Racial Diversity in Hepatocellular Carcinoma in a Predominately African-American Population at an Urban Medical Center

  • Brian RutledgeEmail author
  • Jenny Jan
  • Sindhuri Benjaram
  • Neha Sahni
  • Paul Naylor
  • Philip Philip
  • Murray Ehrinpreis
  • Milton Mutchnick
Original Research



Surveillance, treatment, and outcomes for African-American (AA) populations with hepatocellular carcinoma (HCC) remain under evaluated. This study evaluated demographics, surveillance, therapy, and outcomes for a predominately AA population.


The electronic medical records of a large health-care provider were used to identify 274 patients with visits for HCC between 2010 and 2017. Tumor size at diagnosis was defined by imaging with ≤ 5 cm being defined as “small.” Surveillance for HCC was defined based on ultrasound (US) assessments.


Patients were primarily AA (78%) and male (76%) with an average age at diagnosis of 62 years. Hepatitis C virus (HCV) was more likely to be a risk factor for the development of HCC in AA as compared to non-AA (92% vs 67%; p < 0.005). Surveillance rates were low (16% for AA vs 7% for non-AA). An aspartate aminotransferase platelet ratio index (APRI) value > 0.7 within 2 years of tumor diagnosis was a strong predictor for the risk of the development of HCC (86% AA vs 79 % non-AA). In this study, race was not a factor in treatment or outcomes, and most patients received tumor ablative treatment.


Given the low surveillance rates and the demonstrated increased survival for patients with small tumors, ways to increase surveillance must be initiated. The results of this study demonstrate the need for physician/patient education on the importance of surveillance US. Further, this study supports routine assessment of APRI in AA patients in an effort to identify patients in whom intensive surveillance will significantly improve earlier detection of tumors.


African-American Hepatocellular carcinoma Ultrasound (US) 



This abstract was presented at the Digestive Disease Week in Chicago, IL, USA, on May 8, 2017, and was published as Abstract Mo1419.

Author Contributions

Drs. Brian Rutledge, Neha Sahni, Paul Naylor, Philip Philip, Murray Ehrinpreis, and Milton Mutchnick were responsible for the conception and design of the study and interpretation of data analysis and drafting of the manuscript. Dr. Paul Naylor was responsible for the data analysis. Drs. Jenny Jan and Sindhuri Benjaram made substantial contributions to the acquisition of the data and also subsequent analysis and interpretation of the data along with being responsible for the revisions and critical review of the drafts. All authors have approved the final version of this manuscript.

Funding Information

This research was supported in part by an individual investigator-initiated grant from Gilead Sciences to Dr. Milton Mutchnick and Dr. Paul Naylor. Dr. Milton Mutchnick is a member of the Speaker’s Bureau for Abbvie, CLDF, Gilead, and Intercept.

Compliance with Ethical Standards

Statement of Ethics

This original research article is in compliance with the guidelines for human studies and in accordance with the World Medical Association Declaration of Helsinki. The subjects of this study have not been referred to by their real name, and further no identifying image has been included in this report.

Conflict of Interest

The authors declare that they have no conflict(s) of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyWayne State University School of MedicineDetroitUSA
  2. 2.Department of OncologyKarmanos Cancer Institute/Wayne State University School of MedicineDetroitUSA

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