15-Year Trends in Hepatocellular Carcinoma: Epidemiology, Treatment, and Outcomes from a Hospital-Based Registry.

Background/aims: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality, particularly in Korea. We analyzed trends in the epidemiology, tumor characteristics, treatment modalities, and outcomes of HCC over the past 15 years, using a large-scale hospital-based registry.

Methods: We examined Asan Medical Center HCC registry data on 21,699 treatment-naïve patients with HCC diagnosed between 2009 and 2023. Patients were categorized into four periods based on their year of diagnosis: period 1 (2009-2011), period 2 (2012-2015), period 3 (2016-2019), and period 4 (2020-2023). HCC staging followed the Barcelona Clinic Liver Cancer (BCLC) system.

Results: The prevalence of hepatitis B virus declined continuously from 74.9% to 61.2%, with an increase in nonviral etiologies. The median age at diagnosis increased from 56 years in period 1 to 62 years in period 4, with increased comorbidities such as diabetes and hypertension. Early-stage HCC detection improved, with more patients diagnosed at BCLC stage 0 or A. The use of systemic therapy, particularly atezolizumab-bevacizumab treatment, increased from 2020, especially among patients with BCLC stage C. The 5-year survival rate improved significantly from 44.0% in period 1 to 65.2% in period 3, with overall survival rates increasing across all stages except BCLC stage D. Patients with hepatitis B virus-related HCC experienced the best outcomes. Recurrence rates after curative treatment gradually decreased over time.

Conclusions: Over the past 15 years, significant advancements in the early detection and treatment of HCC in Korea have led to improved survival outcomes. These findings underscore the need for ongoing clinical strategy evolution to address the changing landscape of HCC.