Article
Author: Hernáez-Alsina, Tánia ; Sala, Margarita ; Peñas, Irene ; Perelló, Christie ; Rodríguez-Lope, Carlos ; Cortés-García, Luís ; Fernández-López, Alexia María ; Ferrer, María Teresa ; Díaz-Bethencourt, Dácil ; Vallejo-Senra, Nicolau ; Rodríguez, Manuel ; Chiminazzo, Valentina ; Llamoza-Torres, Camilo Julio ; Macías-Rodríguez, Manuel Alberto ; Roget, Mercè ; Matilla, Ana María ; Delgado, Manuel ; Vergara, Mercedes ; Hernández-Guerra, Manuel ; Aracil, Carles ; Varela, María ; Díaz-González, Álvaro ; Fernández-Bermejo, Miguel ; Morillas, María Julia ; Valer López-Fando, María Paz ; Bustamante, Javier ; Gómez-Rubio, Mariano ; Cuyás, Berta ; Molina, Esther ; Guiberteau, Ana ; Giraldez, Álvaro ; Lázaro, María ; Campos, Marta ; Guerrero, Marta ; Montoliu, Silvia ; González-Santiago, Jesús Manuel ; Reig, María ; Olmo, Javier Fuentes ; Cachero, Alba ; Gacho, Pilar Conde ; Fernández-Marcos, Cristina ; Lué, Alberto ; Urquijo Ponce, Juan José ; Barrio, Mónica Llorente ; Serra, Isabel ; Castro, Raisa Quiñones ; Montero, José Luís ; Coll, Susana ; Unceta, Paloma Rendón ; Serra, Hernán Andreu ; Gutiérrez-García, María Luisa ; Iñarrairaegui, Mercedes ; Sánchez, Araceli García ; Ramos, Irina Calvo ; Pascual, Sonia ; Olmedo, Susana Rebolledo ; Vázquez-Rodríguez, Sergio ; Delgado, Carolina ; Guerrero, Antonio ; Mínguez, Beatriz ; Sogbe, Miguel ; Rifà, Raimon ; Lledó, José Luis ; Rota Roca, Maria Rosa ; Clos, Ariadna ; Romero-Gutiérrez, Marta ; Segarra, José Xavier ; Pacheco Del Río, Gemma ; Rodríguez-González, María Milagros ; Bermúdez-Ramos, María
Background & AimsThe 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.MethodsThis 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.ResultsOf 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.ConclusionsAlcohol 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 implicationsOur 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.