The adverse characteristics of hepatocellular carcinoma in the non‐cirrhotic liver disproportionately disadvantage Black patients
Abstract Background Black patients have higher hepatocellular carcinoma (HCC)‐related mortality than White patients and more often develop HCC in non‐cirrhotic liver. HCC surveillance is primarily directed toward cirrhotic patients. We aimed to characterize HCC in non‐cirrhotic patients and to ident...
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.6654 |
| _version_ | 1797216964535386112 |
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| author | Tali Shaltiel Umut Sarpel Andrea D. Branch |
| author_facet | Tali Shaltiel Umut Sarpel Andrea D. Branch |
| author_sort | Tali Shaltiel |
| collection | DOAJ |
| description | Abstract Background Black patients have higher hepatocellular carcinoma (HCC)‐related mortality than White patients and more often develop HCC in non‐cirrhotic liver. HCC surveillance is primarily directed toward cirrhotic patients. We aimed to characterize HCC in non‐cirrhotic patients and to identify factors associated with HCC beyond Milan criteria. Methods Demographic, imaging, laboratory, and pathology data of HCC patients at our institution, 2003–2018, were reviewed, retrospectively. Race/ethnicity were self‐reported. Cirrhosis was defined as a Fibrosis‐4 score ≥3.25. Results Compared to 1146 cirrhotic patients, 411 non‐cirrhotic patients had larger tumors (median 4.7 cm vs. 3.1 cm, p < 0.01) and were less likely to be within Milan criteria (42.6% vs. 57.7%, p < 0.01). Among non‐cirrhotic patients, Black patients had larger tumors (4.9 cm vs. 4.3 cm, p < 0.01) and a higher percentage of poorly differentiated tumors (39.4% vs. 23.1%, p = 0.02). Among cirrhotic patients, Black patients had larger tumors (3.3 cm vs. 3.0 cm, p = 0.03) and were less likely to be within Milan criteria (52.3% vs. 83.2%, p < 0.01). In multivariable analysis, lack of commercial insurance (OR 1.45 [CI 95% 1.19–1.83], p < 0.01), male sex (OR 1.34 [CI 95% 1.05–1.70], p < 0.01), absence of cirrhosis (OR 1.58 [CI 95% 1.27–1.98], p < 0.01) and Black race/ethnicity (OR 1.34 [CI 95% 1.09–1.66], p = 0.01) were associated with HCC beyond Milan criteria. Black patients had lower survival rates than other patients (p < 0.01). Conclusions Non‐cirrhotic patients had more advanced HCC than cirrhotic patients. Black patients (with or without cirrhosis) had more advanced HCC than comparable non‐Black patients and higher mortality rates. Improved access to healthcare (commercial insurance) may increase early diagnosis (within Milan criteria) and reduce disparities. |
| first_indexed | 2024-03-07T15:43:28Z |
| format | Article |
| id | doaj.art-491e2f1423544cc48a3b84f5d9f5dfc9 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-04-24T11:54:20Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-491e2f1423544cc48a3b84f5d9f5dfc92024-04-09T05:45:47ZengWileyCancer Medicine2045-76342024-02-01133n/an/a10.1002/cam4.6654The adverse characteristics of hepatocellular carcinoma in the non‐cirrhotic liver disproportionately disadvantage Black patientsTali Shaltiel0Umut Sarpel1Andrea D. Branch2Division of Surgical Oncology, Department of Surgery Icahn School of Medicine at Mount Sinai New York New York USADivision of Surgical Oncology, Department of Surgery Icahn School of Medicine at Mount Sinai New York New York USADivision of Liver Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York New York USAAbstract Background Black patients have higher hepatocellular carcinoma (HCC)‐related mortality than White patients and more often develop HCC in non‐cirrhotic liver. HCC surveillance is primarily directed toward cirrhotic patients. We aimed to characterize HCC in non‐cirrhotic patients and to identify factors associated with HCC beyond Milan criteria. Methods Demographic, imaging, laboratory, and pathology data of HCC patients at our institution, 2003–2018, were reviewed, retrospectively. Race/ethnicity were self‐reported. Cirrhosis was defined as a Fibrosis‐4 score ≥3.25. Results Compared to 1146 cirrhotic patients, 411 non‐cirrhotic patients had larger tumors (median 4.7 cm vs. 3.1 cm, p < 0.01) and were less likely to be within Milan criteria (42.6% vs. 57.7%, p < 0.01). Among non‐cirrhotic patients, Black patients had larger tumors (4.9 cm vs. 4.3 cm, p < 0.01) and a higher percentage of poorly differentiated tumors (39.4% vs. 23.1%, p = 0.02). Among cirrhotic patients, Black patients had larger tumors (3.3 cm vs. 3.0 cm, p = 0.03) and were less likely to be within Milan criteria (52.3% vs. 83.2%, p < 0.01). In multivariable analysis, lack of commercial insurance (OR 1.45 [CI 95% 1.19–1.83], p < 0.01), male sex (OR 1.34 [CI 95% 1.05–1.70], p < 0.01), absence of cirrhosis (OR 1.58 [CI 95% 1.27–1.98], p < 0.01) and Black race/ethnicity (OR 1.34 [CI 95% 1.09–1.66], p = 0.01) were associated with HCC beyond Milan criteria. Black patients had lower survival rates than other patients (p < 0.01). Conclusions Non‐cirrhotic patients had more advanced HCC than cirrhotic patients. Black patients (with or without cirrhosis) had more advanced HCC than comparable non‐Black patients and higher mortality rates. Improved access to healthcare (commercial insurance) may increase early diagnosis (within Milan criteria) and reduce disparities.https://doi.org/10.1002/cam4.6654African AmericanBlackdisparitiesequityFibrosis‐4hepatocellular carcinoma |
| spellingShingle | Tali Shaltiel Umut Sarpel Andrea D. Branch The adverse characteristics of hepatocellular carcinoma in the non‐cirrhotic liver disproportionately disadvantage Black patients Cancer Medicine African American Black disparities equity Fibrosis‐4 hepatocellular carcinoma |
| title | The adverse characteristics of hepatocellular carcinoma in the non‐cirrhotic liver disproportionately disadvantage Black patients |
| title_full | The adverse characteristics of hepatocellular carcinoma in the non‐cirrhotic liver disproportionately disadvantage Black patients |
| title_fullStr | The adverse characteristics of hepatocellular carcinoma in the non‐cirrhotic liver disproportionately disadvantage Black patients |
| title_full_unstemmed | The adverse characteristics of hepatocellular carcinoma in the non‐cirrhotic liver disproportionately disadvantage Black patients |
| title_short | The adverse characteristics of hepatocellular carcinoma in the non‐cirrhotic liver disproportionately disadvantage Black patients |
| title_sort | adverse characteristics of hepatocellular carcinoma in the non cirrhotic liver disproportionately disadvantage black patients |
| topic | African American Black disparities equity Fibrosis‐4 hepatocellular carcinoma |
| url | https://doi.org/10.1002/cam4.6654 |
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