The Adverse Characteristics of Hepatocellular Carcinoma in the Non-Cirrhotic Liver Disproportionately Disadvantage Black Patients

Details

• Personal Author:
  Branch AD ; Sarpel U ; Shaltiel T
• Description:
  Background: Black patients have higher hepatocellular carcinoma (HCC)-related mortality than White patients and more often develop HCC in non-cirrhotic liver. HCC surveillance is primarily directed toward cirrhotic patients. We aimed to characterize HCC in non-cirrhotic patients and to identify factors associated with HCC beyond Milan criteria. Methods: Demographic, imaging, laboratory, and pathology data of HCC patients at our institution, 2003-2018, were reviewed, retrospectively. Race/ethnicity were self-reported. Cirrhosis was defined as a Fibrosis-4 score ≥3.25. Results: Compared to 1146 cirrhotic patients, 411 non-cirrhotic patients had larger tumors (median 4.7 cm vs. 3.1 cm, p < 0.01) and were less likely to be within Milan criteria (42.6% vs. 57.7%, p < 0.01). Among non-cirrhotic patients, Black patients had larger tumors (4.9 cm vs. 4.3 cm, p < 0.01) and a higher percentage of poorly differentiated tumors (39.4% vs. 23.1%, p = 0.02). Among cirrhotic patients, Black patients had larger tumors (3.3 cm vs. 3.0 cm, p = 0.03) and were less likely to be within Milan criteria (52.3% vs. 83.2%, p < 0.01). In multivariable analysis, lack of commercial insurance (OR 1.45 [CI 95% 1.19-1.83], p < 0.01), male sex (OR 1.34 [CI 95% 1.05-1.70], p < 0.01), absence of cirrhosis (OR 1.58 [CI 95% 1.27-1.98], p < 0.01) and Black race/ethnicity (OR 1.34 [CI 95% 1.09-1.66], p = 0.01) were associated with HCC beyond Milan criteria. Black patients had lower survival rates than other patients (p < 0.01). Conclusions: Non-cirrhotic patients had more advanced HCC than cirrhotic patients. Black patients (with or without cirrhosis) had more advanced HCC than comparable non-Black patients and higher mortality rates. Improved access to healthcare (commercial insurance) may increase early diagnosis (within Milan criteria) and reduce disparities. [Description provided by NIOSH]
• Subjects:
  Epidemiology Healthcare Disparities Mortality Neoplasms Occupational Health Race Factors Safety
• Keywords:
  Author Keywords: African American Black Carcinomas Cirrhosis Disparities Equity Fibrosis-4 Health Care Health Disparities Hepatocellular Carcinoma Insurance Liver Disease Milan Criteria Mortality Rates Racial Factors Surveillance

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• ISSN:
  2045-7634
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  13
• Issue:
  3
• NIOSHTIC Number:
  nn:20069135
• Citation:
  Cancer Med 2024 Feb; 13(3):e6654
• Contact Point Address:
  Andrea D. Branch, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
• Email:
  andrea.branch@mssm.edu
• Federal Fiscal Year:
  2024
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  True
• Start Date:
  20210701
• Source Full Name:
  Cancer Medicine
• End Date:
  20240630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:ab8519e12763e8c66b02b85a65edf4e86a8bf96f52686ee07119f930231b1f1d5cd4c3d5f3a4121d092fd6d3203d4619d3f7f675037dd1f828e64998280fa920
• Download URL:
  https://stacks.cdc.gov/view/cdc/207672/cdc_207672_DS1.pdf
• File Type:
  [PDF - 987.39 KB ]