Ethnic disparities in the epidemiology, treatment, and outcome of patients with hepatocellular carcinoma in the United States

Abstract

There are significant ethnic disparities in incidence, tumor stage, curative therapy receipt, and survival among patients with hepatocellular carcinoma (HCC) in the US. While previous models had predicted an increasing trend in the incidence rate of HCC until 2030 in the US, recent studies have shown that HCC incidence plateaued in 2013 and then started to decline in 2015. The decreasing trend has been observed in all ethnicities except for American Indians/Alaska Natives, whose incidence rates of HCC continue to rise. Current evidence shows that African-Americans and Hispanics are two groups that are more likely to be diagnosed with late-stage HCC, and this finding has been consistent in different socioeconomic statuses of the patients. These two ethnic minority groups are also among those who are less likely to have curative therapy for early-stage HCC. Finally, advances in early diagnosis and treatment approaches have led to an improvement in HCC survival for all ethnicities; however, African-Americans continue to have the worst survival. More studies to find the causes of these disparities and interventions to eliminate them are urgently needed.

Keywords

Hepatocellular Carcinoma / ethnic / disparity

References

[1] Sung H,Siegel RL.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin2021;71:209-49

[2] Lee YT,Luu M.Comparison of clinical features and outcomes between intrahepatic cholangiocarcinoma and hepatocellular carcinoma in the United States.Hepatology2021;74:2622-32

[3] Rumgay H,Ferlay J.Global burden of primary liver cancer in 2020 and predictions to 2040.J Hepatol2022;77:1598-606 PMCID:PMC9670241

[4] Chakraborty E.Emerging therapies for hepatocellular carcinoma (HCC).Cancers2022;14:2798 PMCID:PMC9179883

[5] Papaconstantinou D,Pawlik TM.Recurrent hepatocellular carcinoma: patterns, detection, staging and treatment.J Hepatocell Carcinoma2022;9:947-57 PMCID:PMC9450909

[6] Thylur RP,Shrivastava A,Shankar S.Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma.JGH Open2020;4:351-9 PMCID:PMC7273694

[7] Teng PC,Lin TY,Yang JD.Diabetes and risk of hepatocellular carcinoma in cirrhosis patients with nonalcoholic fatty liver disease.Gut Liver2023;17:24-33 PMCID:PMC9840929

[8] Devarbhavi H,Arab JP.Global burden of liver disease: 2023 update.J Hepatol2023:S0168-8278(23)00194

[9] Plummer M,Vignat J.Global burden of cancers attributable to infections in 2012: a synthetic analysis.Lancet Glob Health2016;4:e609-16

[10] Marengo A,Bugianesi E.Liver cancer: connections with obesity, fatty liver, and cirrhosis.Annu Rev Med2016;67:103-17

[11] Petrick JL,Znaor A.International trends in hepatocellular carcinoma incidence, 1978-2012.Int J Cancer2020;147:317-30 PMCID:PMC7470451

[12] Liu Y.Changes in the epidemiology of hepatocellular carcinoma in Asia.Cancers2022;14:4473 PMCID:PMC9496757

[13] Rich NE,Yopp AC,Singal AG.Racial and ethnic disparities in survival among patients with hepatocellular carcinoma in the United States: a systematic review and meta-analysis.Clin Gastroenterol Hepatol2022;20:e267-88 PMCID:PMC8243558

[14] Kronenfeld JP,Goldberg D.Disparities in presentation at time of hepatocellular carcinoma diagnosis: a United States safety-net collaborative study.Ann Surg Oncol2021;28:1929-36 PMCID:PMC8099037

[15] Shiels MS.Recent decline in hepatocellular carcinoma rates in the United States.Gastroenterology2020;158:1503-1505.e2 PMCID:PMC7146982

[16] Lee YT,Luu M.State-level HCC incidence and association with obesity and physical activity in the United States.Hepatology2021;74:1384-94

[17] Flores YN,Yang L.Disparities in hepatocellular carcinoma incidence, stage, and survival: a large population-based study.Cancer Epidemiol Biomarkers Prev2021;30:1193-9 PMCID:PMC8172467

[18] Alvarez CS,Parisi D.Racial/ethnic disparities in hepatocellular carcinoma incidence and mortality rates in the United States, 1992-2018.Hepatology2022;76:589-98 PMCID:PMC9352816

[19] Chang ET,Gomez SL.The burden of liver cancer in Asians and Pacific Islanders in the Greater San Francisco Bay Area, 1990 through 2004.Cancer2007;109:2100-8 PMCID:PMC2777532

[20] Petrick JL,Altekruse SF,Rosenberg PS.Future of hepatocellular carcinoma incidence in the United States forecast through 2030.J Clin Oncol2016;34:1787-94 PMCID:PMC4966339

[21] Wasley A,Kuhnert W.The prevalence of hepatitis B virus infection in the United States in the era of vaccination.J Infect Dis2010;202:192-201

[22] Han SS,Li Y.Changing landscape of liver cancer in california: a glimpse into the future of liver cancer in the United States.J Natl Cancer Inst2019;111:550-6 PMCID:PMC7962782

[23] Camplain R,Jiang L,Manson SM.Change in physical activity, food choices and hemoglobin A1c among American Indians and Alaska Natives with type 2 diabetes.Prev Med Rep2022;29:101945 PMCID:PMC9502664

[24] Leston J.The need to expand access to hepatitis C virus drugs in the Indian health service.JAMA2016;316:817-8

[25] McMahon BJ,Townshend-Bulson L.Infection with hepatitis C virus genotype 3 is an independent risk factor for end-stage liver disease, hepatocellular carcinoma, and liver-related death.Clin Gastroenterol Hepatol2017;15:431-437.e2 PMCID:PMC5316337

[26] Reilley B,Hariri S.Birth cohort testing for hepatitis C virus - Indian health service 2012-2015.MMWR Morb Mortal Wkly Rep2016;65:467-9

[27] Setiawan VW,Hernandez BY.Disparity in liver cancer incidence and chronic liver disease mortality by nativity in hispanics: the multiethnic cohort.Cancer2016;122:1444-52 PMCID:PMC4840042

[28] Sloane D,Howell C.Racial disparity in primary hepatocellular carcinoma: tumor stage at presentation, surgical treatment and survival.J Natl Med Assoc2006;98:1934-9 PMCID:PMC2569668

[29] Ha J,Aguilar M.Race/ethnicity-specific disparities in hepatocellular carcinoma stage at diagnosis and its impact on receipt of curative therapies.J Clin Gastroenterol2016;50:423-30

[30] Franco RA,Jarosek S,Galbraith J.Racial and geographic disparities in hepatocellular carcinoma outcomes.Am J Prev Med2018;55:S40-8 PMCID:PMC6708601

[31] Dakhoul L,Jones KR.Racial disparities in liver transplantation for hepatocellular carcinoma are not explained by differences in comorbidities, liver disease severity, or tumor burden.Hepatol Commun2019;3:52-62 PMCID:PMC6312653

[32] Yu JR,Bhuket T,Wong RJ.The impact of ethnic subgroups on tumor stage at diagnosis, treatment received, and long-term survival among Asian adults with hepatocellular carcinoma.J Clin Exp Hepatol2019;9:182-90 PMCID:PMC6477129

[33] Rich NE,Odewole M.Racial and ethnic differences in presentation and outcomes of hepatocellular carcinoma.Clin Gastroenterol Hepatol2019;17:551-559.e1 PMCID:PMC6274621

[34] Pomenti S,Abu Sbeih H.Hepatocellular carcinoma in hispanic patients: trends and outcomes in a large United States cohort.Hepatol Commun2020;4:1708-16 PMCID:PMC7603535

[35] Oluyomi AO,El-Serag HB.Mediating effects of neighborhood-level socioeconomic deprivation on the association between race/ethnicity and advanced hepatocellular carcinoma.Cancer Epidemiol Biomarkers Prev2022;31:1402-9 PMCID:PMC9661396

[36] Tan D,Beg MS,Singal AG.Meta-analysis: underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States.Aliment Pharmacol Ther2013;38:703-12 PMCID:PMC3777750

[37] Singal AG,Narasimman M.HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: a meta-analysis.J Hepatol2022;77:128-39 PMCID:PMC9232881

[38] Zak Y,Visser BC.Predictors of surgical intervention for hepatocellular carcinoma: race, socioeconomic status, and hospital type.Arch Surg2011;146:778-84

[39] Wong RJ,Nguyen L,Nguyen MH.Ethnic disparities and liver transplantation rates in hepatocellular carcinoma patients in the recent era: results from the Surveillance, Epidemiology, and End Results registry.Liver Transpl2014;20:528-35

[40] Xu L,Spolverato G,Pawlik TM.Racial disparities in treatment and survival of patients with hepatocellular carcinoma in the United States.Hepatobiliary Surg Nutr2016;5:43-52 PMCID:PMC4739939

[41] Scaglione S,Caines A.Association between race/ethnicity and insurance status with outcomes in patients with hepatocellular carcinoma.Dig Dis Sci2020;65:1669-78 PMCID:PMC7603399

[42] Wagle NS,Washburn D.Racial, ethnic, and socioeconomic disparities in curative treatment receipt and survival in hepatocellular carcinoma.Hepatol Commun2022;6:1186-97 PMCID:PMC9035560

[43] Ahn JC,Luu M.Racial and ethnic disparities in early treatment with immunotherapy for advanced HCC in the United States.Hepatology2022;76:1649-59

[44] Rich NE,Parikh ND.Hepatocellular carcinoma demonstrates heterogeneous growth patterns in a multicenter cohort of patients with cirrhosis.Hepatology2020;72:1654-65 PMCID:PMC7398837

[45] Makarova-Rusher OV,McNeel TS.Population attributable fractions of risk factors for hepatocellular carcinoma in the United States.Cancer2016;122:1757-65 PMCID:PMC5548177

[46] Singal AG,Tiro J.Racial, social, and clinical determinants of hepatocellular carcinoma surveillance.Am J Med2015;128:90.e1-7 PMCID:PMC4282818

[47] Warnecke RB,Breen N.Approaching health disparities from a population perspective: the national institutes of health centers for population health and health disparities.Am J Public Health2008;98:1608-15 PMCID:PMC2509592

[48] Molinari M,Tsung A,Jonaissaint N.Adult African Americans undergoing cadaveric liver transplantation for hepatocellular carcinoma within the Milan criteria have the lowest 5-year survival among all the ethnic groups in the United States: analysis of USA national data between January 2002.HR2018;4:56

[49] Wang Z,Thrift AP.Factors associated with favorable survival outcomes for Asians with hepatocellular carcinoma: a sequential matching cohort study.PLoS One2019;14:e0214721 PMCID:PMC6447218

[50] Jones PD,Muenyi V.Socioeconomic and survival differences among minorities with hepatocellular carcinoma in Florida.J Hepatocell Carcinoma2019;6:167-81 PMCID:PMC6863179

[51] Welzel TM,Quraishi S.Population-attributable fractions of risk factors for hepatocellular carcinoma in the United States.Am J Gastroenterol2013;108:1314-21 PMCID:PMC4105976

[52] Ding J.Survival improvement and prognosis for hepatocellular carcinoma: analysis of the SEER database.BMC Cancer2021;21:1157 PMCID:PMC8555190

[53] Yao J,Liu Y,Zheng M.Trends in incidence and prognostic factors of two subtypes of primary liver cancers: a surveillance, epidemiology, and end results-based population study.Cancer Control2022;29:10732748211051548 PMCID:PMC8841928

[54] Liu H,Jonassaint N.The closing survival gap after liver transplantation for hepatocellular carcinoma in the United States.HPB2022;24:1994-2005

[55] Shaikh A,Lee TH.Reduction in racial and ethnic disparity in survival following liver transplant for hepatocellular carcinoma in the direct-acting antiviral era.Clin Gastroenterol Hepatol2022:S1542-3565(22)01130