Patel Shyam, Khalili Mandana, Singal Amit G, Pinheiro Paulo S, Jones Patricia D, Kim Rebecca G, Kode Vishwajit, Thiemann Anna, Zhang Wei, Cheung Ramsey, Wong Robert J
Department of Medicine, California Pacific Medical Center, San Francisco, California.
Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, California.
Cancer Epidemiol Biomarkers Prev. 2025 Feb 6;34(2):355-365. doi: 10.1158/1055-9965.EPI-24-1094.
Hepatocellular carcinoma (HCC) disproportionately affects racial/ethnic minorities. We evaluated the impact of income and geography on racial/ethnic disparities across the HCC care cascade in the United States.
Using NCI registry data spanning 2000 to 2020, adults with HCC were evaluated to determine race/ethnicity-specific differences in tumor stage at diagnosis, delays and gaps in treatment, and survival. Adjusted regression models evaluated predictors of HCC outcomes.
Among 112,389 adults with HCC, cohort characteristics were as follows: 49.8% non-Hispanic White (NHW), 12.0% African American(AA), 20.5% Hispanic, 16.5% Asian/Pacific Islander, and 1.1% American Indian/Alaska Native. Compared with NHW patients, AA patients had lower odds of localized-stage HCC at diagnosis [adjusted odds ratio (aOR), 0.84], lower odds of HCC treatment receipt (aOR, 0.77), greater odds of treatment delays (aOR, 1.12), and significantly greater risk of death [adjusted hazards ratio (aHR), 1.10]. Compared with NHW patients from large metro areas, AA patients from large metro areas had 8% higher mortality risk (aHR, 1.08), whereas AA patients from small-medium metro areas had 17% higher mortality risk (aHR, 1.17; all P < 0.05).
Among a population-based cohort of US adults with HCC, significant race/ethnicity-specific disparities across the HCC care continuum were observed. Lower household income and more rural geography among racial/ethnic minorities are also associated with disparities in HCC outcomes, particularly among AA patients.
Our study shows that lower income and less urban/more rural geography among racial/ethnic minorities are also associated with disparities in HCC outcomes, particularly among AA patients with HCC. This contextualizes the complex relationship between sociodemographic factors and HCC outcomes through an intersectional lens.
肝细胞癌（HCC）对少数种族/族裔的影响尤为严重。我们评估了收入和地理位置对美国HCC诊疗全程中种族/族裔差异的影响。
利用2000年至2020年的美国国立癌症研究所（NCI）登记数据，对成年HCC患者进行评估，以确定诊断时肿瘤分期、治疗延迟和差距以及生存方面的种族/族裔特异性差异。调整后的回归模型评估了HCC预后的预测因素。
在112,389例成年HCC患者中，队列特征如下：49.8%为非西班牙裔白人（NHW），12.0%为非裔美国人（AA），20.5%为西班牙裔，16.5%为亚裔/太平洋岛民，1.1%为美国印第安人/阿拉斯加原住民。与NHW患者相比，AA患者诊断时处于局部阶段HCC的几率较低[调整优势比（aOR），0.84]，接受HCC治疗的几率较低（aOR，0.77），治疗延迟的几率较高（aOR，1.12），死亡风险显著更高[调整风险比（aHR），1.10]。与来自大城市地区的NHW患者相比，来自大城市地区的AA患者死亡风险高8%（aHR，1.08），而来自中小城市地区的AA患者死亡风险高17%（aHR，1.
