Evolving epidemiology of HCC in Spain

• Published in: JHEP Reports
• Main Authors: Margarita Sala, Sonia Pascual, Maria Rosa Rota Roca, Ana María Matilla, Marta Campos, Manuel Delgado, María Teresa Ferrer, José Luís Montero, Jesús Manuel González-Santiago, Antonio Guerrero, Carles Aracil, Carlos Rodríguez-Lope, Marta Romero-Gutiérrez, Miguel Sogbe, Sergio Vázquez-Rodríguez, Javier Fuentes Olmo, Beatriz Mínguez, Luís Cortés-García, Nicolau Vallejo-Senra, Paloma Rendón Unceta, Ariadna Clos, Dácil Díaz-Bethencourt, Araceli García Sánchez, Raisa Quiñones Castro, Javier Bustamante, Christie Perelló, Juan José Urquijo Ponce, Hernán Andreu Serra, Camilo Julio Llamoza-Torres, Silvia Montoliu, Cristina Fernández-Marcos, Ana Guiberteau, Manuel Hernández-Guerra, Mercedes Vergara, Alexia María Fernández-López, María Paz Valer López-Fando, María Luisa Gutiérrez-García, Tánia Hernáez-Alsina, Susana Coll, Berta Cuyás, María Julia Morillas, Susana Rebolledo Olmedo, Miguel Fernández-Bermejo, Mercè Roget, Irina Calvo Ramos, Gemma Pacheco del Río, Raimon Rifà, Pilar Conde Gacho, Mónica Llorente Barrio, Mariano Gómez-Rubio, Irene Peñas, Isabel Serra, Alba Cachero, María Reig, Álvaro Giraldez, Marta Guerrero, José Xavier Segarra, José Luis Lledó, Álvaro Díaz-González, Carolina Delgado, Mercedes Iñarrairaegui, María Milagros Rodríguez-González, María Lázaro, María Bermúdez-Ramos, Alberto Lué, Esther Molina, Manuel Alberto Macías-Rodríguez, Manuel Rodríguez, Valentina Chiminazzo, María Varela
• Format: Article
• Language: English
• Published: Elsevier 2025-05-01
• Subjects: Liver cancer; Surveillance; Etiology; Treatment
• Online Access: http://www.sciencedirect.com/science/article/pii/S2589555925000126

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.