The following is a summary of “Association of Sociodemographic Factors with Surgical Management of Hepatoblastoma and Hepatocellular Carcinoma in Children,” published in the February 2024 issue of Pediatrics by Ziogas al.

This retrospective study aimed to assess potential disparities in surgical care among pediatric patients in the United States diagnosed with hepatoblastoma (HB) and hepatocellular carcinoma (HCC).

Using data from the National Cancer Database spanning from 2004 to 2015, the study included children under 18 years diagnosed with HB or HCC. Multivariable mixed-effects logistic regression was employed to analyze the association between sociodemographic factors (such as age, sex, race, ethnicity, insurance status, income, and proximity to the treating hospital) and the likelihood of undergoing surgical treatment. The analysis adjusted for disease-related factors like tumor size, metastasis, comorbidities, and hospital-level effects. Subgroup analyses by tumor histology were also conducted.

Among the 811 children included (with 80.9% HB and 19.1% HCC), 75.2% underwent surgical treatment. After adjusting for confounding variables, Black race (odds ratio [OR]: 0.46 vs. White, 95% CI [95%CI]: 0.26-0.80, p=0.01), and having Medicaid (OR: 0.58 vs. private, 95%CI: 0.38-0.88, p=0.01) or lacking insurance (OR: 0.33 vs. private, 95%CI: 0.13-0.80, p=0.02) were associated with decreased odds of surgical treatment. In HB patients, Black race was linked to reduced odds of surgical treatment (OR: 0.47 vs. White, 95%CI: 0.25-0.89, p=0.02). Similarly, in HCC patients, Medicaid (OR: 0.10 vs. private, 95%CI: 0.03-0.35, p<0.001) or uninsured status (OR: 0.10 vs. private, 95%CI: 0.01-0.83, p=0.03) were associated with decreased odds of surgical treatment. No additional factors, except for metastatic disease, significantly associated with the likelihood of surgical treatment across both groups.

Black race and having Medicaid or no insurance are independently associated with decreased odds of undergoing surgical treatment in children diagnosed with HB and HCC, respectively. These findings suggest that such children may have reduced access to curative surgery for their liver cancer, highlighting potential disparities in care.

 Source: sciencedirect.com/science/article/abs/pii/S0022347624000660