Hepatocellular carcinoma in South America: Evaluation of risk factors, demographics and therapy

Background and Aims Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. Most studies addressing the epidemiology of HCC originate from developed countries. This study reports the preliminary findings of a multinational approach to characterize HCC in South America. Methods We evaluated 1336 HCC patients seen at 14 centers in six South American countries using a retrospective study design with participating centers completing a template chart of patient characteristics. The diagnosis of HCC was made radiographically or histologically for all cases according to institutional standards. Methodology of surveillance for each center was following AASLD or EASL recommendations. Results Sixty-eight percent of individuals were male with a median age of 64 years at time of diagnosis. The most common risk factor for HCC was hepatitis C infection (HCV, 48%), followed by alcoholic cirrhosis (22%), Hepatitis B infection (HBV, 14%), and NAFLD (9%). We found that among individuals with HBV-related HCC, 38% were diagnosed before age 50. The most commonly provided therapy was Trans-arterial chemoembolization (35% of HCCs) with few individuals being considered for liver transplant (<20%). Only 47% of HCCs were diagnosed during surveillance and there was no difference in age of diagnosis between those diagnosed incidentally versus by surveillance. Nonetheless, being diagnosed during surveillance was associated with improved overall survival (p=0.01). Conclusions Our study represents the largest cohort to date reporting characteristics, and outcomes of HCC across South America. We found an important number of HCCs diagnosed outside of surveillance programs, with associated increased mortality in those patients. This article is protected by copyright. All rights reserved.