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

This retrospective cohort study analyzed administrative health data from Ontario, Canada, to evaluate the incidence, treatment patterns, and survival outcomes of patients diagnosed with hepatocellular carcinoma (HCC) between 2004 and 2021. As the most common primary liver cancer, HCC requires complex, multidisciplinary care, including liver resection or transplantation, which are often centralized in specialized urban centers. The researchers sought to determine if these requirements create regional inequities in access and patient outcomes across Ontario’s Local Health Integration Networks (LHINs).

The study identified 18,494 patients with a first diagnosis of HCC. Metabolic-associated steatotic liver disease (MASLD) was the leading cause of HCC (55.1%). The researchers found that curative-intent surgical treatments—liver resection and transplantation—were disproportionately performed in urban centers. Specifically, the Central Ontario regions (including Toronto Central) exhibited the highest rates of surgical intervention and the best overall and disease-specific survival rates. Conversely, patients in remote and rural regions, such as the North West and South West LHINs, experienced significantly lower survival rates and reduced access to surgical management.

These findings highlight a clear "urban-rural divide" in the management of a highly complex cancer. The observed survival disparities suggest that systemic factors, such as distance to specialized centers and regional variations in care pathways, significantly impact patient prognosis. The results underscore an urgent need for provincial health authorities to improve the coordination of care, enhance access to specialized surgical services for patients in remote areas, and standardize HCC management protocols across all regions to reduce these inequities.