title: Race/Ethnicity-specific Disparities in Hepatocellular Carcinoma Stage at Diagnosis and its Impact on Receipt of Curative Therapies.
abstract: OBJECTIVE
  To evaluate race/ethnicity-specific disparities in hepatocellular carcinoma (HCC) stage at diagnosis and how this impacts receiving curative therapies.
  
  
  BACKGROUND
  HCC is a leading cause of morbidity and mortality worldwide. The highest incidence of HCC is seen among ethnic minorities in the United States.
  
  
  METHODS
  Using the 2003-2011 Surveillance, Epidemiology, and End Results database and United Network of Organ Sharing, population-based registries for cancer and liver transplantation (LT) in the United States, race/ethnicity-specific cancer stage at diagnosis and treatment received among adults with HCC were evaluated.
  
  
  RESULTS
  Compared with non-Hispanic whites, blacks had significantly more advanced HCC at diagnosis [odds ratio (OR), 1.20; 95% confidence interval (CI), 1.10-1.30; P<0.001], whereas Asians were less likely to have advanced disease (OR, 0.87; CI, 0.80-0.94; P<0.001). Among patients with HCC meeting Milan criteria, Hispanics (OR, 0.64; 95% CI, 0.57-0.71; P<0.001) and blacks (OR, 0.67; 95% CI, 0.59-0.76; P<0.001) were significantly less likely to receive curative therapy (resection or LT), whereas Asians were more likely to receive curative therapy (OR, 1.22; 95% CI, 1.10-1.35; P<0.001) compared with non-Hispanic whites. However, Asians (OR, 0.49; 95% CI, 0.42-0.58; P<0.001) and Hispanics (OR, 0.51; 95% CI, 0.44-0.60; P<0.001) were less likely to receive LT.
  
  
  CONCLUSIONS
  Among US adults with HCC, blacks consistently had more advanced stage at diagnosis and lower rates of receiving treatment. After correcting for cancer stage and evaluating the subset of patients eligible for curative therapies, blacks and Hispanics had significantly lower rates of curative HCC treatment.
authors.affiliation: *Department of Medicine ‡Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland †Division of Gastroenterology, University of California, San Francisco §Department of Organ Transplantation, Scripps Green Hospital, San Diego, CA.
authors.forename: John
authors.initials: J
authors.lastname: Ha
authors.forename: Melissa
authors.initials: M
authors.lastname: Yan
authors.forename: Maria
authors.initials: M
authors.lastname: Aguilar
authors.forename: Michele
authors.initials: M
authors.lastname: Tana
authors.forename: Benny
authors.initials: B
authors.lastname: Liu
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Frenette
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D044469:Racial Groups / Q000706:statistics & numerical data; D018426:SEER Program; D014481:United States / Q000453:epidemiology