Racial and ethnic survival disparities in primary liver cancer in the United States: a National Cancer Database propensity score-matched study.
INTRODUCTION Primary liver cancer is a leading cause of cancer mortality worldwide. We evaluated whether racial and ethnic survival disparities among US patients with primary liver cancer persist after adjustment for clinical, treatment, socioeconomic, and access-related factors. METHODS We performed a retrospective cohort study using the National Cancer Database. Race was analyzed as White versus Black, and race/ethnicity groups were defined as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic of any race. Overall survival (OS) was assessed using Kaplan-Meier analysis, log-rank testing, multivariable Cox regression, and 1:1 propensity score matching for the White-versus-Black comparison. RESULTS Among 122,049 patients diagnosed between 2004 and 2016, Black patients more often presented with advanced disease and were less likely to receive surgery, chemotherapy, or radiotherapy. In the unmatched analysis, White patients had better OS. After matching, race was not an independent predictor of survival (HR 0.98, p = 0.11). Hispanic ethnicity remained associated with improved survival compared with NHW and NHB patients (HR 1.32 and 1.29; both p < 0.001). CONCLUSION The unadjusted survival difference between White and Black patients was attenuated after adjustment for clinical, treatment, socioeconomic, and access-related factors. Hispanic ethnicity remained associated with improved survival in secondary analyses, warranting further investigation.