Racial and geographic disparities in the utilization of surgical therapy for hepatocellular carcinoma

The incidence of hepatocellular carcinoma (HCC) continues to increase, a trend that will likely continue because of the rising prevalence of chronic hepatitis C infection. This study sought to determine the recent patterns of utilization of surgical therapy (hepatectomy, ablation, or liver transplantation) for HCC from the Surveillance, Epidemiology, and End Results national cancer registry. Data were extracted for 16,121 patients with HCC diagnosed between 1998 and 2004. Twenty-three percent of patients underwent surgical therapy (9.5% resection, 7.8% ablation, 6% transplant); the proportion of patients treated with surgical therapy increased similar to 9% over the study period. On multivariate analysis, female sex, younger age, and smaller solitary tumors were associated with increased utilization of surgical therapy. Blacks and Hispanics were 24-27% less likely to receive surgical therapy than white individuals (P< 0.001). Racial and geographic disparities persisted despite the adjustment for Health Service Area and limitation of the cohort to small localized HCC. Blacks were especially disadvantaged in the utilization of liver transplant for small HCC (OR= 0.42, P< 0.001). Further investigation to understand the etiology of these profound racial and geographic disparities is essential to ensure equitable provision of surgical therapies, which provide the only potentially curative treatments for HCC.