Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012

AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a populationbased cancer registry. METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White (White, n = 12710), Hispanic (n = 8500), Chinese (n = 2723), non-Hispanic Black (Black, n = 2609), Vietnamese (n = 2063), Filipino (n = 1479), Korean (n = 1099), Japanese (n = 658), American Indian/Alaskan Native (AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian (n = 233), South Asian (n = 190), Hawai` ian/Pacific Islander (n = 172), Thai (n = 95), and Other Asian (n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality. RESULTS After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio (OR) = 0.30, 95% CI: 0.17-0.53], Cambodian (OR = 0.65, 95% CI: 0.45-0.96), AIAN (OR = 0.66, 95% CI: 0.46-0.93), Black (OR = 0.76, 95% CI: 0.67-0.86), and Hispanic (OR = 0.78, 95% CI: 0.72-0.84) patients were less likely, whereas Chinese (OR = 1.58, 95% CI: 1.42-1.77), Koreans (OR = 1.45, 95% CI: 1.24-1.70), Japanese (OR = 1.41, 95% CI: 1.15-1.72), and Vietnamese (OR = 1.26, 95% CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio (HR) = 1.50, 95% CI: 1.29-1.73)], Cambodians (HR = 1.35, 95% CI: 1.16-1.58), and Blacks (HR = 1.07, 95% CI: 1.01-1.13), and lower for Chinese (HR = 0.82, 95% CI: 0.77-0.86), Filipinos (HR = 0.84, 95% CI: 0.78-0.90), Vietnamese (HR = 0.85, 95% CI: 0.80-0.90), Koreans (HR = 0.90, 95% CI: 0.83-0.97), and Hispanics (HR = 0.91, 95% CI: 0.88-0.94); results were similar for all-cause mortality. CONCLUSION Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.