Abstract B114: Impact of nativity on survival among blacks with hepatocellular carcinoma in California (1988-2016)
Authors: Zhou Kali , Song Ziwei , Terrault Norah A , Liu Lihua 
Published: September 2020

Abstract
Introduction/Objective The most striking racial/ethnic disparity among those with hepatocellular carcinoma (HCC) in the United States (US) is worse survival among black Americans. However, existing literature does not consider birthplace among blacks. Differences in risk factors for HCC between US-born (USB) and foreign-born (FB) blacks may influence the natural history of the disease. Our objective was to examine impact of nativity on survival among blacks with HCC utilizing a population-based cohort from California. Methods We identified cases of HCC (ICD-O-3: C220 and 8170) diagnosed between 1988 and 2016 in the statewide California Cancer Registry (CCR). Non-Hispanic black HCC cases with available birthplace information were included in this study (9.7% unknown excluded). Cases were identified as foreign-born if reported or estimated birthplace was outside of the US or its territories. Primary outcome was overall survival after HCC diagnosis. We examined distributions of sociodemographic and tumor characteristics by nativity including disease stage at diagnosis (localized, regional, or distant) and type of therapy received (none, surgical, or non-surgical). The association between nativity and survival was examined using Kaplan-Meier survival curves and multivariable Cox regression. Other factors associated with survival were also evaluated. Results A total of 4019 non-Hispanic black HCC cases were identified in CCR, of which 254 (12.6%) were FB. FB were more likely than USB to be female (30 vs 24%, p=0.02) and more likely to be diagnosed under the age of 40 (10 vs 1%) or between ages 40-50 (15 vs 7%, p&lt;0.001). FB were also more likely to be of higher socioeconomic status (SES) (30 vs 21%, p&lt;0.001). No obvious differences in stage distribution were noted between USB and FB with ~40% localized, ~25% regional, and ~24% distant disease. Nearly half of those in both groups received no treatment. Among those that received treatment, 19% of FB versus 24% of USB received surgical treatment (p=0.54). Overall 75% (191/253) of FB and 90% (3386/3761) of USB died, with median survival of 6 months (IQR 1-32) and 5 months (IQR 1-19), respectively. In multivariable analysis adjusting for age, sex, marital status, SES, tumor stage, and treatment type, FB had improved survival compared to USB (HR 0.8, p=0.006). For both FB and USB, localized stage of disease and receipt of any therapy type were associated with improved survival (p&lt;0.001). Female sex and higher SES were associated with improved survival among USB (p&lt;0.01). No association between age at diagnosis and survival was found for either group. Conclusion FB blacks in California more commonly present with HCC at younger age (&lt;50) than USB. Overall survival was significantly better in FB than USB blacks, though remains low for both groups, and those diagnosed at younger age did not demonstrate improved survival. This study highlights the need to enhance our understanding of factors that contribute to poor outcomes among blacks with HCC.
Citation Format: Kali Zhou, Ziwei Song, Norah A Terrault, Lihua Liu. Impact of nativity on survival among blacks with hepatocellular carcinoma in California (1988-2016) [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B114.