Clinical trends in hepatocellular carcinoma from 2005 to 2019 with a focus on metabolic diseases: a German nationwide study.

INTRODUCTION

Hepatocellular carcinoma (HCC) is the leading primary liver cancer and is associated with a high mortality rate. Liver cirrhosis represents the main risk factor for HCC; however, its underlying etiologies have shifted over the last decade. This German population-based study investigated the effects of the changing trends on etiologies of HCC hospital admissions.

METHODS

We analyzed 369 369 HCC-admissions in German hospitals from 2005 to 2019 based on the diagnosis-related groups via German International Classification of Diseases and Operation and Procedure key System codes. Temporal trends and associations were assessed using linear and multivariate logistic regression.

RESULTS

HCC admissions increased significantly by 21.8%, from 19 594 in 2005 to 25 899 in 2019, while the in-hospital mortality rate decreased from 13.6 to 10.8%. The most common underlying etiology was alcohol-related liver disease (ALD), accounting for 55.5% of all HCC etiologies, followed by viral hepatitis (32.3%). While admissions of patients with ALD increased by 34.5% from 4008 to 5392, viral hepatitis declined significantly from 3532 to 1580. Metabolic dysfunction-associated steatotic liver disease (MASLD) underlying for HCC represented 4.5%, but exhibited the strongest increase of 3.7-fold among all etiologies. The in-hospital mortality rate of ALD-associated HCC decreased from 15.3 to 11.6%, whereas in viral hepatitis-associated HCC, it remained more similar (11.5 vs. 11.0%). Cardiometabolic risk factors significantly increased in HCC admissions over time (P < 0.001). Furthermore, HCC admissions exhibited a greater burden of metabolic comorbidities than other malignancies.

CONCLUSIONS

This study highlights the increase in underlying ALD, MASLD, and metabolic risk factors in HCC admissions. Especially, cardiometabolic risk factors appear to play a significant role as drivers of hospital admissions in patients with HCC.