Racial disparities in hepatocellular carcinoma (HCC) treatment and survival: A SEER-Medicare analysis.

Abstract

144 Background: Between 2017-2022, approved systemic therapies for HCC increased from 1 to 10. Studies have shown racial disparities in overall survival (OS), but no studies have evaluated disparities in new systemic treatments. Methods: We identified patients in SEER-Medicare data diagnosed with HCC in 2014-2019 with claims through 2020. We identified demographics, liver disease type, cirrhosis complications (e.g, jaundice), diagnosis stage, receipt of local therapies (e.g, resection) and receipt of systemic therapies (e.g, sorafenib). We described cohort characteristics by race. OS and receipt of treatment were analyzed using Cox and logistical regression models adjusted for the above covariates. Results: The study included 8,257 patients (77.7% White, 11.9% Asian, 9.1% Black, 0.9% American Indian). Median OS for all patients was 9.1 months. Compared to White patients, Black patients had worse OS (hazard ratio [HR] 1.36, p= <.0001). Black patients receiving no treatment (HR 1.24, p=0.002) and local therapy first (HR 1.29, p=0.003) also had worse survival, while Black patients receiving systemic therapy first had similar OS (HR 1.08, p=0.62) to White patients. Black patients were less likely than White patients to receive any treatment (odds ratio [OR]: 0.64, p=<.0001) or curative treatment if they had early stage-HCC (OR 0.49, p=0.013), but had no difference in receipt of a new systemic therapy if receiving any systemic therapy (OR 0.72, p=0.19) (Table). Compared to White patients, Asian patients had better OS among all patients (HR 0.91, p=0.04) and among patients receiving local therapy first (HR 0.89), but similar OS among patients receiving no treatment (HR 0.90, p=0.13) or systemic therapy first (HR 1.07, p=0.60). Asian patients were as likely as White patients to receive any treatment (OR 1.07, p=0.43), curative treatment for early-stage HCC (OR 0.94, p=0.70) and novel therapies if receiving systemic therapy (OR 1.10, p=0.70). Conclusions: As new HCC therapies emerged, there were racial disparities in OS and receipt of any treatment or local therapies, but not in receipt of new systemic treatments. Targeted interventions are essential to address these disparities and ensure equitable access to care. Treatment and survival disparities, by race. All PatientsN=8,218 White N=6412 Black N=747 Asian or Pacific Islander N=983 American Indian/Alaskan Native* N=76 Median Overall survival, months 9.1 9.5 5.6 10.1 8.3 No treatment, n (%) 3213 (39.1) 2510 (39.2) 348 (46.6) 330 (33.6) 25 (32.9) Systemic first, n (%) 894 (10.9) 693 (10.8) 85 (11.4) 103 (10.5) 13 (17.1) Local first, n (%) 4111 (50.0) 3209 (50.0) 314 (42.0) 550 (56.0) 38 (50.0) Of patients with early-stage HCC, those who received curative treatment, n (%) 749 (41.7) >542 (>41.5) 43 (29.3) 147 (45.2) <11 (<40.0) Of patients receiving systemic therapy, those who got a novel therapy, n (%) 763 (44.3) >581 (>43.9) 63 (40.9) 103 (46.0) <11 (<50.0)