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Maximiliano Servin-Rojas*1, Leigh Anne Dageforde1, Nahel Elias1, Parsia Vagefi2, Motaz Qadan1
1Massachusetts General Hospital, Boston, MA; 2The University of Texas Southwestern Medical Center, Dallas, TX

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. In the United States, the incidence and mortality of HCC are expected to continue increasing over the decade. Furthermore, disparities have been described in access to different treatment modalities. Using a nationwide database, we sought to identify survival disparities following liver transplantation (LT) or hepatectomy.

We conducted a retrospective analysis of the National Cancer Database. Black and White patients with Stage I-II HCC were identified, and two separate analyses were conducted for patients who underwent LT or hepatectomy. Groups were compared using univariable analyses. Survival analyses were conducted through the Kaplan-Meier method, log-rank test, and multivariable Cox regression.

We identified 8714 patients who underwent LT of whom 10.5% were Black, and 89.5% were White. Compared to White patients, Black patients were more likely to be younger (58 years, IQR 54-63 vs. 59 years, IQR 55-64, p<0.001), female (29% vs. 22%, p<0.001), government-insured (48% vs. 44%, p=0.002), had lower income (44% vs. 21%, p<0.001), were closer to their treatment center (47% vs. 21%, p<0.001), and were more likely to receive chemotherapy (60% vs. 52%,p<0.001). Median survival was shorter in Black patients (143 months, 95% CI 132-167 vs. 167 months, 95% CI 156-NA, p=0.02) compared to White patients. In the multivariable analysis, Black race was an independent predictor of decreased survival (HR 1.18, 95% CI 1.04-1.35, p=0.013).
In patients who underwent hepatectomy, there were a total of 11,006 patients identified, of whom 81.2% were White, and 18.8% were White. Compared to White patients, Black patients were more likely to be younger (62 years, IQR 57-67 vs. 66 years IQR 59-73, p<0.001), female (31% vs 28%, p=0.010), treated at academic facilities (67 vs. 58%), uninsured (4% vs 2%, p<0.001), had lower median income (50% vs 22%, p<0.001), more likely to have ≥ 2 comorbidities (26% vs 23%, p=0.035) to be stage II (30% vs 27%, p=0.022), and were closer to their treatment center (64% vs 36%, p<0.001). Median survival was similar between both groups (69 months, 95% CI 62-75 vs. 66 months, 95% CI 64-69%, p=0.73). Race was not an independent predictor of survival in patients who underwent hepatectomy.

We identified survival disparities in Black patients who underwent LT for HCC. Conversely, there were no survival disparities identified following hepatectomy. While the cause is likely multifactorial, the complex management surrounding LT might provide barriers related to care. Prompt investigation is needed to address ongoing racial disparities.

Panel A. Survival probability following hepatectomy. Panel B. Survival probability following liver transplant.

Multivariable Cox regression model for survival adjusting for demographic, clinical, and pathologic variables.

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