Racial and geographic disparities in the utilization of hepatectomy for primary hepatic malignancies

Abstract

Introduction: Hepatectomy serves as the only potentially curative therapy for the common primary hepatic malignancies: hepatocellular cancer (HCC) and intrahepatic cholangiocarcinoma (IHCC). Given the increasing incidence of both of these tumors, effective and readily available application of this procedure is a necessity. This study sought to identify those patient and tumor characteristics associated with the likelihood of undergoing hepatectomy for primary liver cancer. Methods: Retrospective cohort analysis of 13,758 adult patients with HCC or IHCC from the Surveillance, Epidemiology, and End Results (SEER) National Database, 1992 to 1999. Primary outcome measure was performance of hepatic resection with curative intent for either HCC or IHCC, adjusted for patient demographics including age, sex, race, geographic location, median household income based on county of residence, and tumor characteristics. Results: Over the entire study period, approximately 9.8% of the 13,758 patients underwent partial hepatectomy with curative intent. In the adjusted analysis, females were more likely to have hepatic resection compared to males [Odds Ratio (OR) 1.52, 95% CI 1.33–1.72]. In contrast, Hispanic (OR 0.79, 95%CI 1.03–1.43), African-American (OR 0.42, 95% CI 0.32–0.56), and Native American patients (OR 0.39, 95% CI 0.13–1.12) were less likely to have hepatic resection relative to Caucasians. Patients with tumor size > 4 cm (OR ≤ 0.42, 95% CI 0.35–0.50) and those living in New Mexico (OR 0.43, 95% CI 0.26–0.70) were also less likely to have resection. Income level was not significantly associated with hepatectomy after adjustment for race and geographic location. Conclusions: The proportion of patients having resection of HCC or IHCC varies according to race, sex, and geographic location. Among African-Americans and Native Americans, race is as strong a negative predictor of hepatectomy as is tumor size. These associations occur independent of median household income and tumor characteristics. Further research and policy initiatives are necessary to ensure the equitable application of this highly specialized procedure, particularly in light of the increasing incidence of primary liver cancers.