Trends in the incidence and surgical treatment of hepatocellular carcinoma in Ontario

This retrospective cohort study examined the incidence, management, and survival outcomes of hepatocellular carcinoma (HCC) in Ontario, Canada, between 2004 and 2021. Using administrative health data, researchers analyzed 18,494 patients to determine how geographic location—specifically their Local Health Integration Network (LHIN)—impacted access to curative-intent treatments like liver resection and transplantation.

The study identified metabolic-associated steatotic liver disease (MASLD) as the leading cause of HCC, accounting for over 55% of cases. While the overall incidence of HCC remained stable, there was a clear urban-rural divide in care. Surgical interventions were heavily concentrated in urban areas, particularly within the central Ontario region. Consequently, patients residing in these central areas experienced significantly higher survival rates compared to those in remote or less urbanized regions, such as the North West and South West LHINs, which recorded the lowest survival outcomes.

These findings suggest that the current model of HCC care in Ontario is characterized by regional inequities. The concentration of specialized surgical services in urban centers creates barriers for patients in rural and remote areas, likely contributing to the observed survival disparities. The authors emphasize that these differences are multifactorial, stemming from a combination of patient demographics, clinical presentation, and systemic factors. Addressing these gaps will require improved coordination and more equitable distribution of specialized liver cancer care across the province.