title: Race/ethnicity-specific disparities in cancer incidence, burden of disease, and overall survival among patients with hepatocellular carcinoma in the United States.
abstract: Hepatocellular carcinoma (HCC) is one of the fastest rising causes of cancer-related deaths in the United States, with disparities observed in cancer incidence and survival between ethnic groups. This report provides updated analyses on race-specific disparities in US HCC trends.
  
  
  
  This large, population-based cohort study was conducted using Surveillance, Epidemiology, and End Results cancer registry data from 2003 to 2011 to investigate race-specific disparities in HCC incidence and survival. Survival was analyzed using Kaplan-Meier methods and multivariate Cox proportional-hazards models.
  
  
  
  From 2003 to 2011, Asians had the highest HCC incidence, followed by blacks, Hispanics, and non-Hispanic whites. During the same period, Hispanics had the greatest increase in HCC incidence (+35.8%), whereas Asians experienced a 5.5% decrease. Although patients aged ≥65 years had the highest HCC incidence among all racial/ethnic groups, the higher HCC incidence in Asians was observed only for patients ages <50 and ≥65 years, whereas HCC incidence among patients ages 50 to 64 years was similar among Asians, blacks, and Hispanics. The overall 5-year HCC survival rate was highest among Asians (26.1%; 95% confidence interval [CI], 24.5%-27.6%) and lowest among blacks (21.3%; 95% CI, 19.5%-23.1%). On multivariate regression, Asians (hazard ratio, 0.83; 95% CI, 0.79-0.87; P < .001) and blacks (hazard ratio, 0.94; 95% CI, 0.89-0.99; P = .01) had significantly higher survival compared with non-Hispanic whites.
  
  
  
  Asians were the only group to demonstrate a declining HCC incidence in the form of a shift from advanced HCC to more localized HCC. These findings most likely reflect improved screening and surveillance efforts for this group. Cancer 2016;122:2512-23. © 2016 American Cancer Society.
authors.affiliation: Department of Medicine, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: John
authors.initials: J
authors.lastname: Ha
authors.affiliation: Department of Medicine, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Melissa
authors.initials: M
authors.lastname: Yan
authors.affiliation: Department of Medicine, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Maria
authors.initials: M
authors.lastname: Aguilar
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Tana
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Benny
authors.initials: B
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford Health Care, Stanford, California.|Hepatitis B Foundation, Doylestown, Pennsylvania.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gish
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D017281:Cost of Illness; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D011159:Population Surveillance; D016016:Proportional Hazards Models; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology / Q000208:ethnology
keywords: Epidemiology; Surveillance; and End Results (SEER); incidence; liver cancer; racial differences; screening