Immigrant Adults With Hepatocellular Carcinoma May Have Higher Survival Rates Than Those Born in the United States

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Immigrant adult patients who have hepatocellular carcinoma and reside in the United States may have higher rates of survival compared with those who have the disease and were born in the United States, according to a new study published by Zhou et al in the Journal of the National Cancer Institute. The findings revealed a previously unrecognized disparity in survival after a diagnosis of hepatocellular carcinoma across all major racial/ethnic groups and suggested that nativity may be a predictor of overall survival for adult patients with the disease.


Hepatocellular carcinoma, the most common form of hepatic cancer, contributes to more than 27,000 deaths per year in the United States. Hepatocellular carcinoma is often a cancer type with poor prognosis and is common among immigrants—though rising in those born in the United States.

California has a high concentration of immigrants, representing about 25% of the foreign-born population nationwide. Immigrants comprise a significant proportion of those diagnosed with hepatocellular carcinoma in the United States. Although it has been shown that birthplace—or nativity—can impact the incidence and risk factors for hepatocellular carcinoma, little was known about its influence on overall survival after diagnosis.

Study Methods and Results 

In the new study, investigators identified 51,533 adult patients who had hepatocellular carcinoma—20,400 of whom were born in foreign countries—using nativity data from the California Cancer Registry between 1988 and 2017. The investigators then categorized the cases by patients who were either born in the United States or any other country and stratified them by four mutually exclusive race and ethnicity groups: Hispanic, non-Hispanic White, non-Hispanic Black, and non-Hispanic Asian/Pacific Islander.

The investigators discovered that despite 40% of all cases of hepatocellular carcinoma being among those born outside of the United States, the 5-year survival rate was higher among immigrant adult patients compared with patients with hepatocellular carcinoma who were born in the United States across all four major race and ethnicity groups. Further, among immigrant adult patients, a lower rate of mortality was observed in those from Central and South America compared with those from Mexico for the Hispanic population; those from East Asia compared with those from Southeast Asia for the Asian/Pacific Islander population; and those from East Europe and the Greater Middle East compared with those from West, South, and North Europe for the White population.


“[Hepatic] cancer is one of few cancers with increasing deaths. We identified a novel disparity by [nativity], whereby immigrants with [hepatocellular carcinoma] demonstrated better survival than their U.S.-born counterparts,” emphasized lead study author Kali Zhou, MD, Assistant Professor of Clinical Medicine at the Keck School of Medicine at the University of Southern California (USC) and a transplant hepatologist in the Cancer Epidemiology Program at the USC Norris Comprehensive Cancer Center. “This was true across different racial/ethnic groups. This finding is important as [hepatic] cancer rates are rising among U.S.-born, and understanding why immigrants have better outcomes may help us create strategies to improve the survival of those born here,” she added.

The population-based California Cancer Registry provided investigators with a unique opportunity to compare hepatocellular carcinoma survival rates by nativity separated by regions of origin within individual race and ethnicity groups. Understanding the factors contributing to better survival among immigrants may help investigators address survival disparities by identifying ways to improve outcomes for patients born in the United States.

Disclosure: The research in this study was supported by the California Department of Public Health; the Centers for Disease Control and Prevention’s National Program of Cancer Registries; and the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. For full disclosures of the study authors, visit

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