Introduction Hepatocellular carcinoma (HCC) outcomes are critically dependent on stage at diagnosis, with early-stage disease offering opportunities for curative therapies such as resection, ablation, or transplantation. Despite advances in imaging, surveillance strategies, and treatment modalities, a substantial proportion of patients continue to be diagnosed at advanced stages.
Introduction
Hepatocellular carcinoma (HCC) outcomes are critically dependent on stage at diagnosis, with early-stage disease offering opportunities for curative therapies such as resection, ablation, or transplantation. Despite advances in imaging, surveillance strategies, and treatment modalities, a substantial proportion of patients continue to be diagnosed at advanced stages. This reflects persistent gaps in cirrhosis recognition, suboptimal screening uptake, and healthcare access disparities. Understanding real-world patterns of HCC diagnosis, staging, treatment, and survival is essential to guide quality improvement in liver care.
Problem Statement
There is limited contemporary, system-level data evaluating how patients with HCC are diagnosed and managed across large healthcare systems. Key uncertainties remain regarding the proportion of patients diagnosed early, factors influencing treatment access, and determinants of survival—particularly in relation to screening and engagement in liver care.
Summary
In this Veterans Health Administration cohort (2023), only 56.7% had known cirrhosis prior to HCC diagnosis, highlighting under-recognition of at-risk patients. Early-stage diagnosis (T1/T2) occurred in ~60% but was strongly associated with prior cirrhosis recognition and screening, with 86.3% of screen-detected cases diagnosed early. Most patients (75.8%) received treatment, with Y-90 radioembolization being the most common. Survival was significantly better in patients diagnosed early, those undergoing screening, with preserved liver function, and those receiving curative therapies.
This study underscores a central message for clinical practice: screening and structured liver care engagement are the most powerful modifiable factors to improve HCC outcomes, emphasizing the need for system-level interventions to close existing care gaps.
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