Survival for Patients With Liver Cancer Differs by Race
A study of nearly 1000 patients with hepatocellular carcinoma (HCC), the most common liver cancer, found that black patients with the disease had a 33% greater risk of death compared with non-Hispanic whites. Further, black patients with HCC were far less likely to undergo life-saving liver transplants, according to a presentation at Digestive Disease Week 2016.
"When we looked at a diverse sample of patients being diagnosed with HCC, race was the strongest predictor of survival," said Patricia D. Jones, MD, MSCR, assistant professor of medicine and member at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Florida, and lead author of the study. "Black patients were more likely to present with tumors that were larger — indicating that they were at a later stage of HCC when diagnosed, potentially delaying their eligibility for a liver transplant, a curative option for HCC."
The researchers reviewed 999 patients with HCC diagnosed at the University of Miami Comprehensive Cancer Center/Jackson Memorial Hospital between January 2005 and December 2014. Demographics of the study population were 76.8% men, 14.7% black, 79.7% white, 2.3% Asian, and 3.3% of unknown race. Slightly more than half of the patients were born outside North America.
When the records were analyzed by race, median survival after diagnosis was 301 days for black patients, compared with 534.5 days for non-Hispanic white patients and 437 days for Hispanics. After adjusting for factors, such as alcohol use, tobacco use, insurance, and age at diagnosis, non-Hispanic whites had a 25% reduced risk of death and Hispanics had a 21% reduced risk of death, compared with black patients. Researchers also found that black patients were more likely to have hepatitis B virus (HBV), an underlying cause of HCC.
Although liver transplants are associated with a 66% reduction in risk of death, only 11.9% of black patients underwent a liver transplant, compared with 33.3% of non-Hispanic whites.
"We are conducting additional research to determine which factors contribute to the lower survival rate in black patients, such as access to care, birthplace, socio-economic status or increased prevalence of viral hepatitis," added Jones. "Hepatitis B can be prevented by vaccination and management of this infection depends on access to care, which may be an underlying issue for this community."
1. Jones PD, Martin P, Kobetz E. Racial disparities in survival after hepatocellular carcinoma diagnosis in a diverse American population. Presentation at: Digestive Diseases Week 2016; May 22-14, 2016; San Diego, CA.