Department of Internal Medicine, Loyola University Medical Center, 2160 S, 1st Avenue, Maywood, IL, 60153, USA.
Department of Public Health Sciences, Loyola University Medical Center, Maywood, IL, USA.
Dig Dis Sci. 2020 Jun;65(6):1669-1678. doi: 10.1007/s10620-019-05890-2. Epub 2019 Oct 23.
Racial/ethnic disparities in prognosis have been reported in patients with hepatocellular carcinoma (HCC); however, few studies have evaluated racial/ethnic disparities in the context of insurance status.
Characterize racial/ethnic and insurance status in early tumor detection, receipt of curative therapy and overall survival in a multicenter diverse cohort of HCC patients from the USA.
We included patients with HCC diagnosed between June 2012 and May 2013 at four centers in the USA. Generalized linear mixed effects models were used to compare early tumor detection (defined using Milan Criteria) and curative treatment receipt (liver transplantation, surgical resection, or local ablation) as a function of patient race/ethnicity and insurance status. A multivariable frailty survival model was used to compare risk of death between patient groups.
Of 379 HCC patients (52.8% non-Hispanic White, 19.5% Hispanic White, 19.8% Black), 46.4% and 48.0% were found at an early stage and underwent curative therapy, respectively, and median overall survival of the cohort was 25.7 months. Early detection of HCC was associated with gastroenterology subspecialty care and receipt of HCC surveillance but not race/ethnicity or insurance status in adjusted models. However, commercial insurance was significantly associated with higher odds of curative treatment receipt, which in turn was the strongest correlate for overall survival. After adjusting for health system and insurance status, race/ethnicity was not associated with curative treatment receipt or overall survival.
Insurance status and access to gastroenterology subspecialty care may be important drivers of racial/ethnic disparities in prognosis among HCC patients.
肝细胞癌（HCC）患者的预后存在种族/民族差异；然而，很少有研究在保险状况的背景下评估种族/民族差异。
描述美国多中心多样化 HCC 患者人群中种族/民族和保险状况与早期肿瘤检测、接受根治性治疗和总体生存的关系。
我们纳入了在美国四个中心于 2012 年 6 月至 2013 年 5 月间诊断为 HCC 的患者。采用广义线性混合效应模型比较了患者种族/民族和保险状况与早期肿瘤检测（根据米兰标准定义）和根治性治疗（肝移植、手术切除或局部消融）之间的关系。采用多变量脆弱性生存模型比较了不同患者组的死亡风险。
在 379 名 HCC 患者中（52.8%非西班牙裔白人、19.5%西班牙裔白人、19.8%黑人），分别有 46.4%和 48.0%在早期阶段发现并接受了根治性治疗，队列的中位总生存期为 25.7 个月。在调整后的模型中，HCC 的早期检测与胃肠病学亚专科治疗和 HCC 监测的实施有关，但与种族/民族或保险状况无关。然而，商业保险与接受根治性治疗的可能性显著相关，而根治性治疗又是总体生存的最强相关因素。在调整了卫生系统和保险状况后，种族/民族与接受根治性治疗或总体生存无关。
保险状况和获得胃肠病学亚专科治疗可能是 HCC 患者预后种族/民族差异的重要驱动因素。
