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Disparities in Hepatocellular Carcinoma Outcomes Among Subgroups of Asians and Pacific Islanders: A SEER Database Study

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Abstract

Hepatocellular carcinoma (HCC) is highly prevalent in Asians and Pacific Islanders (API) but this heterogenous group is often aggregated into a single category, despite vast differences in culture, socioeconomic status, education, and access to care among subgroups. There remains a significant knowledge gap in HCC outcomes among different subgroups of API. The Surveillance, Epidemiology, and End Results (SEER) database was accessed, and site/ICD codes were used to identify HCC patients during 2010–2019 who were API ethnicity. Data collected: demographics, socioeconomic status, tumor characteristics, treatment, and survival. Subgroup analyses were performed among different Asian ethnicities in a secondary analysis. 8,249 patients were identified/subdivided into subgroups of Asian ethnicities and Other Pacific Islanders (NHOPI) groups. The median age was 65 years for Asians and 62 years for NHOPI (p < 0.01), and significant differences were found in income (p < 0.01). A higher proportion of NHOPI lived in rural areas compared to Asians (8.1 vs. 1.1%, p < 0.01). There were no statistically significant differences in tumor size, stage, pre-treatment AFP level, or surgical treatments between the two groups. However, Asians had higher overall median survival than NHOPI (20 months v 12 months, p < 0.01). Secondary analyses among different subgroups of Asian ethnicities revealed significant differences in tumor size and staging, surgical resection, transplant rates, and median survival. While API had similar tumor characteristics and treatment, Asians had much higher survival than NHOPI. Socioeconomic differences and access to care may contribute to these differences. This study also found significant survival disparities within API ethnicities.

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Availability of Data and Materials

This study utilized a publicly available SEER database.

Abbreviations

AFP:

Alpha-fetoprotein

AJCC:

American Joint Committee on Cancer

API:

Asians and Pacific Islanders

BCLC:

Barcelona Clinic Liver Cancer

CI:

Confidence interval

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

ICD:

International Classification of Diseases

ICD-O-3:

International Classification of Disease for Oncology, 3rd edition

LRT:

Locoregional therapy

NAFLD:

Nonalcoholic fatty liver disease

NHOPI:

Native Hawaiians and Other Pacific Islanders

NOS:

Not otherwise specified

SEER database:

The Surveillance, Epidemiology, and End Results database

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Funding

This study was not supported by funding or grants. All authors report no financial disclosures (none declared).

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198, USA

    Tomoki Sempokuya & Chansong Choi

  2. Department of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA

    Chun-Wei Pan

  3. Department of Gastroenterology and Hepatology, HCA Healthcare, Sunrise Consortium Graduate Medical Education, Las Vegas, NV, USA

    Robert J. Pattison

  4. Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan

    Akane Nogimura

  5. Division of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan

    Akane Nogimura

  6. Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA

    Linda L. Wong

Authors
  1. Tomoki Sempokuya
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  2. Chun-Wei Pan
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  4. Chansong Choi
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  5. Akane Nogimura
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  6. Linda L. Wong
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Contributions

ST, PCW, PRJ, CC, NA contributed to the literature review, manuscript drafting, and editing; WL contributed to study supervision, manuscript drafting, and editing; all of the authors have approved the final version of the manuscript.

Corresponding author

Correspondence to Tomoki Sempokuya.

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Conflict of Interest

Linda L Wong is a speaker bureau of Eisai.

Ethical approval

This study utilized a publicly available database; therefore, institutional review board approval was not needed to conduct this study. This study followed the SEER Research Data Use Agreement.

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Sempokuya, T., Pan, CW., Pattison, R.J. et al. Disparities in Hepatocellular Carcinoma Outcomes Among Subgroups of Asians and Pacific Islanders: A SEER Database Study. J Immigrant Minority Health 25, 824–834 (2023). https://doi.org/10.1007/s10903-023-01478-1

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  • DOI: https://doi.org/10.1007/s10903-023-01478-1

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