Racial disparity in primary hepatocellular carcinoma : Tumor stage at presentation, surgical treatment and survival

The incidence and mortality rates from primary hepatocellular carcinoma (HCC) are higher in black Americans compared to whites. The goal of this study was to determine if there are racial disparities in HCC stage at diagnosis and treatment. We compared patient age, tumor stage, rates of surgical intervention and survival in black (n=1718) and white (n=9752) HCC cases between 1992 and 2001 in the Surveillance, Epidemiology and End Results (SEER)-11 + Alaska database. Black HCC cases were significantly younger at diagnosis (p < 0.0001). Black cases were more likely to have regional and distant metastasis at presentation (p < 0.0005) and were less likely to have surgery performed (p < 0.001). The racial difference in surgery treatment was significant among patients with localized (p = 0.001) and regional (p = 0.012) HCC, but not with distant HCC. Overall survival rates were lower in blacks (p = 0.0033). Survival was similar in blacks and whites with regional and distant disease. Yet, among patients with localized HCC, survival rates were lower in blacks (p = 0.0030). Black HCC patients have more advanced tumor stage at diagnosis and lower rates of both surgical intervention and survival. The racial disparities in surgical treatment utilization and survival were most striking between black and white HCC patients with localized HCC.