Racial/ethnic disparities in access to care and survival for patients with early-stage hepatocellular carcinoma

Arch Surg. 2010 Dec;145(12):1158-63. doi: 10.1001/archsurg.2010.272.


Objective: To determine whether controlling for differences in the use of invasive therapy affects racial/ethnic differences in survival of early-stage hepatocellular carcinoma (HCC).

Design: 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.

Patients: All patients diagnosed as having stage I or II HCC from January 1, 1995, through December 31, 2006 (N = 13 244).

Setting: Data were obtained from the National Cancer Institute's SEER registry.

Main outcome measures: Differences in survival by race/ethnicity accounting for the use of invasive therapy and treatment benefit.

Results: 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).

Conclusions: 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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Carcinoma, Hepatocellular / ethnology
  • Carcinoma, Hepatocellular / mortality*
  • Carcinoma, Hepatocellular / pathology*
  • Carcinoma, Hepatocellular / surgery
  • Cause of Death*
  • Cohort Studies
  • Early Detection of Cancer
  • Ethnicity / statistics & numerical data
  • Female
  • Health Status Disparities
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / ethnology
  • Liver Neoplasms / mortality*
  • Liver Neoplasms / pathology*
  • Liver Neoplasms / surgery
  • Male
  • Multivariate Analysis
  • Neoplasm Staging
  • Prognosis
  • Proportional Hazards Models
  • Racial Groups / statistics & numerical data
  • Registries
  • Retrospective Studies
  • SEER Program
  • Sex Factors
  • Socioeconomic Factors
  • Survival Analysis
  • United States