Abstract D104: Presentation, treatment, and survival of hepatocellular carcinoma (HCC) in a diverse population: Experience of a single transplant center
Authors: Barzi Afsaneh , Patel Ravi , Tulpule Varsha , Albertian Robert , Yu Bo , Lynch Gwendolyn , El-Khoueiry Anthony , Wang Songren , Setiawan Veronica Wendy 
Published: September 2020

Abstract
Background: HCC has pathognomonic imaging and predominantly non-surgical treatment paradigms. Most patients do not have histological diagnosis, an integral part of case identification for population based cancer registries. The unique patterns of diagnosis and treatment may hamper population-based study of HCC outcomes and patterns of care. We examined racial differences in the HCC underlying etiology, presentation, treatment, and outcome in a diverse patient population in a single transplant center. Methods: HCC patients who were diagnosed/treated at Norris Comprehensive Cancer Center between 2003-2018 were identified from cancer registry. Registry data including vital status were linked with medical records. Demographics, stage at diagnosis [Barcelona Clinic Liver Cancer stage (BCLC) and Tumor Node Metastasis (TNM)], underlying etiology [hepatitis C (HCV), hepatitis B (HBV), nonalcoholic steatohepatitis (NASH), alcoholic liver disease], treatment information, and vital status were retrieved. The chi-square test was used to compare characteristics of patients by race. Multivariable Cox’s models were used to identify factors associated with overall survival. Results: A total of 619 patients (152 non-Hispanic whites (NHW), 285 Hispanics, 158 Asians, and 24 African Americans) were included in the analysis. The median follow-up was 27.0 months. The average age at diagnosis was 63 years, and 76% of patients were male. Underlying etiology varied significantly across racial groups (P&lt;0.0001); HCV was the most common etiology in African Americans (79%), NHW (70%), and Hispanics (52%), while HBV was the main etiology in Asians (54%). The proportion of NASH-related HCC was 13% in Hispanics, 8% in NHW, 4% in African Americans, and 3% in Asians. There was no significant difference in TNM stage at presentation, however, compared to NHW (36%), Asians (48%) and Hispanics (52%) were more likely to be diagnosed with Barcelona stage A (P≤0.021). Median AFP values at presentation was highest in African Americans and lowest in Hispanics (P heterogeneity ≤0.033). Only 7% of patients received no treatment, 49, 26, and 19% of patients received locoregional, systemic, or transplant respectively. There was no difference in access to these treatments by race, despite significant differences in the insurance status. In the multivariate analyses, higher stage at presentation, NASH-related HCC, and non-transplant treatment were associated with worse survival. Surveillance for HCC showed trend for improved survival (P=0.057). Conclusion: Among patients with appropriate and similar access to care prognosis of HCC is driven by stage, underlying etiology, and curative treatment. Surveillance may improve survival in patients with appropriate access to care.
Citation Format: Afsaneh Barzi, Ravi Patel, Varsha Tulpule, Robert Albertian, Bo Yu, Gwendolyn Lynch, Anthony El-Khoueiry, Songren Wang, Veronica Wendy Setiawan. Presentation, treatment, and survival of hepatocellular carcinoma (HCC) in a diverse population: Experience of a single transplant center [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 D104.