Abstract A76: Characteristics associated with racial disparities in Hepatocellular carcinoma survival: A matched cohort study
Authors: Thrift Aaron P. 
Published: February 2019

Background: Large racial/ethnic disparities exist in risk and outcomes of hepatocellular cancer (HCC).

Objective: To determine to what extent the racial disparity in survival for patients with HCC is due to disparity in presentation characteristics at diagnosis or disparity in subsequent treatment.

Methods: Data were from 16 U.S. Surveillance, Epidemiology and End Results (SEER) sites in the SEER-Medicare database. We compared 559 black patients 65 years and older diagnosed with HCC between 2004 and 2011 with 3 sets of 559 matched non-Hispanic white control patients selected from 4,039 non-Hispanic white potential controls. Similarly, we compared 494 Hispanic patients 65 years and older diagnosed with HCC between 2004 and 2011 with 3 sets of 494 matched non-Hispanic white control patients selected again from the 4,039 non-Hispanic white potential controls. All patients received follow-up through December 31, 2013, and the black and Hispanic case patients were separately matched to the 3 non-Hispanic white control populations on demographic (age, year of diagnosis, and SEER site), presentation (demographics variables plus patient comorbid conditions and tumor characteristics such as stage, size, and AFP), and treatment (presentation variables plus details of surgery, radiation therapy, and chemotherapy) characteristics.

Results: The absolute difference in 5-year survival between black (4.6%) and non-Hispanic white (10.6%) patients was 6.0% (95% CI, 4.0% to 8.2%; P&lt;0.001) in the demographic characteristics match. After matching for presentation characteristics, the difference in 5-year survival between black and non-Hispanic white patients decreased to 2.2% (95% CI, 0.5% to 4.2%; P=0.04). After additional matching for treatment characteristics, this difference decreased to 2.0% (95% CI, -0.1% to 3.9%; P=0.07) and was not statistically significant. The disparity in survival attributed to treatment differences made up only an absolute 0.2% of the overall 6.0% survival disparity between blacks and non-Hispanic whites with HCC. In the analyses comparing Hispanic and non-Hispanic white patients with HCC, we found no statistically significant differences in 5-year survival rates (Hispanics, 6.1%; non-Hispanic white demographic match, 7.5%; non-Hispanic white treatment match, 5.6%).

Conclusions: In the SEER-Medicare database, we observed significant disparities in survival of black versus non-Hispanic white patients with HCC. This persistent disparity seemed to be more related to presentation characteristics at diagnosis than to subsequent treatment differences. There were no differences in survival between Hispanic and non-Hispanic white patients with HCC.

Note: This abstract was not presented at the conference.

Citation Format: Aaron P. Thrift. Characteristics associated with racial disparities in Hepatocellular carcinoma survival: A matched cohort study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A76.