Hepatitis C-Positive Black Patients Develop Hepatocellular Carcinoma at Earlier Stages of Liver Disease and Present with a More Aggressive Phenotype

Details

• Personal Author:
  Branch AD ; Carr J ; Cohen NA ; Gleeson EM ; Golas BJ ; Labow DM ; Magge DR ; Pletcher ER ; Sarpel U ; Shaltiel T ; Siderides C ; Zheng S
• Description:
  Background: 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. The objective of this study was to clarify factors contributing to this disparity by analyzing liver and tumor characteristics in patients with HCC who have a history of hepatitis C virus (HCV) infection. Methods: Records of patients with HCV and HCC at the authors' institution from 2003 to 2018 were retrospectively reviewed. Race and ethnicity were self-identified. Imaging, laboratory, and pathologic features were compared between Black and non-Black cohorts. Results: Among 1195 individuals with HCC, 390 identified as Black. At the time of HCC diagnosis, Black patients had better liver function, as measured by Child-Pugh score, Model of End-Stage Liver Disease score, histology of nontumor tissue, and fibrosis-4 (FIB-4) score (all P < .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 < .05), larger tumors (median [interquartile range]: 3.5 cm [2.2-6.2 cm] vs 3.1 cm [2.1-5.1 cm]; P < .01), more multiple tumors (median, [interquartile range]: 1 tumor [1-3 tumors] vs 1 tumor [1-2 tumors]; P = .03), more poorly differentiated tumors (30.3% vs 20.5%; P < .05), and more microvascular invasion (67.2% vs 56.5%; P < .05). Conclusions: 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 that stress HCC surveillance for cirrhotic patients with HCV may need to be revised to be more inclusive for Black patients. In addition, tumors in Black patients carry worse prognostic features, and molecular studies are needed to characterize their biologic properties. [Description provided by NIOSH]
• Subjects:
  Neoplasms Occupational Health Race Factors Safety Viral Diseases
• Keywords:
  Author Keywords: Black Race Cancer Carcinomas Cirrhosis Disparities Hepatitis C Hepatitis C Virus Hepatocellular Carcinoma Humans Liver Cancer Liver Cells Liver Disease Liver Function Liver Tissue Liver Tumors Medical Management Guidelines Medical Screening Racial Factors Surveillance Tumors Viral Infections

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• ISSN:
  0008-543X
• 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:
  127
• Issue:
  9
• NIOSHTIC Number:
  nn:20062129
• Citation:
  Cancer 20121 May; 127(9):1395-1406
• Contact Point Address:
  Umut Sarpel, MD, Department of Surgery, Box 1259, The Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029-6574
• Email:
  umut.sarpel@mountsinai.org
• Federal Fiscal Year:
  2021
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  True
• Start Date:
  20170701
• Source Full Name:
  Cancer
• End Date:
  20210630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:a5cca874db2bebd24b1a0b4ac50dde59c24bbde43d6761deeefefb170b5dfec19899e23717294534df7cb3ada6a474846522d4d831f7541e3ff164e9ccd5567b
• Download URL:
  https://stacks.cdc.gov/view/cdc/225439/cdc_225439_DS1.pdf
• File Type:
  [PDF - 277.73 KB ]