Abstract C076: Racial/ethnic disparities in clinical presentation, surgical procedures, and hospital outcomes among patients with hepatocellular carcinoma in the United States, 2010-2014
Authors: Cuitiva Sebastian , Armand Nicole , Suarez Deborah , Rubens Muni , Villalona-Calero Miguel 
Published: August 2020

Purpose: Hepatocellular carcinoma (HCC) is an aggressive tumor with a median survival of 6-20 months at diagnosis. There is significant racial/ethnic variation in the incidence of HCC in the United States with highest incidence in Asians or Pacific Islanders (7.8 per 100,000 persons), followed by African Americans (4.2 per 100,000), Native Americans (3.2 per 100,000), and whites (2.6 per 100,000). However, racial/ethnic variations in clinical presentation, surgical procedures and treatment outcomes among HCC patients is unknown. Hence, we examined racial/ethnic disparities in pretreatment, treatment and post-treatment stages of hospitalized HCC patients in the United States using National Inpatient Sample (NIS).

Methods: This study was a cross-sectional analysis of NIS 2010-2014. Multivariate logistic regression analyses were used to examine the risk adjusted association between race/ethnicity and the pretreatment, treatment and post-treatment stages. Pretreatment outcomes were stage of disease (metastatic versus nonmetastatic) and Elixhauser comorbidity index (≤4 versus &gt;4). Treatments included surgical procedures (surgery done versus not done) like major hepatectomy, hepatic wedge resection, liver ablation, and liver transplantation. Post-treatment outcomes were postoperative complications (yes versus no) and in-hospital mortality (died versus did not die). All outcomes were identified using ICD-9-CM diagnosis and procedure codes.

Results: A total of 71,739 weighted HCC hospitalizations were reported during the period 2010-2014. Majority of the participants were whites (57.9), followed by African Americans (17.1%), Hispanic (15.7%), Asian or Pacific Islanders (8.7%) and Native Americans (0.61%). Compared to whites, African Americans (adjusted odds ratio [aOR], 1.26; 95% confidence interval (CI), 1.13-1.42), Hispanic (aOR, 1.12; 95% CI, 1.01-1.27), and Native Americans (aOR, 1.82; 95% CI, 1.16-2.86) were more likely to have comorbidities. There were no significant association between race/ethnicity and stage of the disease. Compared to whites, African Americans (aOR, 0.63; 95% CI, 0.54-0.73), Hispanic (aOR, 0.70; 95% CI, 0.59-0.83), and Native Americans (aOR, 0.47; 95% CI, 0.24-0.93) were less likely to receive surgical procedures. Compared to whites, African-Americans were more likely to develop postoperative complications (aOR, 1.67; 95% CI, 1.52-1.88) and in-hospital mortality (aOR, 1.22; 95% CI, 1.03-1.43). Asian or Pacific Islander were more likely to have in-hospital mortality (aOR, 1.24; 95% CI, 1.01-1.52).

Conclusions: Our study found that, after controlling for potential confounders, there were significant racial/ethnic disparities in pretreatment presentation, surgical procedure allocation, and post-treatment outcomes among patients with HCC. Further studies are needed to find the underlying factors for these disparities and interventions to reduce these gaps.

Citation Format: Sebastian Cuitiva, Nicole Armand, Deborah Suarez, Muni Rubens, Miguel Villalona-Calero. Racial/ethnic disparities in clinical presentation, surgical procedures, and hospital outcomes among patients with hepatocellular carcinoma in the United States, 2010-2014 [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C076.