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

Purpose: We conducted this large population-based study to evaluate the impact of socioeconomic status (SES) factors on cancerspecific 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 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 TNMSES 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.