Mo1491 Racial Disparities in Survival After Hepatocellular Carcinoma Diagnosis in a Diverse American Population

Abstract

Background and Aims: Hepatocellular carcinoma (HCC) is a leading cause of cancer and cancer-related death nationally and internationally. Incidence and mortality are increasing, however the rate of increase in incidence and mortality differs by race. We aimed to identify associations between race and survival after a diagnosis of HCC in a diverse American population. Methods: We reviewed patients diagnosed with HCC at the University of Miami Sylvester Comprehensive Cancer Center (SCCC) /Jackson Memorial Hospitals (JMH) between 1/4/2005-12/19/2014. We performed a retrospective analysis of this cohort using univariate and bivariate analyses. We used Cox proportional hazards regression modeling to describe the association between race and survival, after controlling for confounders. Results: A total of 999 patients were diagnosed with HCC during this period, of whom 76.8% were men,14.7% were Black, 79.7% were Caucasian, 2.3% were Asian and 3.3% were of unknown race (Table 1). Hispanic ethnicity was noted in 34.9% of patients and 52.9% of our cohort was born outside of North America. The majority of patients had private insurance, 42.9%, or Medicare, 32.2%. Only 7.1% of the sample was uninsured and 17% had Medicaid. More Black patients had hepatitis B, 24.1%, compared to 7% of Whites, p<0.01. For the entire sample, median survival was 452 days (interquartile range (IQR) 162-1152). When stratified by race, median survival was 301 days (IQR: 90-1025) in Blacks, 534.5 days (IQR: 212- 1365) in non-Hispanic Whites, 437 days (IQR:139-1004) in Hispanics, 458 days (IQR: 144-1275) in Asians and 424.5 days (IQR:166-1139) in others, p<0.01. Non-Hispanic Whites had a 33% reduced risk of death compared to Blacks, (hazard ratio (HR) 0.67, 95% Confidence Interval (CI) 0.54-0.85). After adjusting for birth continent, alcohol use, gender, tobacco use, insurance, cancer status, receipt of chemotherapy, hospital setting, age at diagnosis and tumor size, we found that non-Hispanic Whites had 25% reduced risk of death (HR 0.75, 95%CI 0.59-0.96) compared to Blacks ( Figure 1). Hispanics had a 21% reduced risk of death (HR 0.79, 95% CI 0.61-1.01) compared to Blacks. When adjusted for transplant, the survival difference by race diminished. Non-Hispanic Whites had 8% reduced risk of death, (HR 0.92, 95% CI 0.72-1.17) and Hispanics had 7% reduced risk of death, (HR 0.93, 95% CI 0.72-1.20), compared to Blacks. Transplant was associated with 66% reduction in death (HR 0.34, 95% CI 0.25-0.45). However, only 11.9% of Blacks had liver transplant, compared to 33.3% of non-Hispanic Whites and 26.3% of Hispanics, p <0.01. Conclusions: In a diverse sample of patients, race was associated with survival after HCC diagnosis. Blacks were less likely to receive curative liver transplant and have the worst survival. Factors contributing to these differences in survival need to be identified. (Table Presented).