Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas.
Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
Clin Gastroenterol Hepatol. 2022 Feb;20(2):e267-e288. doi: 10.1016/j.cgh.2020.12.029. Epub 2020 Dec 30.
Hepatocellular carcinoma (HCC) is the fastest rising cause of cancer-related death in the United States; however, HCC incidence and mortality are not equally distributed among racial and ethnic groups. Our aim was to characterize the direction and magnitude of racial and ethnic disparities in overall survival and early tumor detection among patients with HCC.
We searched MEDLINE, EMBASE and Cochrane databases from inception through August 2020 for studies reporting HCC outcomes (early stage presentation and overall survival) by race and ethnicity. We calculated pooled hazard ratios (HRs) and odds ratios (ORs) for each racial and ethnic group (White, Black, Hispanic, Asian) using the DerSimonian and Laird method for a random-effects model.
We identified 35 articles comprising 563,097 patients (53.0% White, 17.3% Black, 18.4% Hispanic, 5.0% Asian). Compared with White patients, Black patients had worse survival (pooled HR 1.08; 95% CI, 1.05 - 1.12), whereas Hispanic (pooled HR 0.92; 95% CI, 0.87 - 0.97) and Asian (pooled HR 0.81; 95% CI, 0.73 - 0.88) patients had better survival. Among articles reporting tumor stage (n = 20), Black patients had lower odds of early stage HCC compared with White patients (OR, 0.66; 95% CI, 0.54 - 0.78). Conversely, there was no difference in odds of early HCC detection for Asian (OR, 1.01; 95% CI, 0.97 - 1.05) or Hispanic patients (OR, 0.87; 95% CI, 0.74 - 1.01) compared with White patients. The most common limitation of studies was risk of residual confounding from socioeconomic status and liver dysfunction.
There are significant racial and ethnic disparities in HCC prognosis in the United States, with Black patients having worse overall survival and Hispanic and Asian patients having better overall survival compared with White patients. Interventions are needed to reduce disparities in early HCC detection to improve HCC prognosis.
肝细胞癌（HCC）是美国癌症相关死亡人数增长最快的原因；然而，HCC 的发病率和死亡率在不同种族和族裔之间的分布并不均衡。我们的目的是描述 HCC 患者总生存率和早期肿瘤检出方面的种族和族裔差异的方向和程度。
我们从 MEDLINE、EMBASE 和 Cochrane 数据库中检索了截至 2020 年 8 月报告 HCC 结局（早期表现和总生存率）的种族和族裔研究。我们使用随机效应模型的 DerSimonian 和 Laird 方法计算每个种族和族裔（白人、黑人、西班牙裔、亚洲人）的 pooled hazard ratios（HRs）和 odds ratios（ORs）。
我们确定了 35 篇文章，共包含 563097 名患者（53.0%为白人，17.3%为黑人，18.4%为西班牙裔，5.0%为亚洲人）。与白人患者相比，黑人患者的生存率较差（pooled HR 1.08；95% CI，1.05 - 1.12），而西班牙裔（pooled HR 0.92；95% CI，0.87 - 0.97）和亚洲人（pooled HR 0.81；95% CI，0.73 - 0.88）患者的生存率较好。在报告肿瘤分期的文章中（n = 20），与白人患者相比，黑人患者早期 HCC 的可能性较低（OR，0.66；95% CI，0.54 - 0.78）。相反，与白人患者相比，亚洲人（OR，1.01；95% CI，0.97 - 1.05）或西班牙裔（OR，0.87；95% CI，0.74 - 1.01）患者早期 HCC 检出的可能性没有差异。研究中最常见的局限性是社会经济地位和肝功能障碍引起的残余混杂风险。
在美国，HCC 的预后存在显著的种族和族裔差异，与白人患者相比，黑人患者的总体生存率较差，而西班牙裔和亚洲患者的总体生存率较好。需要采取干预措施减少早期 HCC 检出方面的差异，以改善 HCC 的预后。
