Factors associated with favorable survival outcomes for Asians with hepatocellular carcinoma: A sequential matching cohort study.

Zhensheng Wang,Aaron P Thrift,Xiangjun Gu,Isabelle Chemin

doi:10.1371/journal.pone.0214721

Zhensheng Wang, Aaron P Thrift + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0214721

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Journal: PloS one	Publication Date: Apr 3, 2019
Citations: 14	License type: CC BY 4.0

Affiliation: Baylor College of Medicine

Abstract

BackgroundOverall 5-year survival rates for patients diagnosed with hepatocellular carcinoma (HCC) are poor, but vary by race/ethnicity. We undertook a comprehensive assessment of underlying contributing factors to the favorable survival outcomes of HCC among Asians compared with non-Hispanic whites (NHW).MethodsWe identified 1,284 Asian and 7,072 NHW patients newly diagnosed with HCC between 1994 and 2011 in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. We used a novel three-step sequential matching approach to identify demographic, presentation and treatment factors that may explain survival differences between Asians and NHWs. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for the association between Asian race and risk of HCC-related mortality were estimated using Cox proportional hazards models.ResultsThe absolute difference in 5-year survival rates between Asians and NHWs was 8.4% (95% CI: 4.6%-12.0%) in the demographics match analysis. The disparity remained unchanged after additionally matching on stage, grade and comorbidities in the presentation match analysis. However, in the treatment match analysis, which accounts for differences in demographic, presentation and treatment factors, the absolute difference in 5-year survival rates was reduced to 5.8% (95% CI: 2.6%-9.3%). Treatment differences explained more of survival disparity in Asian and NHW patients with localized disease than for those with regional or distant stage HCC.ConclusionsAsian patients with HCC continue to have more favorable survival outcomes than NHWs with HCC. This persistent disparity seems to be more related to treatment differences than to differences in presentation characteristics including stage.

Highlights

Hepatocellular carcinoma (HCC) is the most common type of liver cancer, accounting for around 75% of an estimated 42,220 incident liver cancer cases in the United States during 2018 [1]
The absolute difference in 5-year survival rates between Asians and non-Hispanic whites (NHWs) was 8.4% in the demographics match analysis
In the treatment match analysis, which accounts for differences in demographic, presentation and treatment factors, the absolute difference in 5-year survival rates was reduced to 5.8%

Summary

Introduction

Hepatocellular carcinoma (HCC) is the most common type of liver cancer, accounting for around 75% of an estimated 42,220 incident liver cancer cases in the United States during 2018 [1]. The factors underlying the better survival outcomes of Asians with HCC compared with non-Hispanic whites (NHWs) with HCC are likely multifactorial, including differences in stage at diagnosis, access to screening, existing comorbid conditions at diagnosis, socioeconomic status and receipt of treatment. A previous study reported that Asians with HCC are 13% less likely than NHWs to be diagnosed at advanced stage [12] Another potentially important contributing factor to the survival disparity is differences in receipt of surgical therapy including liver transplantation and hepatectomy. Overall 5-year survival rates for patients diagnosed with hepatocellular carcinoma (HCC) are poor, but vary by race/ethnicity. We undertook a comprehensive assessment of underlying contributing factors to the favorable survival outcomes of HCC among Asians compared with non-Hispanic whites (NHW)

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Results