Updates in Characteristics and Survival Rates of Hepatocellular Carcinoma in a Nationwide Cohort of Real-World US Patients, 2003–2021

Background & Aim: Causes of hepatocellular carcinoma (HCC) may change as treatments become available for some liver diseases. We examined the distribution of HCC cause and survival of a nationwide cohort of insured patients. Methods: Optum’s de-identified Clinformatics ® Data Mart Database (CDM), 2003– 2021. Results: A total of 34707 patients with HCC were included: mean age: 68.3± 11.6 years, 61% male, 62% Caucasian, 74% cirrhosis. Non-alcoholic fatty liver disease (NAFLD) was the most common etiology (38.9%), then hepatitis C virus (HCV) (25.3%), cryptogenic (18.0%), alcohol-associated liver disease (9.4%), other liver diseases (5.8%) and hepatitis B virus (HBV) at 2.6%. NAFLD patients were the oldest (mean age 71.1± 11.2) and had the highest Charlson Comorbidity Index (CCI) (mean 10.5± 3.9), while HCV were the youngest (mean age 64.2± 9.2 years) and HBV had the lowest CCI (mean 7.2± 4.4) (both P < 0.0001). The overall 5-year survival was 18.8% (95% CI 18.2– 19.3) but was lower in the recent 2014– 2021 period vs 2003– 2013 (18.1% vs 19.5%, P =0.003). The 2014– 2021 cohort (inclusive of HCV treatment advances) was significantly older, with more females, fewer Caucasians, more African Americans, more Hispanics, fewer Asians, more cirrhosis, more NAFLD, and higher CCI (all P < 0.001). On multivariable analysis, males (aHR: 1.13), Caucasians (aHR: 1.46), African Americans (aHR: 1.53) and Hispanics (aHR: 1.28) vs Asians, 2014– 2021 (vs 2003– 2013) cohort (aHR: 1.12), NAFLD (aHR: 1.14) or cryptogenic liver disease (aHR: 1.45) were associated with increased mortality (all P < 0.001). Conclusion: HCC patients in more recent time 2014– 2021 were more likely to be older, more likely to have nonviral etiology, and had worse survival compared to those from 2003 to 2013. Keywords: ethnic disparities, NAFLD, nonviral, epidemiology