Abstract
Hepatocellular carcinoma (HCC) remains an important form of cancer-related morbidity and mortality in the U.S. and worldwide. Previous U.S.-based studies on survival suggest ethnic disparities in HCC patients, but the complex interplay of multiple factors that contribute are still incompletely understood. Here we considered the influences of risk factors contributing towards HCC survival, including ethnic background, over ten years at a premier academic medical center with a majority (57.20%) African American (AA) population. Retrospective HCC data were collected from 2008–2018 at LSUHSC-Shreveport, an urban tertiary medical center. Data included demographics, comorbidities, liver disease characteristics, and tumor parameters. Statistical analysis was performed using Chi Square and one-way ANOVA. Results: 229 HCC patients were identified (male 78.6%). The mean HCC age at diagnosis was 61 years (SD = 7.3). Compared to non-Hispanic Caucasians (42.7%), AA patients (57.2% of total) were older at presentation, had more frequent diabetes/dyslipidemia/NAFLD (45 (34.3%) compared with 19 (19.3%) in non-Hispanic Caucasians, p = 0.02), and had a larger HCC burden at diagnosis. We conclude that compared to white patients, despite having similar BMI and MELD scores and rates of portal vein thrombosis, AA patients with HCC in our cohort were older at presentation, had a significantly increased incidence of modifiable metabolic risk factors including diabetes, higher AFP values, increased incidence of gallstones, and larger sized HCCs, and were more likely to be outside Milan criteria. These findings have important prognostic and diagnostic implications for developing a more targeted HCC surveillance program.
Highlights
Hepatocellular carcinoma (HCC) causes ~800,000 deaths annually [1] and is the fourth leading cause of cancer-related death [1]
53.06% of the non-Hispanic Caucasian patients were free of comorbidities; 19.30% were in group 2 and 27.55% were in group 3
Since HCC-related mortality continues to increase in the U.S, ethnic disparities in overall survival have attracted significant attention [6]
Summary
Hepatocellular carcinoma (HCC) causes ~800,000 deaths annually [1] and is the fourth leading cause of cancer-related death [1]. Hepatocellular cancer (HCC) is the fifth most frequently diagnosed cancer in men, and the ninth most commonly diagnosed cancer in women [2]. The National Cancer Institute Surveillance (SEER) Database stated that HCC incidence rates increased 3.1 percent per year from 2008–2012 [3]. HCC exhibits unique geographic, sex, and age distributions that may reflect etiologic factors. 82% of HCC cases occur in developing countries that have high rates of chronic HBV infection, (Southeast Asian/African countries vs US). Four major etiologic factors associated with HCC have been established: chronic viral infection (HCV, HBV), alcoholism, non-alcoholic steatohepatitis (NASH), and food contaminants (aflatoxin)
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