The Impact of Socioeconomic Status on Staging, Prognosis in Hepatocellular Carcinoma

Abstract

Yongjie Zhou,1– 3,* Wen Zhang,1– 3,* Jingqin Ma,1– 3 Zihan Zhang,1– 3 Minjie Yang,1– 3 Jianjun Luo,1– 4 Zhiping Yan1– 4 1Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Shanghai Institution of Medical Imaging, Shanghai, People’s Republic of China; 3National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 4Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianjun Luo; Zhiping Yan, Department of Interventional Radiology, Zhongshan Hospital, Fudan University No. 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Email [email protected]; [email protected]: We conducted this large population-based study to evaluate the impact of socioeconomic status (SES) factors on cancer-specific survival (CSS) of patients with hepatocellular carcinoma (HCC). We further assessed the value of a novel TNM-SES staging system, which incorporated these SES factors with TNM stage on staging and prognosis.Methods: A total of 13,791 patients diagnosed with HCC from 2012 to 2016 were retrieved from one large population database. Cox proportional hazards regression model and Harrell’s concordance index (C-index) were used to identify the SES factors associated with CSS and analyze the prognostic value of TNM-SES stage. Kaplan–Meier curves and Log rank test were performed to evaluate CSS.Results: Four SES factors (marital status, insurance status, education, household income) were identified as the prognostic factors associated with CSS. The SES-2 (lower SES) stage was significantly correlated to unfavorable CSS of the patients with HCC, with a 32.0% increased risk (HR = 1.32, 95% CI (1.26– 1.39), P < 0.001), after adjusting for several confounders. The C-index of the TNM-SES stage was 0.735 (95% CI (0.729– 0.741)) which was higher than that of the TNM stage (0.718, 95% CI (0.712– 0.724)), indicating a high accuracy of prognostic prediction.Conclusion: Our comprehensive study revealed that SES was significantly associated with prognosis of patients with HCC after adjusting several confounders. The novel TNM-SES staging system which combined TNM stage and SES stage had more superior predictive value than the traditional TNM stage. Disparity on SES should receive more attention for patients with HCC in clinical management.Keywords: socioeconomic status, TNM stage, hepatocellular carcinoma SEER database

Keywords

• socioeconomic status
• tnm stage
• hepatocellular carcinoma seer database