Racial and ethnic disparities in survival among patients with early-onset primary liver cancer: A 15-year SEER analysis.

Abstract

e13749 Background: Early-onset liver cancer is increasingly recognized as a distinct clinical entity, yet population-level outcomes across racial and ethnic groups remain poorly defined. We examined disparities in stage at diagnosis and survival among patients diagnosed with primary liver cancer before age 50. Methods: Patients aged < 50 years with primary liver cancer diagnosed between 2006 and 2021 were identified from the Surveillance, Epidemiology, and End Results Program (SEER) database. Stage at diagnosis was compared by race/ethnicity using chi-square testing. Overall survival (OS) and cancer-specific survival (CSS; liver cancer death) were estimated using Kaplan–Meier methods. Multivariable Cox proportional hazards models evaluated associations between race/ethnicity and survival, adjusting for age, sex, year of diagnosis, and stage. Results: A total of 3,661 patients were included: Non-Hispanic White (35.9%), Non-Hispanic Asian or Pacific Islander (24.8%), Hispanic (24.3%), Non-Hispanic Black (13.5%), and Non-Hispanic American Indian/Alaska Native (1.2%). Overall stage distribution was localized 42.1% (n = 1,541), regional 30.0% (n = 1,097), and distant 27.9% (n = 1,023), with modest variation by race/ethnicity (p = 0.058). Median OS ranged from 9 months in Non-Hispanic Black patients to 22 months in Non-Hispanic White patients. Twelve-month OS was 43.7% in Non-Hispanic Black patients versus 63.2% in Non-Hispanic White patients; 60-month OS was 21.0% versus 34.3%, respectively. On adjusted analysis (reference: Non-Hispanic White), worse OS was observed among Non-Hispanic Black (HR 1.60, 95% CI 1.41–1.81; p < 0.001), Non-Hispanic Asian or Pacific Islander (HR 1.23, 95% CI 1.11–1.37; p < 0.001), and Hispanic patients (HR 1.23, 95% CI 1.11–1.37; p < 0.001). Similar disparities were seen for CSS, with the highest risk among Non-Hispanic Black patients (HR 2.19, 95% CI 1.84–2.60; p < 0.001). Table 1 below shows survival estimates. Conclusions: Significant racial and ethnic disparities in OS and CSS persist among patients with early-onset primary liver cancer, independent of stage at diagnosis. Kaplan–Meier survival estimates by race/ethnicity. Race/Ethnicity Median OS (mo) OS 12 mo OS 60 mo Liver Cancer Death (%) Non-Hispanic White 22 63.2% 34.3% 26.3 Non-Hispanic White 9 43.7% 21.0% 43.6 Non-Hispanic Asian/PI 12 49.5% 28.7% 46.0 Hispanic (All Races) 15 54.2% 26.5% 30.3 AI/AN 27 70.2% 29.4% 29.5