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