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Clinical Presentation of Hepatocellular Carcinoma in African Americans vs. Caucasians: A Retrospective Analysis
Authors:Hrishikesh Samant  Kapil Kohli  Krunal Patel  Runhua Shi  Paul Jordan  James Morris  Annie Schwartz  Jonathan Steven Alexander
Institution:1.Section of Gastroenterology and Hepatology, Departments of Medicine, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103, USA; (H.S.); (K.K.); (P.J.); (J.M.);2.Lane Gastroenterology, Zachary, LA 70791, USA;3.Department of Molecular and Cellular Physiology, LSU Health Sciences Center Shreveport, Shreveport, LA 71130, USA; (R.S.); (A.S.)
Abstract:Hepatocellular carcinoma (HCC) remains an important form of cancer-related morbidity and mortality in the U.S. and worldwide. Previous U.S.-based studies on survival suggest ethnic disparities in HCC patients, but the complex interplay of multiple factors that contribute are still incompletely understood. Here we considered the influences of risk factors contributing towards HCC survival, including ethnic background, over ten years at a premier academic medical center with a majority (57.20%) African American (AA) population. Retrospective HCC data were collected from 2008–2018 at LSUHSC-Shreveport, an urban tertiary medical center. Data included demographics, comorbidities, liver disease characteristics, and tumor parameters. Statistical analysis was performed using Chi Square and one-way ANOVA. Results: 229 HCC patients were identified (male 78.6%). The mean HCC age at diagnosis was 61 years (SD = 7.3). Compared to non-Hispanic Caucasians (42.7%), AA patients (57.2% of total) were older at presentation, had more frequent diabetes/dyslipidemia/NAFLD (45 (34.3%) compared with 19 (19.3%) in non-Hispanic Caucasians, p = 0.02), and had a larger HCC burden at diagnosis. We conclude that compared to white patients, despite having similar BMI and MELD scores and rates of portal vein thrombosis, AA patients with HCC in our cohort were older at presentation, had a significantly increased incidence of modifiable metabolic risk factors including diabetes, higher AFP values, increased incidence of gallstones, and larger sized HCCs, and were more likely to be outside Milan criteria. These findings have important prognostic and diagnostic implications for developing a more targeted HCC surveillance program.
Keywords:hepatocellular carcinoma  ethnicity  race  overall survival  survival disparity
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