Area Deprivation Index as a Predictor of Hepatocellular Carcinoma Prognosis: Limited Predictive Utility in an Integrated Care Model.

Abstract

Purpose: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, yet mortality outcomes in patients with HCC can vary widely. Socioeconomic disparities are known to influence health outcomes in patients with various cancers. We aim to investigate the relationship between socioeconomic status as measured by the Area Deprivation Index (ADI) and risk of mortality and Barcelona Clinic Liver Cancer (BCLC) stage at the time of diagnosis in patients with HCC.

Methods: A retrospective cross-sectional study of patients treated for HCC at an academic liver center between January 1, 2016, and December 31, 2020. The primary outcome was time to cause-specific death. The secondary outcome was BCLC stage at the time of HCC diagnosis.

Results: A total of 980 patients (median age 66 years; interquartile range 61-72) were included. ADI was not a significant predictor of mortality across all ADI quintiles. Severity of HCC at diagnosis was associated with increasing deprivation at the state level ADI (P < 0.5 at all quintiles) but not the national ADI level. Advanced BCLC stage (C and D) was significantly associated with cause-specific death in patients with HCC in both models (hazard ratio, 1.94, 95% CI, 1.44-2.62; P < 0.001; hazard ratio, 1.94; 95% CI, 1.44-2.61; P < 0.001).

Conclusion: In patients with HCC treated at an academic liver center, ADI was associated with the severity of cancer at HCC diagnosis; however, mortality risk remained consistent across all ADI quintiles. Access to centers that provide coordinated, multidisciplinary HCC care may help mitigate the impact of socioeconomic disparities on HCC mortality.