Longitudinal survival and complete tumor resection rates in Native American patients with hepatocellular carcinoma treated at academic institutions.
Authors: Aidan John Becken, Vikram Murugan, Christopher Reese Bine, Peter T. Silberstein
Journal: Journal of Clinical Oncology (2024)

e16281 Background: Hepatocellular carcinoma (HCC) is the prevailing type of primary liver cancer, exhibited at a higher frequency in individuals afflicted by chronic liver conditions, notably cirrhosis induced by hepatitis B or hepatitis C infection. Past literature has demonstrated the impact certain socioeconomic factors (eg. race, occupation, place of residence) have on the prognosis of HCC, however the analysis of facility types where treatment was received in relation to HCC has yet to be further examined. Historically, Native American patients have exhibited a higher incidence of advanced-stage cancers at the time of diagnosis compared to white counterparts and experience the lowest cancer survival rates among all racial and ethnic groups. Using the NCDB, this study analyzed the relationship between the facility type where care was received and survival in Native American patients with HCC. Methods: The National Cancer Database (NCDB) was used to identify Native American patients diagnosed with Hepatocellular Carcinoma from 2004 to 2019 using the histology code 8170 and race code 03 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: Of 1186 Native American patients included in the sample, 697 (45%) received treatment at an academic facility. Native American patients treated at academic facilities experienced greater survival as compared to those who were treated at nonacademic facilities (52 months vs 30 months, p &lt; 0.05). When controlling for age, year of diagnosis, surgical status, income bracket and surgical margins, receiving care at an academic facility was associated with an independent decrease in hazard (HR = 0.403; p &lt; 0.05). Native American patients who went to an academic facility were more likely present with Stage I and II tumors, receive surgery, have no residual tumor after surgery and have private insurance (p &lt; 0.05). Nonacademic facility patients, on the other hand, were more likely to present with Stage III and IV tumors, poorly differentiated and undifferentiated tumors, and have bone, brain, liver and lung metastases (p &lt; 0.05). No differences were seen in Charlson-Deyo score, adjuvant therapy type, or same hospital readmission within thirty days of hospital discharge. Conclusions: This study found that Native American patients with HCC who received treatment at academic facilities experienced improved overall survival. These results follow previous trends, wherein academic institutions may offer more specialized care or a greater spectrum of services that yield improved patient outcomes. Further research can explore other treatment differences that Native American HCC patients face and elucidate the cause of the disparity described here.