Rich Nicole E, Jones Patricia D, Zhu Hong, Prasad Tanushree, Hughes Amy, Pruitt Sandi, Murphy Caitlin C, Seif-El-Dahan Karim, Daher Darine, Figueroa Gloria, Castaneda Stephanie, Quirk Lisa, Gonzales Michael, Carranza Osiris, Bourque Samantha, Baset Nargis, Yopp Adam C, Singal Amit G
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA.
Hepatol Commun. 2024 Oct 10;8(11). doi: 10.1097/HC9.0000000000000477. eCollection 2024 Nov 1.
Racial and ethnic disparities have been reported for HCC prognosis, although few studies fully account for clinically important factors and social determinants of health, including neighborhood socioeconomic status.
We conducted a retrospective multicenter cohort study of patients newly diagnosed with HCC from January 2010 through August 2018 at 4 large health systems in the United States. We used multivariable logistic regression and cause-specific Cox proportional hazard models to identify factors associated with early-stage HCC presentation and overall survival.
Of 2263 patients with HCC (37.6% non-Hispanic White, 23.5% non-Hispanic Black, 32.6% Hispanic, and 6.4% Asian/other), 42.0% of patients presented at an early stage (Barcelona Clinic Liver Cancer stage 0/A). In fully adjusted models, there were persistent Black-White disparities in early-stage presentation (OR: 0.63, 95% CI: 0.45-0.89) but not Hispanic-White disparities (OR: 0.93, 95% CI: 0.70-1.24). Median survival was 16.2 (IQR: 5.8-36.8) months for White patients compared to 15.7 (IQR: 4.6-34.4) months for Hispanic, 10.0 (IQR: 2.9-29.0) months for Black, and 9.5 (IQR: 3.4-31.9) months for Asian/other patients. Black-White disparities in survival persisted after adjusting for individual demographics and clinical factors (HR: 1.30, 95% CI: 1.09-1.53) but were no longer observed after adding HCC stage and treatment (HR: 1.05, 95% CI: 0.88-1.24), or in fully adjusted models (HR: 0.97, 95% CI: 0.79-1.18). In fully adjusted models, Hispanic-White (HR: 0.87, 95% CI: 0.73-1.03) and Asian/other-White (HR: 0.85, 95% CI: 0.63-1.15) differences in survival were not statistically significant, although patients in high-SES neighborhoods had lower mortality (HR: 0.69, 95% CI: 0.48-0.99).
In a multicenter cohort of patients with HCC, racial and ethnic differences in HCC prognosis were explained in part by differences in tumor stage at diagnosis and neighborhood SES. These data inform targets to intervene and reduce disparities.
已有报道称肝癌预后存在种族和民族差异，尽管很少有研究充分考虑临床重要因素和健康的社会决定因素，包括邻里社会经济地位。
我们对2010年1月至2018年8月在美国4个大型医疗系统中新诊断为肝癌的患者进行了一项回顾性多中心队列研究。我们使用多变量逻辑回归和特定病因的Cox比例风险模型来确定与早期肝癌表现和总生存期相关的因素。
在2263例肝癌患者中（37.6%为非西班牙裔白人，23.5%为非西班牙裔黑人，32.6%为西班牙裔，6.4%为亚裔/其他），42.0%的患者在早期阶段（巴塞罗那临床肝癌分期0/A期）就诊。在完全调整模型中，早期就诊存在持续的黑人和白人差异（比值比：0.63，95%置信区间：0.45 - 0.89），但西班牙裔和白人之间不存在差异（比值比：0.93，95%置信区间：0.70 - 1.24）。白人患者的中位生存期为16.2（四分位间距：5.8 - 36.8）个月，西班牙裔为15.7（四分位间距：4.6 - 34.4）个月，黑人为10.0（四分位间距：2.9 - 29.0）个月，亚裔/其他患者为9.5（四分位间距：3.4 - 31.9）个月。在调整了个体人口统计学和临床因素后，生存方面的黑人和白人差异仍然存在（风险比：1.30，95%置信区间：1.09 - 1.53），但在加入肝癌分期和治疗因素后不再显著（风险比：1.05，95%置信区间：0.88 - 1.24），在完全调整模型中也是如此（风险比：0.97，95%置信区间：0.79 - 1.18）。在完全调整模型中，西班牙裔和白人（风险比：0.87，95%置信区间：0.73 - 1.03）以及亚裔/其他和白人（风险比：0.85，95%置信区间：0.63 - 1.15）在生存方面的差异无统计学意义，尽管高社会经济地位社区的患者死亡率较低（风险比：0.69，95%置信区间：0.48 - 0.99）。
在一个多中心肝癌患者队列中，肝癌预后的种族和民族差异部分可由诊断时肿瘤分期和邻里社会经济地位的差异来解释。这些数据为干预和减少差异提供了目标依据。
