Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States

Avo Artinyan, Brian Mailey, Nicelio Sanchez-Luege, Joshua Khalili, Can Lan Sun, Smita Bhatia, Lawrence D. Wagman, Nicholas Nissen, Steven D Colquhoun, Joseph Kim

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

BACKGROUND: Racial, ethnic, and socioeconomic disparities in the survival of patients with hepatocellular carcinoma (HCC) continue to exist. The authors of this report hypothesized that these differences result from inequities in access to care and in response to therapy. METHODS: Patients with HCC (n = 20,920) were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and patients who underwent liver transplantation for HCC (n = 4735) were identified from the United Network for Organ Sharing (UNOS) database. Clinical and pathologic factors were compared after patients were stratified by race and ethnicity. RESULTS: The survival of patients with HCC improved over time for all racial, ethnic, and income groups (P < .001). Black and low income individuals had the poorest long-term survival (P < .001). On multivariate analysis, black race was predictive of the poorest survival (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.09-1.22; P < .001), whereas Asian race was associated with the best survival (HR, 0.87; 95% CI, 0.83-0.91; P < .001). After liver transplantation, black patients had the worst graft survival and overall survival (median survival [MS], 30.5 months and 39.7 months, respectively; P < .001), whereas Hispanics had the best survival (MS, 83.4 months and 86.6 months, respectively; P < .001). In a multivariate analysis of transplantation patients, race and ethnicity were associated significantly with outcome. CONCLUSIONS: Significant racial and ethnic disparities in the outcome of patients with HCC persist despite the receipt of comparable treatment. The authors concluded that further investigations are warranted to identify the reasons for the stark disparity in outcomes between black patients and Hispanic patients after liver transplantation for HCC.

Original languageEnglish (US)
Pages (from-to)1367-1377
Number of pages11
JournalCancer
Volume116
Issue number5
DOIs
StatePublished - Mar 1 2010
Externally publishedYes

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Social Class
Hepatocellular Carcinoma
Survival
Liver Transplantation
Hispanic Americans
Multivariate Analysis
Databases
Confidence Intervals
Graft Survival
Ethnic Groups
Epidemiology
Transplantation
Therapeutics

Keywords

  • Ethnicity
  • Health disparity
  • Hepatocellular carcinoma
  • Race
  • Transplantation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Artinyan, A., Mailey, B., Sanchez-Luege, N., Khalili, J., Sun, C. L., Bhatia, S., ... Kim, J. (2010). Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States. Cancer, 116(5), 1367-1377. https://doi.org/10.1002/cncr.24817

Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States. / Artinyan, Avo; Mailey, Brian; Sanchez-Luege, Nicelio; Khalili, Joshua; Sun, Can Lan; Bhatia, Smita; Wagman, Lawrence D.; Nissen, Nicholas; Colquhoun, Steven D; Kim, Joseph.

In: Cancer, Vol. 116, No. 5, 01.03.2010, p. 1367-1377.

Research output: Contribution to journalArticle

Artinyan, A, Mailey, B, Sanchez-Luege, N, Khalili, J, Sun, CL, Bhatia, S, Wagman, LD, Nissen, N, Colquhoun, SD & Kim, J 2010, 'Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States', Cancer, vol. 116, no. 5, pp. 1367-1377. https://doi.org/10.1002/cncr.24817
Artinyan, Avo ; Mailey, Brian ; Sanchez-Luege, Nicelio ; Khalili, Joshua ; Sun, Can Lan ; Bhatia, Smita ; Wagman, Lawrence D. ; Nissen, Nicholas ; Colquhoun, Steven D ; Kim, Joseph. / Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States. In: Cancer. 2010 ; Vol. 116, No. 5. pp. 1367-1377.
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abstract = "BACKGROUND: Racial, ethnic, and socioeconomic disparities in the survival of patients with hepatocellular carcinoma (HCC) continue to exist. The authors of this report hypothesized that these differences result from inequities in access to care and in response to therapy. METHODS: Patients with HCC (n = 20,920) were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and patients who underwent liver transplantation for HCC (n = 4735) were identified from the United Network for Organ Sharing (UNOS) database. Clinical and pathologic factors were compared after patients were stratified by race and ethnicity. RESULTS: The survival of patients with HCC improved over time for all racial, ethnic, and income groups (P < .001). Black and low income individuals had the poorest long-term survival (P < .001). On multivariate analysis, black race was predictive of the poorest survival (hazard ratio [HR], 1.15; 95{\%} confidence interval [CI], 1.09-1.22; P < .001), whereas Asian race was associated with the best survival (HR, 0.87; 95{\%} CI, 0.83-0.91; P < .001). After liver transplantation, black patients had the worst graft survival and overall survival (median survival [MS], 30.5 months and 39.7 months, respectively; P < .001), whereas Hispanics had the best survival (MS, 83.4 months and 86.6 months, respectively; P < .001). In a multivariate analysis of transplantation patients, race and ethnicity were associated significantly with outcome. CONCLUSIONS: Significant racial and ethnic disparities in the outcome of patients with HCC persist despite the receipt of comparable treatment. The authors concluded that further investigations are warranted to identify the reasons for the stark disparity in outcomes between black patients and Hispanic patients after liver transplantation for HCC.",
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T1 - Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States

AU - Artinyan, Avo

AU - Mailey, Brian

AU - Sanchez-Luege, Nicelio

AU - Khalili, Joshua

AU - Sun, Can Lan

AU - Bhatia, Smita

AU - Wagman, Lawrence D.

AU - Nissen, Nicholas

AU - Colquhoun, Steven D

AU - Kim, Joseph

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N2 - BACKGROUND: Racial, ethnic, and socioeconomic disparities in the survival of patients with hepatocellular carcinoma (HCC) continue to exist. The authors of this report hypothesized that these differences result from inequities in access to care and in response to therapy. METHODS: Patients with HCC (n = 20,920) were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and patients who underwent liver transplantation for HCC (n = 4735) were identified from the United Network for Organ Sharing (UNOS) database. Clinical and pathologic factors were compared after patients were stratified by race and ethnicity. RESULTS: The survival of patients with HCC improved over time for all racial, ethnic, and income groups (P < .001). Black and low income individuals had the poorest long-term survival (P < .001). On multivariate analysis, black race was predictive of the poorest survival (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.09-1.22; P < .001), whereas Asian race was associated with the best survival (HR, 0.87; 95% CI, 0.83-0.91; P < .001). After liver transplantation, black patients had the worst graft survival and overall survival (median survival [MS], 30.5 months and 39.7 months, respectively; P < .001), whereas Hispanics had the best survival (MS, 83.4 months and 86.6 months, respectively; P < .001). In a multivariate analysis of transplantation patients, race and ethnicity were associated significantly with outcome. CONCLUSIONS: Significant racial and ethnic disparities in the outcome of patients with HCC persist despite the receipt of comparable treatment. The authors concluded that further investigations are warranted to identify the reasons for the stark disparity in outcomes between black patients and Hispanic patients after liver transplantation for HCC.

AB - BACKGROUND: Racial, ethnic, and socioeconomic disparities in the survival of patients with hepatocellular carcinoma (HCC) continue to exist. The authors of this report hypothesized that these differences result from inequities in access to care and in response to therapy. METHODS: Patients with HCC (n = 20,920) were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and patients who underwent liver transplantation for HCC (n = 4735) were identified from the United Network for Organ Sharing (UNOS) database. Clinical and pathologic factors were compared after patients were stratified by race and ethnicity. RESULTS: The survival of patients with HCC improved over time for all racial, ethnic, and income groups (P < .001). Black and low income individuals had the poorest long-term survival (P < .001). On multivariate analysis, black race was predictive of the poorest survival (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.09-1.22; P < .001), whereas Asian race was associated with the best survival (HR, 0.87; 95% CI, 0.83-0.91; P < .001). After liver transplantation, black patients had the worst graft survival and overall survival (median survival [MS], 30.5 months and 39.7 months, respectively; P < .001), whereas Hispanics had the best survival (MS, 83.4 months and 86.6 months, respectively; P < .001). In a multivariate analysis of transplantation patients, race and ethnicity were associated significantly with outcome. CONCLUSIONS: Significant racial and ethnic disparities in the outcome of patients with HCC persist despite the receipt of comparable treatment. The authors concluded that further investigations are warranted to identify the reasons for the stark disparity in outcomes between black patients and Hispanic patients after liver transplantation for HCC.

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KW - Health disparity

KW - Hepatocellular carcinoma

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KW - Transplantation

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