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Black patients with HCC are less likely than White patients to receive curative treatment.
Black patients with hepatocellular carcinoma (HCC) appear to be less likely than White patients to receive treatments that cure their disease, researchers report.
“Black patients with larger tumors and low albumin are less likely to receive curative treatment than White,” Kim Abbegail Tan Aldecoa, MD, and coauthors wrote in an abstract presented at the 2024 ASCO Annual Meeting and in the Journal of Clinical Oncology.
Research based on data from the Surveillance, Epidemiology and End Results (SEER) Program projects more than 56,000 HCC cases in 2030 in the US, and studies in the medical literature suggest that disparities exist in HCC treatment and outcomes based on region, race, and socioeconomic status.
“After the implementation of the Affordable Care Act, including Michigan’s Medicaid Expansion in 2014, there’s increased interest in how these changes affect HCC care,” the authors noted.
With the goal of analyzing existing HCC treatment disparities to inform future intervention strategies, Dr. Aldecoa and her colleagues conducted a retrospective chart review of patients with HCC treated at six Michigan community-based hospitals, four of which were university-affiliated, from January 2016 to September 2023. The study team excluded patients without imaging or histologic confirmation and used logistic regression to analyze the data.
After screening 680 patients with HCC, the researchers analyzed data from 347 patients who met the inclusion criteria. These patients averaged 70 years; 71% were male, 78.3% were White, and 16.9% were Black. Overall, 53.9% were insured privately, and 35% had government insurance. Primary HCC etiologies were alcohol and hepatitis C virus infection, and 74.4% had cirrhosis. The patients’ cancers were at various Barcelona Clinic Liver Cancer (BCLC) stages: stage A (early) in 10.6%, B (intermediate) in 28.2%, C (advanced) in 36.4%, and D (end-stage) in 24.8%.
Physicians provided curative treatment to 59.4% of patients (4.6% resection, 30.3% liver-directed, 13.3% systemic, 10.1% combination), while 38.3% received best supportive care.
Factors Linked With Curative Treatment
In univariate analysis, the authors identified factors more likely to indicate receipt of curative treatment, including several that did not reach statistical significance: Private rather than government insurance; smaller tumor size, absence of metastasis, absence of portal vein thrombosis; Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2; Child-Pugh class A; lower model for end-stage liver disease (MELD)-Na scores; alpha-fetoprotein levels less than 400 ng/mL; better bilirubin and international normalized ratio (INR) values.
- The one-year survival rate was 64% for those who received curative treatment vs. 35% for those who had best supportive care (P<05).
- On multivariable analysis, Black patients (OR, 0.21; 95% CI, 0.051-0.881; P=0.033) with larger tumors (OR, 0.885; 95% CI, 0.783-1.00; P=0.050) and those lower albumin levels (OR, 3.811; 95% CI, 1.649-8.805; P=0.002) at presentation were less likely to receive curative treatment.
- Compared with White patients, Black patients were more likely to be diagnosed at a younger age (66.7 vs. 71.0 years, P=0.01), to have more advanced BCLC stages (C, advanced) or D (end-stage) (74% vs. 57%, P=0.04) on presentation, and to have hepatitis C coinfection (58% vs. 32%, P<0.001).
- The median survival was 757 days among Black patients vs. 823 days among White patients (P=0.89).
“Higher HCV coinfection in the Black population suggests a focus area for early intervention,” the authors concluded. “Further investigation of HCC disparities across various settings is warranted.”
