Real-World Epidemiology, Treatment Patterns, and Outcomes of Hepatocellular Carcinoma in Brazil: A Multicenter Retrospective Study.

Abstract

The treatment landscape of hepatocellular carcinoma (HCC) has evolved substantially; however, limited access to novel therapies and regional epidemiologic differences lead to heterogeneous real-world treatment patterns worldwide. The purpose of this study was to describe the epidemiology, treatment patterns, and outcomes of patients diagnosed with HCC in Brazil between 2017 and 2022. This was a national, multicenter, retrospective, real-world observational study including patients with confirmed HCC and first diagnosis between 2017 and 2022. Data were collected from 10 centers across four geographic regions in Brazil. Of 318 patients screened, 303 were included: 107 with early-stage disease Barcelona Clinic Liver Cancer (BCLC 0-B) and 196 with advanced-stage disease (BCLC C-D). The median age was 71 years (64-77); 77.6% were men, 48.5% self-identified as Black or mixed race, and 62% were treated in public institutions. Main etiologies were hepatitis C virus (35%), alcohol-related liver disease (27.4%), hepatitis B virus (7.6%), and metabolic dysfunction-associated steatotic liver disease (MASLD; 10.9%). Among early-stage patients, 57% was classified as Child-Pugh A and 85% received local therapy (26.7% surgery or ablation; 58.8% transarterial chemoembolization [TACE]/Drug-Eluting Bead-TACE). The median progression-free survival was 10.4 months (95% CI, 8.7 to 15.7), and the median overall survival (OS) was 19.6 months (95% CI, 15.9 to 29.0). In advanced disease, 41% was classified as Child-Pugh A, portal vein thrombosis was present in 39.8%, and extrahepatic disease was present in 42.9%. Systemic therapy was administered to 48.5% of patients. The median OS was 8 months with systemic therapy versus 3 months without treatment. In this Brazilian real-world cohort, hepatitis C and alcohol were the predominant etiologies, whereas MASLD accounted for 10% of cases. Although most localized cases received locoregional therapy with outcomes consistent with the literature, access to modern systemic treatments for advanced disease remained limited.