title: Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States.
abstract: BACKGROUND
  Racial, ethnic, and socioeconomic disparities in the survival of patients with hepatocellular carcinoma (HCC) continue to exist. The authors of this report hypothesized that these differences result from inequities in access to care and in response to therapy.
  
  
  METHODS
  Patients with HCC (n = 20,920) were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and patients who underwent liver transplantation for HCC (n = 4735) were identified from the United Network for Organ Sharing (UNOS) database. Clinical and pathologic factors were compared after patients were stratified by race and ethnicity.
  
  
  RESULTS
  The survival of patients with HCC improved over time for all racial, ethnic, and income groups (P < .001). Black and low income individuals had the poorest long-term survival (P < .001). On multivariate analysis, black race was predictive of the poorest survival (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.09-1.22; P < .001), whereas Asian race was associated with the best survival (HR, 0.87; 95% CI, 0.83-0.91; P < .001). After liver transplantation, black patients had the worst graft survival and overall survival (median survival [MS], 30.5 months and 39.7 months, respectively; P < .001), whereas Hispanics had the best survival (MS, 83.4 months and 86.6 months, respectively; P < .001). In a multivariate analysis of transplantation patients, race and ethnicity were associated significantly with outcome.
  
  
  CONCLUSIONS
  Significant racial and ethnic disparities in the outcome of patients with HCC persist despite the receipt of comparable treatment. The authors concluded that further investigations are warranted to identify the reasons for the stark disparity in outcomes between black patients and Hispanic patients after liver transplantation for HCC.
authors.affiliation: Division of Oncologic Surgery, City of Hope, Duarte, CA, USA.
authors.forename: Avo
authors.initials: A
authors.lastname: Artinyan
authors.forename: Brian
authors.initials: B
authors.lastname: Mailey
authors.forename: Nicelio
authors.initials: N
authors.lastname: Sanchez-Luege
authors.forename: Joshua
authors.initials: J
authors.lastname: Khalili
authors.forename: Can-Lan
authors.initials: CL
authors.lastname: Sun
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Wagman
authors.forename: Nicholas
authors.initials: N
authors.lastname: Nissen
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colquhoun
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
mesh_terms: D001741:Black or African American; D001213:Asian; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D007182:Income; D008113:Liver Neoplasms / Q000191:economics / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D018426:SEER Program; D012923:Social Class; D016019:Survival Analysis; D014481:United States