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Hepato-pancreato-biliary

E277: The Role of Neighborhood Socioeconomic Deprivation on Overall Survival for Stage I/II Hepatocellular Carcinoma Patients in Florida: An Incidence-Based Retrospective Cohort Study

Introduction: Prior research illustrates a clear link between socioeconomic status and both the treatment and overall survival rates of early-stage hepatocellular carcinoma (HCC) patients. However, a common limitation of these studies has been their reliance on broad imprecise geographic areas like zip codes or counties for assessment. Considering this, we utilized a statewide cancer registry to narrow down the assessment to the neighborhood level, using socioeconomic deprivation (SED) as a lens to evaluate overall survival (OS) in early-stage HCC patients.

Methods: We leveraged the incidence-based Florida Cancer Database to identify 3,610 early-stage HCC patients (AJCC 7th edition stage I/II), reported to be clinically eligible for surgery between 2008 and 2015. The Area Deprivation Index, a validated dataset, was employed to assess SED by ranking neighborhoods (census block groups) on a scale of 1-100 (with higher scores indicating higher deprivation) at a national level. OS was then analyzed by quintile, and survival analysis techniques like Kaplan-Meier, log-rank test, and Cox proportional hazard regression were deployed.

Results:

The study found a median national SED ranking of 64, with a median follow-up time of 22.1 months. The treatment rates were 77.5% for no procedural treatment, 11.2% for hepatectomy, and 11.3% for transplant. The median OS stood at 14.6, 48.4, and 97.4 months for no procedural treatment, hepatectomy, and transplant, respectively (p< 0.05). When comparing the lowest and highest SED quintiles, the median OS was 24.4 and 18.9 months respectively (p< 0.05). In cases of hepatectomy or transplant, no significant OS difference was found between the lowest and highest SED quintiles (64.4 and 61.6 months, respectively). However, post demographic and treatment variables adjustment, a higher mortality rate was observed in the highest SED quintile compared to the lowest (HR 1.19; 95% CI,1.05-1.37).

Conclusions: The findings reveal that in Florida, early-stage HCC patients from higher SED neighborhoods are less likely to receive treatment and have poorer overall survival rates compared to those from lower SED neighborhoods. This OS disparity remained even after accounting for demographic and treatment variables, highlighting a pressing need to further explore the impact of SED on the HCC cancer continuum.

Learning Objectives:

  • Develop an understanding of socioeconomic deprivation (SED) and analyze its impact on the treatment and overall survival (OS) of early-stage hepatocellular carcinoma (HCC) patients.
  • Learn to apply validated datasets like the Area Deprivation Index for assessing SED at a more precise geographic level such as neighborhoods.
  • Explore potential strategies to mitigate the identified disparities and improve healthcare outcomes for HCC patients across different socioeconomic groups.