/ethnic differences in overall and treatment-adjusted survival were assessed using the Kaplan-Meier method and base- and treatment-stratified multivariable Cox proportional hazards models.

PATIENTS: All patients diagnosed as having stage I or II HCC from January 1, 1995, through December 31, 2006 (N = 13 244).

SETTING: Data were obtained from the National Cancer Institute's SEER registry.

MAIN OUTCOME MEASURES: Differences in survival by race/ethnicity accounting for the use of invasive therapy and treatment benefit.

RESULTS: Overall, 32.8% of patients received invasive therapy. We found higher mortality rates in the base survival model for black (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15-1.33) and Hispanic (1.08; 1.01-1.15) patients and lower mortality rates in Asian patients (0.87; 0.82-0.93) compared with whites. After treatment stratification, compared with white patients, blacks had a 12% higher mortality rate (HR, 1.11; 95% CI, 1.03-1.20), Hispanics had a similar mortality rate (0.97; 0.91-1.04), and Asians had a 16% lower mortality rate (0.84; 0.79-0.89).

CONCLUSIONS: For early-stage HCC, racial/ethnic disparities in survival between minority and white patients are notable. After accounting for differences in stage, use of invasive therapy, and treatment benefit, no racial/ethnic survival disparity is evident between Hispanics and whites, but blacks have persistently poor survival.

Author List

Mathur AK, Osborne NH, Lynch RJ, Ghaferi AA, Dimick JB, Sonnenday CJ

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Carcinoma, Hepatocellular
Cause of Death
Cohort Studies
Early Detection of Cancer
Female
Health Status Disparities
Healthcare Disparities
Humans
Kaplan-Meier Estimate
Liver Neoplasms
Male
Multivariate Analysis
Neoplasm Staging
Prognosis
Proportional Hazards Models
Registries
Retrospective Studies
SEER Program
Sex Factors
Socioeconomic Factors
Survival Analysis
United States