Demographic and survival characteristics of untreated hepatocellular carcinoma patients: insights into the natural history and prognostic determinants.

BACKGROUND

hepatocellular carcinoma (HCC) patients with advanced symptoms or liver failure are often ineligible for transplantation, leading to only symptom control. In addition, various factors lead to other HCC stage patients remaining in natural history.

OBJECTIVE

to describe the demographics of untreated HCC patients and to analyze survival-influencing factors.

METHODS

a single-center retrospective observational study was performed to examine HCC patients diagnosed from 2015 to 2021 who received symptom control as their primary treatment. Baseline characteristics and survival data were collected and analyzed.

RESULTS

of 685 HCC patients, 26 % (n = 181) remained in natural history, with a median age of 71 years, 82 % were male patients, 93 % with cirrhosis, and 53 % with previous decompensation. At a mean follow-up of 9.98 months, the mortality rate was 84 %. Whereas 49.8 % of patients were Barcelona Clinic Liver Cancer (BCLC) D stage, other reasons for remaining in natural history included frailty (25.4 %), comorbidities (16 %), and treatment refusal (8 %). Independent survival factors were BCLC stage, previous decompensation and diagnosis within a screening program, with 37 % of untreated patients detected through surveillance.

CONCLUSIONS

liver function, BCLC stage and functional status influence survival in natural HCC history. A significant proportion of cases (37 %) diagnosed through screening indicates the need for inclusion to avoid overdiagnosis and optimize resources.