‘Significant’ racial, ethnic disparities exist in curative treatment for early-stage HCC
Click Here to Manage Email Alerts
WASHINGTON — Fewer Black and Hispanic patients received curative treatment for early-stage hepatocellular carcinoma compared with white patients, according to research presented at The Liver Meeting.
“HCC is the third leading cause of cancer-related death worldwide. Prognosis varies significantly based on stage of diagnosis. Unfortunately, HCC is usually detected at a later stage when treatment options are limited, and prognosis is poor. However, curative treatments are available for patients detected at an early stage, and these include surgical resection, local ablation and liver transplantation,” Ashwini Arvind, MD, a third-year medicine resident at UT Southwestern Medical Center, said. “Unfortunately, curative treatment is underutilized in the United States, particularly in Black, Hispanic and low-income populations, and this contributes in part to disparities in survival.”
Seeking to identify barriers to care for patients with early-stage HCC, Arvind and colleagues reviewed individual patient charts to determine receipt of curative treatment at two hospital systems between 2008 and 2021. They identified 1,897 patients, of whom 39.2% had early-stage HCC (73.7% men, 39.1% white, 25.9% Black, 27.8% Hispanic).
According to results, 59.3% of patients received curative treatment, including resection (36.9%), ablation (34.1%) or transplantation (29%). Compared with white patients, fewer Black and Hispanic patients received curative treatment (63.9% vs. 56% and 54.1%, respectively). This trend among Black (OR = 0.61; 95% CI, 0.39-0.94) and Hispanic patients (OR = 0.65; 95% CI, 0.42-1) continued after adjusting for factors such as age, gender, liver disease etiology and tumor burden.
Additional results showed a higher proportion of Hispanic and white patients failed to undergo resection due to liver dysfunction compared with Black patients (70% and 76.4% vs. 51%), while Black patients were more likely to not undergo resection due to tumor burden (31.4% vs. 14.1% white and 11.6% Hispanic) and comorbidities (9.8% vs. 7% white and 3.3% Hispanic).
Although all groups cited social and financial reasons for transplant ineligibility, Hispanic (27.1%, 33.9%) and Black patients (25%, 25%) were more often affected compared with white patients (20%, 25.7%). Arvind also noted that Black patients had the highest tumor progression (17.3%).
“There are significant racial and ethnic disparities in receipt of curative treatment for early-stage HCC,” Arvind concluded. “These disparities are mitigated after adjusting for insurance status. Underlying reasons vary by race, ethnicity and treatment modality.”
She added, “These data are essential to inform interventions to reduce inequities in HCC outcomes.”
Collapse
Rich NE, et al. Factors underlying racial and ethnic inequities in curative treatment receipt for early-stage HCC. Presented at: The Liver Meeting; Nov. 4-8, 2022; Washington (hybrid meeting).
Click Here to Manage Email Alerts