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Hepatitis C Positive Black Patients Develop Hepatocellular Carcinoma at Earlier Stages of Liver Disease and Present with a More Aggressive Phenotype
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5 01 2021
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Source: Cancer. 127(9):1395-1406
[PDF-725.61 KB]
Details:
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Alternative Title:Cancer
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Personal Author:
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Description:Background and Aims:
In the United States, mortality after a diagnosis of hepatocellular carcinoma (HCC) is higher in patients who are Black than in patients of other racial groups. We aimed to clarify factors contributing to this disparity by analyzing liver and tumor characteristics in patients with HCC and a history of hepatitis C virus (HCV) infection.
Methods:
Records of HCV/HCC patients at our institution, 2003–2018, were reviewed retrospectively. Race/ethnicity was self-identified. Imaging, laboratory, and pathological features were compared between Black and non-Black cohorts.
Results:
Among 1195 individuals with HCC, 390 identified as Black. At HCC diagnosis, Black patients had better liver function, as measured by Child-Pugh score, model of end stage liver disease score, histology of non-tumor tissue, and fibrosis-4 (FIB-4) score (all p< 0.05). FIB-4 scores were <3.25 in 31% of Black patients. In addition, Black patients had less early stage HCC (20.2% vs. 32.3%, p<0.05); larger tumors [median, interquartile range (IQR), 3.5 (2.2–6.2) cm vs. 3.1 (2.1–5.1) cm, p<0.01]; more multiple tumors [median, IQR, 1 (1–3) vs. 1 (1–2), p=0.03]; more poorly differentiated tumors (30.3% vs. 20.5%, p<0.05); and more microvascular invasion (67.2% vs. 56.5%, p<0.05).
Conclusion:
Black patients with HCV exposure develop HCC at earlier stages of liver disease than members of other racial groups. Nearly one-third would not qualify for HCC screening using the common FIB-4 cirrhosis threshold. Practice guidelines which stress HCC surveillance for cirrhotic HCV patients may need to be revised to be more inclusive for Black patients. In addition, tumors in Black patients carry worse prognostic features; molecular studies are needed to characterize their biological properties.
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Source:
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Pubmed ID:33629759
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Pubmed Central ID:PMC8084866
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Volume:127
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Issue:9
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