Recent Improvements in Racial Disparity in the Treatment of Hepatocellular Carcinoma: How Times Have Changed

Abstract

Background

Race has been shown to impact receipt of and outcomes following hepatobiliary surgery. We sought to determine if racial disparities in the management of hepatocellular carcinoma persist.

Methods

Information on patients with hepatocellular carcinoma diagnosed between 2012 and 2016 was obtained from the Surveillance, Epidemiology, and End Results database. The sample was stratified by race/ethnicity, and associations between tumor characteristics, treatment, and survival were assessed.

Results

Of 33,672 patients, the mean age was 65 years, and 77% were male. By race, 17,150 (51%) were white, 4755 (14%) black, 6850 (20%) Hispanic, and 4917 (15%) Asian. When assessing the likelihood of treatment versus no treatment for tumors less than 5 cm, no difference was observed between whites and blacks in any year, but Hispanics were less likely than whites to receive treatment in most years. Asians were more likely to receive treatment every year. When assessing the likelihood of transplant versus surgical resection, blacks were less likely than whites to undergo transplant in all years except 2016. Hispanics were equally likely, while Asians were less likely to undergo transplant in all years. For years 2012 to 2016 collectively, Asians had better 5-year survival rates than other races after undergoing ablation and resection. No difference in the risk of death was observed among blacks, whites, or Hispanics after undergoing ablation, resection, or transplant.

Conclusion

Racial disparities for blacks and Hispanics have improved. Although Asians were less likely to undergo transplant, they had better survival after undergoing resection or ablation.

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Authors

Contributions

Ambria S. Moten, MD, MS, contributed to the study design, data analysis and interpretation, drafting of the manuscript, critical revision of the manuscript, and approval of the final version. Alexander M. Fagenson, MD, contributed to the study design, drafting of the manuscript, critical revision of the manuscript, and approval of the final version. Henry A. Pitt, MD, contributed to data interpretation, critical revision of the manuscript, and approval of the final version. Kwan N. Lau, MD, contributed to the study design, data interpretation, drafting of the manuscript, critical revision of the manuscript, and approval of the final version. All authors agree to be accountable for this work.

Corresponding author

Correspondence to Kwan N. Lau.

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Meeting Presentation:

The abstract of this manuscript was presented virtually at the American College of Surgeons Annual Clinical Congress in October 2020.

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Moten, A.S., Fagenson, A.M., Pitt, H.A. et al. Recent Improvements in Racial Disparity in the Treatment of Hepatocellular Carcinoma: How Times Have Changed. J Gastrointest Surg (2021). https://doi.org/10.1007/s11605-021-04912-7

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Keywords

  • Race
  • Disparity
  • Hepatocellular carcinoma
  • Treatment
  • Surgery