S2914 Geographic Disparities in Surgical Treatment Delay for Non-Metastatic Liver Cancer: Regional Patterns, Temporal Trends, and Mortality Impact

Introduction: Surgical resection is the primary curative treatment for non-metastatic liver cancer, but geographic disparities may delay care, potentially worsening outcomes. Understanding the patterns and impacts of these disparities is crucial for ensuring equitable healthcare access. Methods: This retrospective cohort study analyzed 148,190 patients with non-metastatic hepatocellular carcinoma or intrahepatic cholangiocarcinoma from the National Cancer Database (2004–2021). Surgical delays were categorized as >60 days and >90 days post-diagnosis. Multivariable logistic regression identified predictors of delays, while Cox proportional hazards models assessed delays' impact on mortality, accounting for geographic, demographic, and facility-level variables. Interaction terms were examined to evaluate temporal and regional disparities. Results: Overall, 14.88% and 10.22% of patients experienced delays >60 and >90 days, respectively. Significant geographic variation was observed, with the highest adjusted predicted probability of delay >60 days in New England (14.0%) and lowest in the Middle Atlantic (10.5%). Factors associated with increased delay included treatment at Academic/Research Programs (OR 3.41, 95% CI 2.97–3.92) and residence ≥50 miles from facilities (OR 1.37, 95% CI 1.32–1.43). Complex interactions between insurance, race, urbanicity, and regions significantly influenced delays. Over time, disparities fluctuated, notably increasing delays for White (11.0% in 2004 to 13.5% in 2021) and Black patients (9.3% to 12.6%). While delays >60 and >90 days showed poorer unadjusted survival (P < .001), adjusted models paradoxically indicated reduced mortality risks overall (HR 0.36 for >90 days delay), but regional analyses revealed significantly higher mortality risk with delays in regions like West South Central (HR 1.34). Conclusion: Geographic disparities significantly impact surgical timeliness in liver cancer treatment, exhibiting complex regional interactions with sociodemographic and facility factors and dynamic temporal trends. Unexpected survival findings likely reflect residual confounding, selection bias, or clinical nuances, highlighting the need for targeted, region-specific interventions and policies to address disparities and optimize timely, equitable care access.