Differences in the surgical management of early-stage hepatocellular carcinoma at minority versus non-minority-serving hospitals.
Publication/Presentation Date
11-1-2023
Abstract
BACKGROUND: We examined differences in surgical intervention at minority-serving hospitals versus non-minority-serving hospitals among patients with early-stage hepatocellular carcinoma. We also investigated associations between surgical management and overall survival, stratified by minority-serving hospital status.
METHODS: Patients with early-stage hepatocellular carcinoma, defined as cT1, were identified within the National Cancer Database (2004-2018). The primary outcome was surgical intervention (resection, ablation, or transplantation). The proportion of minority (non-Hispanic Black or Hispanic) patients treated at each facility was determined, and hospitals in the top decile were considered minority-serving hospitals.
RESULTS: A total of 46,703 patients with early-stage hepatocellular carcinoma were identified, of whom 4,214 (9.0%) were treated at minority-serving hospitals. Patients treated at minority-serving hospitals were less likely to undergo surgical intervention than patients treated at non-minority-serving hospitals (odds ratio = 0.87, 95% confidence interval: 0.81-0.94). Minority patients treated at non-minority-serving hospitals were less likely to undergo surgical intervention than White patients (odds ratio = 0.86, 95% confidence interval: 0.82-0.90) and had a further associated decrease in the likelihood of surgical intervention when treated at minority-serving hospitals (odds ratio = 0.81, 95% confidence interval: 0.69-0.94). Regardless of minority-serving hospital status, surgery was associated with improved overall survival. There were no clinically meaningful differences in overall survival between White and minority patients who underwent surgery either at minority-serving hospitals or non-minority-serving hospitals.
CONCLUSIONS: Patients with early-stage hepatocellular carcinoma had an associated decrease in the likelihood of surgical intervention when treated at minority-serving hospitals. Minority patients treated at minority-serving hospitals had an associated decrease in the likelihood of surgery, but to a lesser extent when treated at non-minority-serving hospitals. Surgery was associated with improved overall survival regardless of minority or minority-serving hospital status.
Volume
174
Issue
5
First Page
1201
Last Page
1207
ISSN
1532-7361
Published In/Presented At
Elshami, M., Bailey, L., Hoehn, R. S., Ammori, J. B., Hardacre, J. M., Selfridge, J. E., Bajor, D., Mohamed, A., Chakrabarti, S., Mahipal, A., Winter, J. M., & Ocuin, L. M. (2023). Differences in the surgical management of early-stage hepatocellular carcinoma at minority versus non-minority-serving hospitals. Surgery, 174(5), 1201–1207. https://doi.org/10.1016/j.surg.2023.07.017
Disciplines
Medicine and Health Sciences
PubMedID
37604756
Department(s)
Department of Surgery, Lehigh Valley Topper Cancer Institute
Document Type
Article