Late HCC Diagnosis in Blacks Means Fewer Transplants

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• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

SAN DIEGO -- Liver transplant rates were lower in black patients with hepatocellular carcinoma (HCC) than in whites in south Florida, in large part -- though not entirely -- because they typically presented with later stage disease and with larger tumor sizes, a researcher said here.

In an extraordinarily detailed analysis of patients treated at the University of Miami's Miller School of Medicine, researchers there led by Patricia Jones, MD, found that only 9.7% of black patients underwent transplantation, compared with 32.0% of non-Hispanic white patients.

Jones told MedPage Today that the discrepancy largely could be attributed to the fact that 11% of black patients were considered terminal at diagnosis and 31% were staged as advanced, compared with 5% and 14% of non-Hispanic whites, respectively. The median size of largest tumor at diagnosis was 52 mm among blacks versus 35 mm in whites.

As a result, more than 70% of black patients underwent no surgical therapies, versus less than 50% of the white patients, Jones reported at the annual Digestive Disease Week. And transplantation was by far the strongest predictor of survival: patients having transplants had a hazard ratio for death of 0.23 (95% CI 0.18-0.30).

Survival rates were consequently poorer among blacks, though the difference remained significant even after Jones and colleagues adjusted for tumor size and stage and a host of other factors, including insurance status, age, sex, tobacco and alcohol use, hepatitis B and C infection, and many others.

She told MedPage Today that race itself could be a factor affecting treatment and survival, but it couldn't be demonstrated in this analysis, and she didn't think it played much of a role.

Rather, she said, racial biases likely play out as systematic social effects that tend to keep blacks from being diagnosed until HCC becomes advanced, such that many black patients are ineligible for transplantation.

She also explained that the data on insurance status simply noted whether patients had private, public, military, or no insurance. The analysis could not account for variations in coverage within the category of private insurance, which could also drive some of the results. Also, insurance status was the study's only measure of patients' socioeconomic status.

The study covered 999 HCC patients treated at the University of Miami from 2005 to 2014, of which 145 were black, 466 non-Hispanic white, 335 Hispanic, 23 Asian, and 50 other.

The raw data showed generally poorer survival for blacks compared with the other groups (all P<0.01):

• 1-year survival: 55.9% black, 69.1% white, 64.5% Hispanic, 56.6% Asian
• 5-year survival: 33.1% black, 45.1% white, 41.5% Hispanic, 39.1% Asian
• Median survival time: 301 days black, 535 white, 437 Hispanic, 458 Asian

Jones said the study population was both a limitation and a strength of the study. It was a limitation in that the racial-ethnic makeup is not representative of the country as a whole. Even within categories, she said, the patients were far more diverse than in most other parts of the U.S., as more than half of the patients overall were born outside North America and both blacks and Hispanics came from many different countries.

That, however, also made the study richer than those based on SEER data, she said, which tend to be dominated by U.S.-born white patients with correspondingly lower representation from minority groups.

Jones and co-authors disclosed no relevant relationships with industry.

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Late HCC Diagnosis in Blacks Means Fewer Transplants