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 comprehensive administrative health data, the researchers analyzed 18,494 patients to determine whether geographic location—specifically their Local Health Integration Network (LHIN)—correlated with access to curative-intent treatments like liver resection and transplantation.

The study identified a standardized HCC incidence rate of 16.8 per 100,000 people, with metabolic-associated steatotic liver disease (MASLD) emerging as the leading cause (55.1%). While curative-intent surgical treatments are the gold standard for early-stage disease, the researchers found that these interventions were disproportionately performed in urban areas. Consequently, survival rates varied significantly across the province: patients residing in central Ontario regions experienced the highest survival rates, while those in remote or rural regions faced the poorest outcomes. The authors suggest that these disparities are likely multifactorial, stemming from a combination of patient-level clinical factors and systemic barriers to accessing specialized care pathways.

Understanding these geographic inequities is critical for health system planning. The findings suggest that current care delivery models for HCC may not be equitable across Ontario. By highlighting the concentration of surgical expertise in urban centers and the resulting survival gap for rural patients, this research provides a foundation for policymakers to improve coordination and resource allocation, ensuring that patients receive timely, specialized care regardless of their place of residence.