S2625 Disparities in Fibrosis Staging Among Cirrhotic Patients with HCC: Native American and Hispanic Populations Face the Steepest Gaps

Introduction: Despite strong evidence that regular fibrosis assessment improves early HCC detection and survival, staging tools like Fibroscan and liver biopsy remain underused in chronic liver disease. Prior studies have documented disparities in HCC surveillance by race and insurance status, but few have examined whether rates of fibrosis staging and risk stratification in Native American and Hispanic patients, who face disproportionate metabolic risk and mortality. We aimed to evaluate disparities in pre-diagnostic fibrosis staging and functional status among cirrhotic HCC patients in a diverse Southwestern cohort. Methods: We retrospectively analyzed 260 patients with confirmed HCC treated at the University of New Mexico Comprehensive Cancer Center (2015–2023). Among 228 patients with a prior diagnosis of cirrhosis and HCC, we evaluated use of liver biopsy and Fibroscan prior to the HCC diagnosis. A metabolic dysfunction associated steatotic liver disease (MASLD) phenotype was defined by the presence of ≥2 of: obesity, type 2 diabetes, and dyslipidemia. We also compared AFP, Fib-4, albumin, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores across Hispanic (n = 94), Native American (n = 31), and non-Hispanic White (n = 103) cirrhotic patients using ANOVA. Results: MASLD was most prevalent among Native American patients (54.8%), followed by Hispanic (30.2%) and non-Hispanic White patients (25.3%). Despite this, Native American patients had the lowest rate of liver biopsy (3.2%) and no documented Fibroscan evaluations (0.0%). Hispanic patients similarly had no Fibroscan use (0.0%) and modest biopsy utilization (6.6%). Non-Hispanic White patients had slightly higher use of biopsy (5.5%) and Fibroscan (1.1%). ECOG performance status differed significantly across groups (P = 0.004), with Native American and Hispanic patients more likely to present with ECOG ≥2. No significant differences were observed in AFP (P = 0.517), Fib-4 (P = 0.638), or albumin (P = 0.495). Conclusion: In this cirrhotic HCC cohort, Native American and Hispanic patients not only exhibited the highest rates of MASLD, but also the lowest use of biopsy and Fibroscan. These disparities were accompanied by significantly worse functional status at diagnosis. Improved access to fibrosis staging and structured surveillance is urgently needed to reduce inequities in risk stratification and liver disease outcomes.