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种族和民族差异对肝癌患者肝移植和肝移植后生存的影响。

Racial and Ethnic Differences in Liver Transplantation and Post-Liver Transplant Survival Among Patients With Hepatocellular Carcinoma.

机构信息

University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.

出版信息

Cancer Med. 2024 Nov;13(21):e70298. doi: 10.1002/cam4.70298.

DOI:10.1002/cam4.70298
PMID:39506367
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11540875/
Abstract

BACKGROUND

Racial and ethnic disparities in diagnosis and overall outcomes for HCC are well known. We present updated real-world data on racial or ethnic differences in LT and post-LT survival among patients with HCC in a large population-based database.

METHODS

We used the TriNetX database to retrospectively identify patients who had HCC (ICD-10 C22.0, C22.8) and underwent LT (CPT codes 47,135, 47,140, 47,140, 47,141, 47,142) from 2012 to 2022 and compared outcomes across racial and ethnic subgroups.

RESULTS

Majority of the patients were Caucasians (2403/2901, 84.8%), followed by African Americans (267/2901, 9.2%) Hispanic/Asian (231/2901, 7.9%). At follow up of 5 years, we noted no significant difference in mortality between AA and Caucasian patients [HR = 1.087 (95% CI 0.76, 1.56, p = 0.59)] as well as Hispanic/Asian and Caucasian patients [HR = 1.14 (95% CI 0.73, 1.78, p = 0.10)].

CONCLUSIONS

These results indicate that stringent implementation of policies aimed at ensuring equitable access to LT may contribute to bridging disparities in overall outcomes in HCC.

摘要

背景

种族和民族差异在 HCC 的诊断和整体结果中是众所周知的。我们在一个大型基于人群的数据库中展示了关于 HCC 患者在 LT 和 LT 后生存方面种族或民族差异的最新真实世界数据。

方法

我们使用 TriNetX 数据库回顾性地确定了 2012 年至 2022 年间患有 HCC(ICD-10 C22.0、C22.8)并接受 LT(CPT 代码 47,135、47,140、47,140、47,141、47,142)的患者,并比较了不同种族和族裔亚组的结果。

结果

大多数患者为白种人(2403/2901,84.8%),其次是非裔美国人(267/2901,9.2%)、西班牙裔/亚洲人(231/2901,7.9%)。在 5 年的随访中,我们发现非裔美国人和白种人患者之间的死亡率没有显著差异[HR=1.087(95% CI 0.76,1.56,p=0.59)],西班牙裔/亚洲人和白种人患者之间的死亡率也没有显著差异[HR=1.14(95% CI 0.73,1.78,p=0.10)]。

结论

这些结果表明,严格执行旨在确保公平获得 LT 的政策,可能有助于缩小 HCC 整体结果方面的差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/322a/11540875/747addba4a85/CAM4-13-e70298-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/322a/11540875/747addba4a85/CAM4-13-e70298-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/322a/11540875/747addba4a85/CAM4-13-e70298-g001.jpg

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本文引用的文献

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Racial Disparities in Candidates for Hepatocellular Carcinoma Liver Transplant After 6-Month Wait Policy Change.肝癌患者在等待 6 个月政策改变后接受肝移植的种族差异。
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Trends in hepatocellular carcinoma stage by racial/ethnic group in the United States, 1992-2019.1992 - 2019年美国不同种族/族裔群体肝细胞癌分期的趋势
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Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma in the United States: An Update.
美国肝细胞癌肝移植中的种族差异:最新进展。
Dig Dis Sci. 2023 Oct;68(10):4050-4059. doi: 10.1007/s10620-023-08084-z. Epub 2023 Aug 16.
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Reduction in Racial and Ethnic Disparity in Survival Following Liver Transplant for Hepatocellular Carcinoma in the Direct-acting Antiviral Era.直接作用抗病毒药物时代肝移植治疗肝细胞癌后生存的种族和民族差异减少。
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Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma: Analysis of the National Inpatient Sample From 2007 to 2014.种族差异在肝细胞癌肝移植中的表现:2007 年至 2014 年全国住院患者样本分析。
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