Department of Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia, USA.
Cancer. 2011 Oct 1;117(19):4531-9. doi: 10.1002/cncr.26063. Epub 2011 Mar 29.
Prior studies have demonstrated that among patients with hepatocellular carcinoma (HCC), African Americans (AAs) and Asian/Pacific Islanders (APIs) are substantially less likely to undergo liver transplantation (LT) compared with whites. The authors examined whether disparities in the receipt of LT among LT-eligible HCC patients changed over a 10-year time period, and whether the disparities might be explained by sociodemographic or clinical factors.
The National Cancer Data Base, a national hospital-based cancer registry, was used to study 7707 adults with small (≤ 5 cm), nonmetastatic HCC diagnosed between 1998 and 2007. Racial/ethnic patterns in the use of LT were compared during 2 periods of 5 years each: 1998 through 2002 (n = 2412 patients) and 2003 through 2007 (n = 5295 patients). Data regarding comorbid medical conditions were only available during the later time period.
Large and persistent racial/ethnic differences in the probability of receiving LT were observed. Compared with whites, hazard ratios (HRs) and associated 95% confidence intervals (95% CIs) for receiving LT from 1998 through 2002 were 0.64 (95% CI, 0.46-0.89) for AA patients, 1.01 (95% CI, 0.79-1.29) for Hispanic patients, and 0.52 (95% CI, 0.39-0.68) for API patients. Analogous results for 2003 through 2007 were 0.64 (95% CI, 0.54-0.76) for AA patients, 0.86 (95% CI, 0.75-0.99) for Hispanic patients, and 0.58 (95% CI, 0.49-0.69) for API patients. AA patients were less likely than whites to undergo any form of surgery, and API patients were more likely than whites to undergo surgical resection. Adjustment for sociodemographic and clinical factors produced only small changes in these HRs.
Between 1998 and 2007, there were large and persistent racial/ethnic disparities noted in the receipt of LT among patients with HCC. These disparities were not explained by sociodemographic or clinical factors.
先前的研究表明，在肝细胞癌（HCC）患者中，非裔美国人（AA）和亚裔/太平洋岛民（API）接受肝移植（LT）的比例明显低于白人。作者研究了在 10 年时间内，LT 合格 HCC 患者接受 LT 的比例是否发生了变化，以及这些差异是否可以用社会人口统计学或临床因素来解释。
国家癌症数据库（National Cancer Data Base）是一个全国性的基于医院的癌症登记处，作者使用该数据库研究了 1998 年至 2007 年间诊断为小（≤5cm）、非转移性 HCC 的 7707 名成年人。在两个各 5 年的时间段内比较了 LT 的使用种族/民族模式：1998 年至 2002 年（n=2412 例患者）和 2003 年至 2007 年（n=5295 例患者）。只有在较晚的时间段才可以获得有关合并症的医疗条件的数据。
观察到接受 LT 的概率存在显著且持续的种族/民族差异。与白人相比，1998 年至 2002 年接受 LT 的风险比（HR）及其相关的 95%置信区间（95%CI）为 AA 患者 0.64（95%CI，0.46-0.89），西班牙裔患者 1.01（95%CI，0.79-1.29），API 患者 0.52（95%CI，0.39-0.68）。2003 年至 2007 年的类似结果为 AA 患者 0.64（95%CI，0.54-0.76），西班牙裔患者 0.86（95%CI，0.75-0.99），API 患者 0.58（95%CI，0.49-0.69）。与白人相比，AA 患者更不可能接受任何形式的手术，而 API 患者更有可能接受手术切除。调整社会人口统计学和临床因素后，这些 HR 仅略有变化。
1998 年至 2007 年间，HCC 患者接受 LT 的比例存在显著且持续的种族/民族差异。这些差异不能用社会人口统计学或临床因素来解释。
