Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2018; 10(12): 956-965
Published online Dec 27, 2018. doi: 10.4254/wjh.v10.i12.956
One in five hepatocellular carcinoma patients in the United States are Hispanic while less than 40% were eligible for liver transplantation
Ann Robinson, Ajay Ohri, Benny Liu, Taft Bhuket, Robert J Wong
Ann Robinson, Ajay Ohri, Benny Liu, Taft Bhuket, Robert J Wong, Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA 94620, United States
Author contributions: Robinson A and Wong RJ contributed to the study concept and design, acquisition of data, and drafting of the manuscript; Wong RJ contributed to statistical analysis and study supervision; all authors contributed to analysis and interpretation of data, and critical revision of the manuscript for important intellectual content.
Institutional review board statement: The study was reviewed and determined to be exempt by the Alameda Health System Institutional Review Board because human subjects were not involved, as per United States Department of Health and Human Services guidelines, and the SEER database is publicly available without individually identifiable private information.
Informed consent statement: Given the observational study design and large registry-based cohort, this study was granted IRB exemption by Alameda Health System Institutional Review Board because human subjects were not involved, as per United States Department of Health and Human Services guidelines, and the SEER database is publicly available without individually identifiable private information. Thus informed consent was not required and not possible.
Conflict-of-interest statement: Robert J Wong is a consultant, member of the advisory board, research grants, and speaker’s bureau for Gilead and member of speaker’s bureau for Bayer. The other authors declare no conflicts of interest related to this article.
STROBE statement: Guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Robert J Wong, MD, MS, Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, 1411 East 31st Street, Oakland, CA 94620, United States. rowong@alamedahealthsystem.org
Telephone: +1-510-4376531
Received: May 22, 2018
Peer-review started: May 23, 2018
First decision: July 10, 2018
Revised: July 10, 2018
Accepted: August 20, 2018
Article in press: August 21, 2018
Published online: December 27, 2018
Processing time: 219 Days and 8.9 Hours
Abstract
AIM

To evaluate trends and disparities in hepatocellular carcinoma (HCC) outcomes among Hispanic patients in the United States with a focus on tumor stage at diagnosis.

METHODS

We retrospectively evaluated all Hispanic adults (age > 20) with HCC diagnosed from 2004 to 2014 using United States Surveillance, Epidemiology, and End Results (SEER) cancer registry data. Tumor stage was assessed by SEER-specific staging systems and whether HCC was within Milan criteria at diagnosis. Multivariate logistic regression models evaluated for predictors of HCC within Milan criteria at diagnosis.

RESULTS

Overall, Hispanics accounted for 19.8% of all HCC (73.3% men, 60.9% had Medicare or commercial insurance, 33.5% Medicaid, and 5.6% uninsured). Thirty-eight percent of Hispanic HCC patients were within Milan criteria at diagnosis. With latter time periods, significantly more patients were diagnosed with HCC within Milan criteria, and in 2013-2014, 42.6% had HCC within Milan criteria. On multivariate regression, Hispanic males (OR vs females: 0.76, 95%CI: 0.68-0.83, P < 0.001), Hispanics > 65 years (OR vs age < 50: 0.67, 95%CI: 0.58-0.79, P < 0.001), and uninsured patients (OR vs Medicare/commercial: 0.49, 95%CI: 0.40-0.59, P < 0.001) were significantly less likely to have HCC within Milan criteria at diagnosis.

CONCLUSION

While one in five HCC patients in the United States are of Hispanic ethnicity, only 38% were within Milan criteria at time of diagnosis, and thus over 60% were ineligible for liver transplantation, one of the primary curative options for HCC patients. Improved efforts at HCC screening and surveillance are needed among this group to improve early detection.

Keywords: Liver cancer; Surveillance; Epidemiology; End results; Milan criteria; Hepatocellular carcinoma

Core tip: The Hispanic population represents a major contributor to the hepatocellular carcinoma (HCC) burden. However, our current study demonstrates that over 60% of Hispanic HCC patients were ineligible for liver transplantation given the extent of disease severity. This advanced cancer stage at diagnosis likely reflects suboptimal implementation of early and timely HCC screening and surveillance in high-risk populations. These findings emphasize the need to be more vigilant about HCC screening and surveillance, especially among the Hispanic population.