Background: Hepatocellular carcinoma (HCC) has the highest incidence and mortality in Asia. Though the incidence in the US has been decreasing, Asian Americans (AA) continues to face a significant burden from HCC. We aim to examine disparities in patients with non-metastatic HCC in receiving surgery and outcome, with an emphasis on AA ethnic subgroups. Methods: Patients diagnosed with localized or regional HCC were extracted from SEER 17 (1989-2019). Race was categorized into non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, Alaska Indian/American Native (AI/AN) and 12 AA subgroups. Multivariate logistic regression and Cox regression models were used to calculate the odds of receiving surgery and overall mortality, respectively. Results: Among the total of 71,552 patients with non-metastatic HCC (Table), after accounting for multiple comparison, Chinese and Japanese were significantly more likely to receive surgery while NHB, Hispanics, AI/AN, and Laotians were less likely to receive surgery compared to NHWs. Among those who received surgery, Chinese, Korean and other APIs had improved survival while NHB and Samoan had significantly increased overall mortality than NHWs. Conclusions: Although prior studies have combined AAs into a single group, considerable heterogeneity exists amongst AA ethnic subgroups. Further studies are needed to evaluate if socioeconomic status, cultural background, health behaviors, tumor biology, and health care access may underline these disparities and to help identify potential inventions to improve outcomes in this growing but heterogenous population.

^a Model adjusted for age, sex, income, living area (rural vs urban), year of diagnosis, stage, tumor size, lymph node involvement.