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P82. Urban-Rural Disparities in Treatment and Outcomes for Colorectal Liver Metastases in the United States: A SEER-Medicare Analysis

Friday, March 6, 2026
2:44 PM - 2:51 PM MST
Location: 105A-C
Introduction: Curative-intent resection or ablation of colorectal liver metastases (CRLM) offers the best chance for long-term survival, yet limitations in access may drive disparities in cancer care. Area-level disparity markers include socioeconomic status and rurality. Previous work has identified reduced use of liver-directed therapies and survival for regions with adverse socioeconomic conditions, whereas the impact of rurality on CRLM treatment and prognosis has not been previously studied.


Methods: The linked Surveillance, Epidemiology, and End Result (SEER)-Medicare database (2000-2020) was analyzed for patients aged 66-85 years with isolated CRLM. Urban-rural status was defined by linking patient zip code to the USDA Economic Research Service’s Rural-Urban Commuting Area codes. The impact of rurality on receipt of therapy and survival was evaluated by multivariable logistic regression and Cox survival models, respectively, while adjusting for patient and tumor characteristics. Curative-intent liver therapy included any instance of hepatectomy, ablation, or transplantation. A landmark analysis minimized immortal time bias.


Results:  A total of 34,781 patients with isolated CRLM were identified, with most residing in urban areas (n=27,225 [83.4%] compared with rural areas (n=5,416 [16.6%]). Rural populations were more likely to be white (86.7% vs. 76.6%; p< 0.01) and belong to the lowest socio-economic census tracts (Yost quintiles 1-3: 66.1% vs. 4-5 35.0%; p< 0.01). Tumor characteristics were similar between urban and rural populations. Rural residence was associated with higher odds of primary tumor resection (OR 1.13, 95% CI 1.04-1.24; p=0.01) but lower odds of systemic chemotherapy (OR 0.87, 95% CI 0.79-0.97; p< 0.01) and curative-intent liver therapy (OR 0.89, 95% CI 0.81-0.99; p=0.03). Rural residence was independently associated with worse overall survival (HR 1.10, 95% CI 1.05-1.14; p< 0.01).


Conclusions:  Despite similar tumor characteristics and higher likelihood of primary tumor resection, rural patients with CRLM were less likely to receive systemic and liver-directed therapy, and experienced worse survival. These findings highlight persistent geographic disparities in cancer care delivery and outcomes, underscoring the need for targeted interventions specific to rural CRLM populations.

Learning Objectives:

  • Identify contributors to disparities in cancer care delivery and outcomes for patients with colorectal liver metastases.
  • Understand how rural residence influences access to systemic and liver-directed therapies among patients with colorectal liver metastases.
  • Interpret survival data from rural versus urban patients with colorectal liver metastases and consider strategies to address these disparities.