Features of hepatocellular carcinoma in Hispanics differ from African Americans and non-Hispanic Whites

Table 1 Demographics, comorbid conditions and disease characteristics of hepatocellular carcinoma patients, by race

Patient characteristics	Total (n = 195)	Hispanic (n = 44)	African-American (n = 61)	White (n = 90)	P1
Demographics
Age (yr, mean ± SD)	59.7 ± 9.8	62.5 ± 12.5	58.7 ± 10.2	58.9 ± 7.7
Female (n, %)	38, 19.5	11, 25.0	17, 27.9	10, 11.1	aHW, AW
Insurance (n, %)
Medicare/medicaid	120, 61.5	31, 70.5	36, 59.0	53, 58.9
Private	67, 34.4	12, 27.3	22, 36.1	33, 36.7
None	8, 4.1	1, 2.3	3, 4.9	4, 4.4
BMI > 24.9 (n, %)	137, 70.3	31, 70.5	44, 72.1	62, 68.9
Metabolic syndrome3 (n, %)	27, 14.1	8, 18.2	3, 4.9	16, 18.4	aHA, AW
Comorbid conditions
Hyperlipidemia (n, %)	31, 25.4	16, 55.2	5, 13.2	10, 18.2	bHW, HA
On dialysis (n, %)	7, 3.6	5, 11.4	0, 0	2, 2.3	bHNH2
Diabetes mellitus 2 (n, %)	91, 46.7	29, 65.9	19, 31.1	43, 47.8	bHA, aAW
History smoking (n, %)	126, 65	16, 36.3	43, 70.5	67, 75.2	bHW, HA; aAW
Current smoker (n, %)	57, 29.4	2, 4.5	28, 45.9	27, 30.3	bHW, HA; aAW
Triglycerides (median ± SD)	99.5 ± 66.5	101.0 ± 70.2	111.0 ± 64.7	80.5 ± 65.8
History alcohol use (n, %)	163, 83.6	39, 88.6	50, 82	74, 82.2
Cirrhosis characteristics
Etiology4
HCV (n, %)	132, 67.7	18, 40.9	49, 80.3	65, 72.2	bHW, HA
HBV (n, %)	14, 8.1	2, 5.0	8, 14.3	4, 5.2
ETOH (n, %)	55, 28.2	11, 25.0	15, 24.6	29, 32.2
NASH (n, %)	35, 18.0	15, 34.9	5, 8.2	15, 16.7	bHA, aHW
Other5 (n, %)	22, 11.3	11, 25	2, 3.3	9, 11.3	0.056
MELD (median ± SD)	11.0 ± 4.6	11.5 ± 4.4	9.0 ± 3.1	12.0 ± 5.1	aHA, bAW
AFP
Median (IQR)	22.4 (6.1-217.2)	19 (5.9-434.85)	82 (11.9-434.8)	12 (5.0-53.2)
AFP > 200	49, 25.1	12, 27.3	22, 36.1	15, 16.7	aHA, bAW
Hepatic encephalopathy (n, %)	65, 33.3	16, 36.4	8, 13.1	41, 45.6	aHA, bAW
Ascites (n, %)	80, 44.5	23, 54.8	14, 26	43, 51.2	aHW, HA, AW
HCC surveillance performed (n, %)	113, 61.1	27, 65.9	31, 51.7	55, 65.5
Tumor parameters
Tumor size (cm)
Median (± SD) (IQ range)	3.0 ± 3.7 (2.0-6.0)	3.0 ± 3.9 (2.0-5.0)	3.0 ± 3.6 (2.0-6.0)	3.0 ± 3.7 (2.0-6.0)
> 5 cm (n, %)	43, 26.9	8, 22.2	14, 28.6	21, 28
Median > 5 cm (± SD) (IQ range)	8.0 ± 4.0 (6.0-12.0)	13.0 ± 3.4 (7.5-13.0)	9.5 ± 3.1 (6.0-11.0)	7.0 ± 4.7 (6.0-8.0)
Stage at diagnosis (n, %)	99, 52.1	20, 45.5	30, 50.8	49, 56.3
Unifocal	77, 40.5	21, 47.7	25, 42.4	31, 35.6
Multifocal	14, 7.4	3, 6.8	4, 6.8	7, 8.0
Metastatic	29, 24.2	9, 33.3	9, 23.1	11, 20.4
Portal vein involvement (n, %)	35, 47.9	6, 54.5	13, 54.2	16, 42.1
Poorly differentiated within milan criteria (n, %)	121, 62.1	28, 63.6	36, 59.0	57, 63.3

¹P values from χ² tests (two-sided) and fischer for overall race effect followed by pairwise comparisons, for P < 0.05. A significance level of 0.05 was used for the overall race comparisons.

^aP < 0.05,

^bP < 0.001, P values were not calculated for n < 5;

²Given n < 5 for AA (n = 0) and W (n = 2), limited statistical tests for Hispanic to non-Hispanic with P = 0.0074;

³Metabolic syndrome: Three of the following five traits per adult treatment panel III guidelines. Abdominal obesity, defined as a waist circumference in men ≥ 102 cm (40 in) and in women ≥ 88 cm (35 in): (1) serum triglycerides ≥ 150 mg/dL (1.7 mmol/L) or drug treatment for elevated triglycerides; (2) serum HDL cholesterol < 40 mg/dL (1 mmol/L) in men and < 50 mg/dL (1.3 mmol/L) in women or drug treatment for low HDL-C; (3) blood pressure ≥ 130/85 mmHg or drug treatment for elevated blood pressure; (4) fasting plasma glucose (FPG) ≥ 100 mg/dL (5.6 mmol/L) or drug treatment for elevated blood glucose;

⁴Some patients with more than one listed etiology of cirrhosis;

⁵Other: Cryptogenic, hemochromatosis, autoimmune, other not specified. H: Hispanics; A: African Americans; W: Non-Hispanic Caucasians; SD: Standard deviation; IQ: Percentile interquartile range (25%, 75%); HW: Hispanics compared to Whites; HA: Hispanics compared to African Americans; AW: African Americans compared to Whites; HNH: Hispanics compared to non-Hispanics; BMI: Body mass index; HBV: Hepatitis B virus; HCV: Hepatitis C virus; NASH: Nonalcoholic steatohepatitis; HCC: Hepatocellular carcinoma.

Table 2 Treatment patterns for non-metastatic patients at diagnosis: First line treatment patterns for non-metastatic patients by race

First line treatment characteristics	Total (n = 176)1	Hispanic (n = 41) (n, %)	African American (n = 55) (n, %)	White (n = 80)1 (n, %)	P2
Surgery	2	0, 0	2, 3.6	0, 0
Liver directed	154	38, 92.7	48, 87.2	68, 85
Chemotherapy	6	1, 2.4	2, 3.6	3, 3.8
Observation	6	0, 0	1, 1.8	4, 5
Lost to follow-up	7	2, 4.9	2, 3.6	4, 5

¹One patient missing information;

²P values from χ² tests (two-sided) and fischer for overall race effect followed by pairwise comparisons, for P < 0.05. A significance level of 0.05 was used for the overall race comparisons.

Table 3 Treatment patterns for non-metastatic patients at diagnosis: Transplantation patterns by race

Transplantation patterns	Total listed	Hispanic	African American	White	P2
Met milan criteria	121	28	36	57
Transplanted	341, 1.4%	10, 35.7%	6, 16.7%	181, 31.6%
Listed	68	20	17	31
Tumor exception points	33, 48.5%	10, 50%	6, 35.3%	17, 48.4%
Transplanted	381, 55.9%	10, 50%	6, 35.3%	221, 71%1	aAW
Removed from list	28, 41.1%	9, 45%	11, 64.7%	8, 25.8%	bAW
Death	7	3	0	4
Progression	10	3	5	2
Transfer of care	5	2	2	1
Other	5	1	4	0

¹Four patients initially outside of Milan criteria, subsequently listed and transplanted after reassessment and locoregional treatment;

²P values from χ² tests (two-sided) and fischer for overall race effect followed by pairwise comparisons, for P < 0.05. A significance level of 0.05 was used for the overall race comparisons.

^aP < 0.05;

^bP < 0.001. P values were not calculated for n < 5. AW: African American compared to Whites.