Year 2025 / Volume 117 / Number 7
Original
Demographic and survival characteristics of untreated hepatocellular carcinoma patients: insights into the natural history and prognostic determinants

366-373

DOI: 10.17235/reed.2025.11029/2024

Helena González-Sánchez, Andrés Castaño-García, Miriam Celada-Sendino, Pablo Flórez-Díez, Marta García-Calonge, Manuel Rodríguez, Valentina Chiminazzo, María Varela Calvo,

Abstract
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.
Lay Summary
1. The BCLC stage and previous decompensation are significant predictors of increased mortality among patients with untreated HCC. 2. Tumour progression and liver failure are the predominant causes of mortality in untreated HCC patients. 3. The presence of frailty and comorbidities inhibits treatment in nearly half of the patients, presenting a novel insight contrary to previous studies. 4. Nearly 40% of patients with untreated HCC originate from screening programmes, underscoring the need to reallocate resources towards more suitable candidates to reduce cancer mortality. 5. This contemporary cohort of untreated HCC patients provides new insights into the natural history of predominantly alcohol-related liver disease, contextualised within the availability of direct-acting antivirals for hepatitis C and emerging systemic therapies, including immunotherapy.
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González-Sánchez H, Castaño-García A, Celada-Sendino M, Flórez-Díez P, García-Calonge M, Rodríguez M, et all. Demographic and survival characteristics of untreated hepatocellular carcinoma patients: insights into the natural history and prognostic determinants. 11029/2024


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Publication history

Received: 16/12/2024

Accepted: 06/02/2025

Online First: 19/02/2025

Published: 08/07/2025

Article Online First time: 65 days

Article editing time: 204 days


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The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
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