Hepatocellular Carcinoma at a Center of Clinical Excellence in Colombia: A Real-World Cohort Study of Clinical Characteristics, Treatment Trajectories, and Survival.
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PURPOSE: Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide. In middle-income settings, fragmentation of care may delay diagnosis and limit access to timely treatment. This study aimed to describe the sociodemographic and clinical characteristics, treatment patterns, and overall survival of patients with HCC managed at a Center of Clinical Excellence (CCE). PATIENTS AND METHODS: We conducted a retrospective descriptive cohort study of adults (≥18 years) with HCC managed at a CCE between September 2022 and December 2025. Baseline variables included etiology, comorbidities, Child-Pugh class, Model for End-Stage Liver Disease (MELD) score, Barcelona Clinic Liver Cancer (BCLC) stage, and alpha-fetoprotein (AFP) levels. Treatment strategies and clinical course, including stage migration, liver transplantation, and death, were described. Overall survival was estimated using the Kaplan-Meier method. RESULTS: A total of 134 patients were included. Median age was 67.93 years (IQR 63.12-72.59) and 61.19% were men. The most common underlying etiology was metabolic dysfunction-associated steatotic liver disease (MASLD) (34.38%). Most patients were diagnosed at early BCLC stages 0/A (64.18%; n = 86). Ablation and transarterial chemoembolization were the most frequently used treatments, and liver transplantation was performed in 9.70% of patients. After a median follow-up of 21 months, median overall survival was not reached; estimated survival was 93.8% at 1 year and 80.0% at 3 years. CONCLUSION: In this retrospective cohort managed at a CCE, MASLD was the most frequent underlying etiology, and patients were diagnosed at early stages BCLC stages 0/A. Treatment patterns were dominated by locoregional therapies, and median overall survival was not reached during the available follow-up period. These findings provide real-world data on HCC care in a middle-income setting and highlight the clinical relevance of describing treatment trajectories and survival within structured multidisciplinary care programs.