Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
J Natl Cancer Inst. 2023 Jul 6;115(7):861-869. doi: 10.1093/jnci/djad067.
Immigrants comprise a considerable proportion of those diagnosed with hepatocellular carcinoma (HCC) in the United States. Nativity or birthplace affects incidence and risk factors for HCC, but little is known about its influence on survival after diagnosis.
We identified 51 533 adults with HCC with available birthplace in the California Cancer Registry between 1988 and 2017. HCC cases were categorized as foreign born or US born and stratified by mutually exclusive race and ethnicity groups. Primary outcome was all-cause mortality. Race and ethnicity-specific Cox regression propensity score-weighted models evaluated the relationship between nativity and death as well as region of birth among foreign-born patients.
A total of 40% of all HCC cases were foreign born, and 92.2%, 45.2%, 9.1%, and 5.8% of Asian/Pacific Islander (API), Hispanic, White, and Black patients were foreign born, respectively. Five-year survival rates were higher in foreign-born patients compared with US-born patients: 12.9% vs 9.6% for White patients, 11.7% vs 9.8% for Hispanic patients, 12.8% vs 8.1% for Black patients, and 16.4% vs 12.4% for API patients. Nativity was associated with survival, with better survival in foreign-born patients: White patients: hazard ratio (HR) = 0.86 (95% confidence interval [CI] = 0.81 to 0.90), Hispanic patients: HR = 0.90 (95% CI = 0.86 to 0.93), Black patients: HR = 0.89 (95% CI = 0.76 to 1.05), and API patients: HR = 0.94 (95% CI = 0.88 to 1.00). Among foreign-born patients, lower mortality was observed in those from Central and South America compared with Mexico for Hispanic patients, East Asia compared with Southeast Asia for API patients, and East Europe and Greater Middle East compared with West/South/North Europe for White patients.
Foreign-born patients with HCC have better survival than US-born patients. Further investigation into the mechanisms of this survival disparity by nativity is needed.
在美国，移民占肝细胞癌（HCC）诊断患者的相当大比例。出生地或出生国影响 HCC 的发病率和危险因素，但对于其对诊断后生存的影响知之甚少。
我们在加利福尼亚癌症登记处 1988 年至 2017 年间确定了 51533 名 HCC 成人患者，他们的出生地可用。HCC 病例分为外国出生或美国出生，并按相互排斥的种族和族裔群体进行分层。主要结局是全因死亡率。种族和族裔特异性 Cox 回归倾向评分加权模型评估了出生国与死亡之间的关系以及外国出生患者的出生地地区之间的关系。
所有 HCC 病例中有 40%是外国出生的，亚洲/太平洋岛民（API）、西班牙裔、白人、黑人为外国出生的分别占 92.2%、45.2%、9.1%和 5.8%。与美国出生的患者相比，外国出生的患者五年生存率更高：白人患者为 12.9%比 9.6%，西班牙裔患者为 11.7%比 9.8%，黑人患者为 12.8%比 8.1%，API 患者为 16.4%比 12.4%。出生国与生存率相关，外国出生的患者生存率更高：白人患者：危险比（HR）=0.86（95%置信区间[CI]为 0.81 至 0.90），西班牙裔患者：HR=0.90（95%CI=0.86 至 0.93），黑人患者：HR=0.89（95%CI=0.76 至 1.05），API 患者：HR=0.94（95%CI=0.88 至 1.00）。在外国出生的患者中，与墨西哥相比，来自中美洲和南美洲的西班牙裔患者死亡率较低，与东南亚相比，东亚的 API 患者死亡率较低，与西欧/南欧/北欧相比，东欧和大中东的白人患者死亡率较低。
与美国出生的患者相比，外国出生的 HCC 患者的生存率更高。需要进一步研究出生国对这种生存差异的机制。
