Demographic and socioeconomic disparities in access to curative-intent surgery for thymic carcinoma: A population based study.

Thymic carcinoma is a rare, aggressive thoracic malignancy in which surgery is the only potentially curative therapy. National inequities in surgical evaluation and treatment access remain poorly defined. We performed the largest population-based analysis to evaluate demographic and socioeconomic disparities in stage presentation and curative-intent surgery. SEER (2010-2022) was queried for adults with histologically confirmed thymic carcinoma (ICD-O-3: 8586/3). Variables included age, sex, race/ethnicity, median household income, rural-urban classification, stage (Derived EOD 2018), surgery, chemotherapy, radiation, and “Reason for No Cancer-Directed Surgery.” “Surgery not recommended” was used as a proxy for clinical inoperability or limited access to surgical evaluation. Associations were assessed using χ² and multivariable logistic regression, adjusting for age, sex, income, rurality, and stage group. Survival was evaluated using observed survival months. Among 1,009 patients, the cohort was 62% male and racially diverse (White 51%, Black 17%, Asian/Pacific Islander 16%, Hispanic 15%). Stage was undocumented in 66%. Among staged cases, metastatic disease predominated (18%); early-stage (I-II) disease comprised 10%. Surgery was performed in 54%, while 41% had surgery “not recommended.” Early-stage patients underwent surgery in 87% of cases versus 33% of metastatic cases (p < 0.001). Marked racial disparities were noted: surgery “not recommended” among Black (53.5%), Hispanic (45.7%), Asian/Pacific Islander (41.1%), and White (42.9%) patients. After adjustment, Black patients had significantly higher odds of surgery “not recommended” versus White patients (OR 1.61; 95% CI 1.11 - 2.35; p = 0.01). Advanced and unknown stage strongly predicted surgery not being recommended (p < 0.001). Treatment delays >90 days occurred more frequently in non-metropolitan counties (8.8% vs 4.6%). Median survival was markedly longer for patients who received surgery compared with those for whom surgery was not recommended (45 vs 15 months). Substantial racial and socioeconomic inequities limit access to curative-intent surgery for thymic carcinoma in the United States. Black patients experienced significantly higher adjusted odds of surgery being deemed “not recommended,” independent of stage, income, and rurality. High rates of missing stage documentation and prolonged treatment delays in non-metropolitan regions further hinder equitable care delivery. These findings highlight urgent needs for standardized staging, equitable referral pathways to thoracic surgical oncology, and system-level interventions to improve access to curative treatment for this rare malignancy.