Race, insurance, and receipt of surgery among patients with hepatocellular carcinoma

Abstract

6592 Background: Prior studies have found that white patients were more likely than black patients to have some cancer-related surgical procedures; a few studies have found associations between insurance status or other socioeconomic factors and patterns of care. We analyzed factors associated with surgery among patients with hepatocellular carcinoma (HCC) at our institution. Methods: Among consecutive patients diagnosed with HCC from 1/1/02 to 12/31/06, we analyzed the association of demographic (age, sex, race/ethnicity), clinical (etiology, Child-Pugh score, Milan criteria, stage, macrovascular invasion (MVI), AFP, tumor size, hyperlipidemia, diabetes, hypertension, coronary artery disease), lifestyle (tobacco use) and socioeconomic (income, insurance) factors with surgery (resection or transplant) and with survival. Results: Among 403 patients, 164 (41%) had surgery. Median age at diagnosis was 60 years. In a multivariable logistic regression model, factors associated with receiving surgery included private insurance (OR 7.6, 1.5–38.2), Child-Pugh A score (OR 5.9, 1.5- 22.6), and low AFP (OR 242.8, 21.0–999.9). Factors associated with not receiving surgery included Hispanic ethnicity (OR 0.2, 0.1–0.9), tumor more extensive than the Milan criteria (OR 0.1, 0.0–0.5), and macrovascular invasion (OR 0.2, 0.0–0.9). Overall, median survival was 1.9 yrs and 3-yr survival was 14.8%. 3-yr survival was 19.1% for whites, 8.0% for blacks, 11.7% for Hispanics, and 24.4% for Asians. 3-yr survival was 20.2% for privately insured patients, 9.5% for Medicare patients, and 5.7% for Medicaid patients. Kaplan Meier survival curves differed by ethnicity (p=0.0007) and insurance status (p<0.0001). Conclusions: Hispanic patients and those who had Medicaid insurance were less likely than white patients and those who had private insurance to undergo surgery. However, although they were less likely to have surgery, Hispanics had better 3-yr survival than blacks. Patient Characteristics and Survival N % surgery % 3-year survival Ethnicity * White 159 55.4 19.1 Black 50 36.0 8.0 Hispanic 129 27.1 11.7 Asian 41 48.8 24.4 Child-Pugh * A 125 63.2 23.2 B 118 37.3 11.9 C 151 25.2 8.0 Insurance * Private 236 57.6 20.2 Medicare 74 21.6 9.5 Medicaid 71 16.9 5.7 Milan * Yes 122 63.1 22.1 No 198 24.2 9.6 AFP * ≤400 208 69.7 21.7 >400 195 9.7 5.1 *P-value <0.0001 No significant financial relationships to disclose.