低社会经济地位（SES）的早期肝细胞癌（HCC）患者往往较少接受程序性治疗，并且存活期较短。我们对SES基础的存活差异中治疗相关差异与其他因果路径的影响程度知之甚少。本研究旨在估计在I-II期HCC患者中，SES基础的存活差异中由治疗和医疗机构相关因素介导的比例。我们使用全国癌症数据库对2008-2016年间年龄在18-75岁，诊断为I-II期HCC的患者进行了分析。使用逆向几率加权介导分析法计算了三个介导因素（手术类型、医疗机构规模和医疗机构提供的程序性干预）介导的比例。进行了分析交叉，以确定治疗差异是否在黑人和西班牙裔患者的存活差异中起到更大的作用。在46,003名患者中，15.0%的患者处于低SES，71.6%为中等SES，13.4%为高SES。高、中、低SES患者的五年总体生存率分别为46.9%、39.9%和35.7%。对于低SES和中等SES患者而言，手术类型中介的总体生存差异比例分别为45.9%（95%置信区间[CI] 31.1-60.7%）和36.7%（95% CI 25.7-47.7%），高于两个医疗机构水平的介导因素。对于低-中SES的黑人（46.6-48.2%）和西班牙裔患者（92.9-93.7%），手术类型介导的存活差异比例较白人患者（29.5-29.7%）更大。基于SES的程序性干预差异在存活差异中起到了较大的介导作用，尤其是在黑人和西班牙裔患者中。应推行旨在减弱这些治疗差异的措施。© 2023年，外科肿瘤学会。

Low socioeconomic status (SES) patients with early-stage hepatocellular carcinoma (HCC) receive procedural treatments less often and have shorter survival. Little is known about the extent to which these survival disparities result from treatment-related disparities versus other causal pathways. We aimed to estimate the proportion of SES-based survival disparities that are mediated by treatment- and facility-related factors among patients with stage I-II HCC.We analyzed patients aged 18-75 years diagnosed with stage I-II HCC in 2008-2016 using the National Cancer Database. Inverse odds weighting mediation analysis was used to calculate the proportion mediated by three mediators: procedure type, facility volume, and facility procedural interventions offered. Intersectional analyses were performed to determine whether treatment disparities played a larger role in survival disparities among Black and Hispanic patients.Among 46,003 patients, 15.0% had low SES, 71.6% had middle SES, and 13.4% had high SES. Five-year overall survival was 46.9%, 39.9%, and 35.7% among high, middle, and low SES patients, respectively. Procedure type mediated 45.9% (95% confidence interval [CI] 31.1-60.7%) and 36.7% (95% CI 25.7-47.7%) of overall survival disparities for low and middle SES patients, respectively, which was more than was mediated by the two facility-level mediators. Procedure type mediated a larger proportion of survival disparities among low-middle SES Black (46.6-48.2%) and Hispanic patients (92.9-93.7%) than in White patients (29.5-29.7%).SES-based disparities in use of procedural interventions mediate a large proportion of survival disparities, particularly among Black and Hispanic patients. Initiatives aimed at attenuating these treatment disparities should be pursued.© 2023. Society of Surgical Oncology.