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Hepato-pancreato-biliary

E280: The Association of Neighborhood Socioeconomic Deprivation and Treatment for Stage I/II Hepatocellular Carcinoma in Florida: An Incidence-Based Retrospective Cohort Study

Introduction: Studies have shown that early-stage hepatocellular carcinoma (HCC) is undertreated in the United States. Although socioeconomic status is thought to be associated with HCC treatment disparities, studies have commonly used large geographic areas (zip codes or counties), which can lead to imprecision. To overcome this obstacle, a granular measure of socioeconomic status at the neighborhood level was used to assess HCC treatment in Florida.

Methods: Using the incidence-based Florida Cancer Database, 3,610 patients diagnosed AJCC 7th edition stage I/II hepatocellular carcinoma from 2008-2015 reported to be eligible for surgery were identified. The Area Deprivation Index, a validated dataset that ranks neighborhoods (census block groups) from 1-100, where higher scores=higher socioeconomic deprivation (SED). Procedural treatment was defined as radiofrequency ablation (RFA), hepatectomy, and transplant and was categorized by ADI quintile. Descriptive statistics, tests of association, and logistic regression were used for analysis.

Results: The median national SED ranking for HCC was 64. SED was associated with age, race, insurance status, stage (I/II), number of tumors, and receipt of procedural treatment (p< 0.05). Sex, ethnicity, stage, tumor size, and hepatic vascular invasion were not associated with SED. For the cohort, 67.8% received no procedural treatment. RFA, hepatectomy ± RFA, and transplant were delivered to 9.7%, 11.2% and 11.3% of patients, respectively. The lowest SED quintile had nearly double the rate of hepatectomy or transplant (32.2%) compared to the highest SED quintile (17.4%). After adjustment for potential confounders, the lowest SED quintile had an increased odds of hepatectomy/transplant compared to the highest SED quintile (OR 1.71; 95% CI,1.33-2.19).

Conclusions:

For stage I/II HCC patients in Florida, the vast majority did not receive surgical treatment. Higher neighborhood SED was independently associated with significantly lower rates of hepatectomy and transplantation.  Assessment of the barriers that higher SED patients face to receive treatment for HCC are urgently needed to address treatment disparities.

Learning Objectives:

  • Analyze the advantage of using neighborhood-level measures over broader geographic indicators like zip codes or counties to gauge SES disparities in HCC treatment.
  • Evaluate the correlation between the Area Deprivation Index (ADI) and various treatment options, such as radiofrequency ablation (RFA), hepatectomy, and transplantation for AJCC 7th edition stage I/II HCC patients.
  • Understand potential barriers and challenges that patients with higher socioeconomic deprivation face in accessing HCC treatments with possible interventions.