Prognosis after resection or ablation of hepatocellular carcinoma: real-world evidence from a Danish population-based cohort

OBJECTIVES: The real-world clinical course of hepatocellular carcinoma (HCC) remains poorly understood. We aimed to describe the prognosis of Danish patients with HCC treated with curative-intent resection or ablation strategies. METHODS: This was a population-based, historical cohort study of all patients with HCC within two Danish regions (population 2 million). Information was extracted from patients' medical records. Patients diagnosed with HCC in 2013-2023 and treated first-line with resection/ablation with curative intent were included. We used multistate models, competing risk analyses, and cause-specific Cox models to describe the clinical course and examine risk factors for recurrence. The risk of early recurrence (within 2 years) was 55% (95% CI 50-61) and similar for resection- and ablation-treated patients. Five years post resection/ablation, 10% of patients remained alive and recurrence-free. Alpha-fetoprotein was a strong predictor of recurrence, and a high Child-Pugh score and high comorbidity burden were predictors of death without recurrence. The 10-year probability of receiving systemic treatment was 24%. For the total cohort, the median survival time was 3.5 years (IQR 1.5-5.9) and the median recurrence-free survival time was 1.1 years (IQR 0.5-2.4). CONCLUSION: This population-based real-world study demonstrated that current curative-intent treatment strategies for early HCC are insufficient for long-term disease control, and that we need more effective management and follow-up of patients with HCC.