Journal: Annals of surgical oncology
Study focus
This study evaluated which patients with colorectal cancer liver metastases (CRLM) receive potentially curative local liver treatments (hepatectomy or ablation) and how receipt of these interventions varies by race/ethnicity, socioeconomic factors, insurance, and treatment setting.
Data and methods
- Data source: National Cancer Database, 2011–2021
- Population: 72,273 patients with CRLM
- Outcome: Receipt of liver-directed intervention (hepatectomy or ablation) vs no local liver intervention
- Analysis: Multivariable modeling to adjust for patient- and center-level factors
Key findings
- Utilization: Only 18.0% of patients with CRLM underwent liver resection or ablation.
- Race/ethnicity:
- Non-Hispanic Black patients: lower odds of receiving liver intervention vs non-Hispanic White (OR 0.83, 95% CI 0.78–0.88).
- Hispanic/Latino patients: also less likely to receive intervention vs non-Hispanic White (OR 0.92, 95% CI 0.85–0.99).
- Treatment setting:
- Care at academic programs was strongly associated with higher intervention rates vs community cancer programs (OR 2.24, 95% CI 2.06–2.43).
- Insurance status (vs uninsured):
- Private insurance: OR 2.07 (95% CI 1.86–2.30)
- Medicaid: OR 1.40 (95% CI 1.24–1.58)
- Medicare: OR 1.81 (95% CI 1.61–2.03)
- Other government insurance: OR 2.20 (95% CI 1.81–2.66)
- Income:
- Patients in the highest income quartile had higher odds of intervention than those in the lowest quartile (OR 1.18, 95% CI 1.10–1.27).
- Travel distance:
- Patients receiving liver interventions traveled farther than those managed non-surgically (p<0.001).
Interpretation and implications for practice
Local liver therapy for CRLM—critical for potential cure in appropriate candidates—is underutilized overall and disproportionately accessible to wealthier, insured, and non-Hispanic White patients treated at academic centers. The findings highlight systemic disparities in access to advanced liver-directed care and underscore the need for:
- Better referral pathways to high-volume/academic centers,
- Targeted efforts to improve access for uninsured and low-income patients, and
- Focused interventions to address racial and ethnic inequities in surgical and ablative management of CRLM.