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Racial Disparities in Utilization of Liver Transplantation for Hepatocellular Carcinoma in the United States, 1998–2002

Siegel, Abby B., M.D.1; McBride, Russell B., M.P.H.2; El-Serag, Hashem B., M.D., M.P.H.3; Hershman, Dawn L., M.D., M.S.1,2; Brown, Robert S. Jr, M.D., M.P.H.1; Renz, John F.1; Emond, Jean, M.D.1; Neugut, Alfred I., M.D., Ph.D.1,2

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 120–127
ORIGINAL CONTRIBUTIONS: LIVER AND BILIARY TRACT
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BACKGROUND AND AIMS The extent of use of liver transplantation on a population scale to treat hepatocellular carcinoma (HCC) in the United States is unknown. We assessed recent predictors of use of liver transplantation and its effect on survival for those with nonmetastatic HCC.

METHODS The Surveillance, Epidemiology, and End Results (SEER) program is a collection of population-based cancer registries. We identified adults registered in SEER with HCC between 1998 and 2002. We examined determinants for receipt of a liver transplant in univariate and multivariable analyses. Kaplan–Meier survival curves were constructed for those who received and did not receive a transplant for HCC.

RESULTS We identified 1,156 adults with small (5 cm or less) nonmetastatic HCC. Approximately 45% were white, 29% Asian, 17% Hispanic, and 9% African American. Only 21% received a transplant. More recent year of diagnosis, younger age, being married, white race, and smaller tumor size each predicted receipt of transplant. African Americans and Asians were about half as likely to receive a transplant as compared with white patients (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.21–0.90 for African Americans, and 0.57, 95% CI 0.36–0.89 for Asians). Hispanics trended in the same direction, but this was not statistically significant (OR 0.66, 95% CI 0.39–1.12). Those who underwent liver transplantation for localized HCC had 3- and 5-yr survivals of 81% and 75%, respectively.

CONCLUSIONS Only one-fifth of those with small, nonmetastatic HCC received liver transplantation. Transplanted patients have long-term survival similar to that of the best single-institution studies. However, marked racial variations were seen, with African Americans and Asians significantly less likely to receive a transplant after controlling for other variables.

1Departments of Medicine and Surgery and 2the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York and 3Sections of Health Services Research and Gastroenterology at the Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas

Reprint requests and correspondence: Abby B. Siegel, M.D., 622 West 168th St., PH 14, New York, NY 10032.

Received January 31, 2007; accepted July 19, 2007.

CONFLICT OF INTERESTGuarantor of the article: Abby Siegel, M.D.

Specific author contributions: Abby Siegel: initial concept, design, statistical analyses, and writing manuscript; Russell McBride: study design, statistical analyses, and editing manuscript; Hashem El-Serag, Dawn Hershman, Robert S. Brown, Jr., John Renz, and Jean Emond: study design and editing manuscript; and Alfred Neugut: concept, design and editing manuscript.

Financial support: Dr. Abby Siegel is sponsored by a Pardes Scholarship from New York-Presbyterian Hospital. Dr. Alfred Neugut is the recipient of a K05 award from the National Cancer Institute (NCI) (CA89155) and a grant from the American Cancer Society (RSGT-01–024-04-CPHPS). Dr. Hashem El-Serag is the recipient of a VA HSR&D Award (RCD00–013-2). Dr. Dawn Hershman is the recipient of an American Society of Clinical Oncology Career Development Award and a K07 Award from the NCI (CA95597). Russell McBride is the recipient of an NCI-R25 (CA94061) and a T32 (ULI RR024156) grant. Dr. Robert S. Brown is supported by an RO1 from the National Institutes of Health (NIH) (DK58369).

Potential competing interests: None.

© The American College of Gastroenterology 2008. All Rights Reserved.
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