Racial/Ethnic Disparities in Access to Care and Survival for Patients With Early-Stage Hepatocellular Carcinoma

Abstract

To determine whether controlling for differences in the use of invasive therapy affects racial/ethnic differences in survival of early-stage hepatocellular carcinoma (HCC). A retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) HCC data. Invasive therapy was defined as tumor ablation, hepatectomy, or liver transplant. Race/ethnicity was defined as white, black, Asian, Hispanic, or other. Racial/ethnic differences in overall and treatment-adjusted survival were assessed using the Kaplan-Meier method and base- and treatment-stratified multivariable Cox proportional hazards models. All patients diagnosed as having stage I or II HCC from January 1, 1995, through December 31, 2006 (N = 13 244). Data were obtained from the National Cancer Institute's SEER registry. Differences in survival by race/ethnicity accounting for the use of invasive therapy and treatment benefit. Overall, 32.8% of patients received invasive therapy. We found higher mortality rates in the base survival model for black (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15-1.33) and Hispanic (1.08; 1.01-1.15) patients and lower mortality rates in Asian patients (0.87; 0.82-0.93) compared with whites. After treatment stratification, compared with white patients, blacks had a 12% higher mortality rate (HR, 1.11; 95% CI, 1.03-1.20), Hispanics had a similar mortality rate (0.97; 0.91-1.04), and Asians had a 16% lower mortality rate (0.84; 0.79-0.89). For early-stage HCC, racial/ethnic disparities in survival between minority and white patients are notable. After accounting for differences in stage, use of invasive therapy, and treatment benefit, no racial/ethnic survival disparity is evident between Hispanics and whites, but blacks have persistently poor survival.