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The Impact of Race on Survival After Hepatocellular Carcinoma in a Diverse American Population

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Abstract

Background and Aims

Hepatocellular carcinoma (HCC) incidence is increasing at differential rates depending on race. We aimed to identify associations between race and survival after HCC diagnosis in a diverse American population.

Methods

Using the cancer registry from Sylvester Comprehensive Cancer Center, University of Miami and Jackson Memorial Hospitals, we performed retrospective analysis of 999 patients diagnosed with HCC between 9/24/2004 and 12/19/2014. We identified clinical characteristics by reviewing available electronic medical records. The association between race and survival was analyzed using Cox proportional hazards regression.

Results

Median survival in days was 425 in Blacks, 904.5 in non-Hispanic Whites, 652 in Hispanics, 570 in Asians, and 928 in others, p < 0.01. Blacks and Asians presented at more advanced stages with larger tumors. Although Whites had increased severity of liver disease at diagnosis compared to other races, they had 36% reduced rate of death compared to Blacks, [hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.51–0.8, p < 0.01]. After adjusting for significant covariates, Whites had 22% (HR 0.78, 95% CI 0.61–0.99, p 0.04) reduced risk of death, compared to Blacks. Transplant significantly reduced rate of death; however, only 13.3% of Blacks had liver transplant, compared to 40.1% of Whites, p < 0.01.

Conclusions

In this diverse sample of patients, survival among Blacks is the shortest after HCC diagnosis. Survival differences reflect a more advanced tumor stage at presentation rather than severity of underlying liver disease precluding treatment. Improving survival in minority populations, in whom HCC incidence is rapidly increasing, requires identification and modification of factors contributing to late-stage presentation.

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Author information

Authors and Affiliations

  1. Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA

    Patricia D. Jones, Joselin Gonzalez-Diaz & Paul Martin

  2. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA

    Patricia D. Jones, Paul Martin & Erin Kobetz

  3. Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA

    Carlos Diaz

  4. Department of Medicine, University of Miami Miller School of Medicine/JFK Medical Center Palm Beach Regional GME Consortium, Miami, FL, 33136, USA

    Danlu Wang

  5. Division of Computational Medicine and Population Health, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA

    Erin Kobetz

  6. Jay Weiss Institute for Health Equity, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA

    Erin Kobetz

Authors
  1. Patricia D. Jones
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  2. Carlos Diaz
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  4. Joselin Gonzalez-Diaz
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Contributions

PDJ contributed to project conception, study design, data collection, statistical analysis, manuscript drafting, and critical revision. PDJ has approved the final draft submitted. CD contributed to data collection, data analysis, manuscript drafting, and critical revision. CD has approved the final draft submitted. DW contributed to data collection, data analysis, manuscript drafting, and critical revision. DW has approved the final draft submitted. JGD contributed to data collection, manuscript drafting, and critical revision. JGD has approved the final draft submitted. PM contributed to study design, data collection, data analysis, manuscript drafting, and critical revision. PM has approved the final draft submitted. EK contributed to project conception, study design, data collection, statistical analysis, manuscript drafting, and critical revision. EK has approved the final draft submitted.

Corresponding author

Correspondence to Patricia D. Jones.

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Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

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Supplementary Figure 1

Study Flow Diagram. EMR = electronic medical record, HCC = hepatocellular carcinoma, SCC = squamous cell carcinoma (JPEG 59 kb)

Supplementary material 2 (DOCX 121 kb)

Supplementary material 3 (DOCX 28 kb)

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Jones, P.D., Diaz, C., Wang, D. et al. The Impact of Race on Survival After Hepatocellular Carcinoma in a Diverse American Population. Dig Dis Sci 63, 515–528 (2018). https://doi.org/10.1007/s10620-017-4869-3

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  • DOI: https://doi.org/10.1007/s10620-017-4869-3

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