Evolving epidemiology of HCC in Spain

Abstract

Etiology; Liver cancer; Surveillance

Etiología; Cáncer de hígado; Vigilancia

Etiologia; Càncer de fetge; Vigilància

Background & Aims The epidemiological landscape of hepatocellular carcinoma (HCC) in Europe is evolving. This study aims to provide an updated description of the current epidemiology of liver cancer in Spain. Methods This multicenter prospective study collected demographic and clinical data on primary liver cancer between October 2022 and January 2023. We conducted descriptive and comparative analyses with data collected in 2008 and 2014. Results Of the 767 cases of primary liver cancer collected from 52 centers, 91% were diagnosed as HCC. The majority of patients were male (83.3%), average age 68 years, 80.7% had cirrhosis. The primary causes were alcohol (29.9% alone, 55% combined with other etiologies), liver disease related to metabolic syndrome (LDrMS, 23%) and hepatitis C (17.3%). Treatments included ablation (15.7%), systemic therapy (14.7%), and chemoembolization (14.6%). Data from 29 centers (n = 1,351) across three registries revealed a significant increase in LDrMS (from 4.9% to 24%) and HCC in non-cirrhotic livers (from 4.2% to 7.9%). Meanwhile, hepatitis C decreased sharply (from 43% to 17.5%). Alcohol-related cases remained stable. There was a slight increase in male patients and hypertension, diabetes, and obesity. Patients with cirrhosis diagnosed outside of screening programs presented with larger tumors and more advanced disease. This led to fewer evaluations for curative treatments. Conclusions Alcohol accounts for 30% of HCC cases and is the main etiology. The registry shows a decrease in hepatitis C-related HCC, an increase in LDrMS and HCC in non-cirrhotic livers. Surveillance was implemented in ∼80% of the recommended population. There is a need for improved screening and prevention strategies, particularly for alcohol abuse and LDrMS, to enhance HCC management. Impact and implications Our study showcases the involvement of numerous reference centers across Spain and examines over 1,300 patients to track the changing epidemiology of hepatocellular carcinoma (HCC) over 14 years. In patients with known liver cirrhosis, more than 80% of HCC diagnoses were made through screening leading to early-stage identification and curative treatment opportunities. Notably, there has been a shift in HCC etiology within the registries from hepatitis C to liver disease related to metabolic syndrome, with an increase in cases without cirrhosis. Findings indicate a need for the prevention and early detection of HCC, particularly focusing on alcohol and liver disease related to metabolic syndrome, along with greater involvement of health authorities, to improve the participation of at-risk patients in screening programs.

The Spanish Association for the Study of the Liver (AEEH) has supported the design of the database in the online digital platform (REDCap®) and the storage in an electronic file (https://aeeh.es/politica-de-privacidad/). Elena Avanzas, Ph.D, expert medical writer has reviewed all the content to ensure that the grammar and style sound natural in British English. BM received competitive grants from Instituto de Salud Carlos III (grant numbers PI18/00961 and PI21/00714) cofounded by the EU and a research grant from Laboratorios Viñas S.L. MR received grant support from Instituto de Salud Carlos III (PI18/0358 and PI22/01427), from Centro de Investigación Biomédica en Red - CIBER (Immune4Al, S2300092_3) and from the Spanish Association Against Cancer (AECC, PRYCO234831).