This study showed that female patients and those diagnosed with ascites or multinodular HCC were more likely to have advanced untreated HCC ( 10). Similarly, an analysis of an Italian liver cancer database that utilized data from 21 medical institutions showed that 11.7% of untreated patients had a median OS of 9 months ( 10). This study also identified a model for end-stage liver disease (MELD) scores and alpha-fetoprotein (AFP) levels as prognostic factors in untreated patients, independent of the BCLC stage ( 9). In an analysis of 128 hospitals by the United States (US) Veterans Administration, 24% of patients with HCC were untreated, and the median overall survival (OS) time was 3.6 months. Further research regarding clinical variables is necessary to determine the natural course of untreated HCC. However, this study employed an administrative claims dataset that lacked data pertaining to important clinical variables, such as performance status, Barcelona Clinic Liver Cancer (BCLC) stage, and tumor markers ( 8).
In this study, the risk of mortality was higher for untreated patients in every subgroup, and the fully-adjusted hazard ratio (HR) for all-cause mortality comparing untreated to treated patients was 3.11 (95% confidence interval, 3.04–3.18) ( 8). According to the results of a National Health Insurance Service database study in Korea, 27.6% of patients with HCC were left untreated between 20. A recent Korean study has addressed this issue. To date, a considerable number of patients with HCC have remained untreated. Recent advances in immune-based therapies have enabled survival in patients with advanced HCC ( 6, 7). Despite advances in the diagnosis and treatment of HCC, prognoses following tumor development remain poor, with 5-year survival rates of 33.6% in the Republic of Korea and 18.1% in other Asian countries ( 3). Among patients in Korea, hepatitis B virus (HBV) infection is the leading cause of HCC (65%), followed by hepatitis C virus (HCV) (10%), and other causes (25%) ( 3– 5). The average crude incidence rate of HCC in Korea over the past 10 years was 22.4/100,000 person-years ( 3). Hepatocellular carcinoma (HCC) accounts for 75–85% of primary liver cancers and is a major healthcare issue ( 1, 2). Primary liver cancer is the sixth most commonly diagnosed cancer and the third leading cause of cancer-related deaths worldwide ( 1).
In untreated patients with HCC, advanced stage BCLC, serum AFP level ≥1,000 ng/mL, and MELD score ≥10 were significantly associated with overall survival. Multivariate Cox regression analysis demonstrated that BCLC stage D (hazard ratio, 4.282 P < 0.001), model for end-stage liver disease (MELD) score ≥10 (HR, 1.484 P < 0.001), and serum alpha-fetoprotein (AFP) level ≥1,000 ng/mL (HR, 1.506 P < 0.001) were associated with poor survival outcomes in patients with untreated HCC. The median survival times for each Barcelona Clinic Liver Cancer (BCLC) stage were as follows: 31.0 months for stage 0/A (n = 123), 10.0 months for stage B (n = 96), 3.0 months for stage C (n = 599), and 1.0 month for stage D (n = 227). Most untreated patients (94.2%) died during the observation period. Results and discussion: The mean age of the untreated patients at HCC diagnosis was 59.6 years, and 52.1% of patients had hepatitis B. A Cox proportional regression model was used to identify the variables associated with patient survival. Thereafter, we analyzed the clinical characteristics of patients who survived for <12 or ≥12 months. Methods: We identified 1,045 patients with HCC who did not receive HCC treatment and were registered in the Korean Primary Liver Cancer Registry between 20, and were followed-up up to December 2018. Introduction: In this study, we examined the natural course of untreated hepatocellular carcinoma (HCC) and identified predictors of survival in an area where hepatitis B is the predominant cause of HCC.
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