Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths and remains a major burden on healthcare systems worldwide. The incidence of HCC continues to rise globally, despite preventative efforts being made. Aims: This study aimed to investigate epidemiological changes observed in the etiology and survival outcomes of HCC patients at Klinikum Klagenfurt am Wörthersee between 2012 and 2023. Methods: This was a retrospective, single-center cohort study. Two time-periods (2012–2017 and 2018–2023) were created to enable comparison between the respective intervals. IBM SPSS was used to analyze statistical data. Results: More patients were diagnosed with HCC during the second time period (n= 128,n= 148). The median age of diagnosis was 72.5 years (SD 8.6). Patients were on average 2 years younger in the second time period compared to the first (p= 0.042). Alcohol remained the leading underlying etiology of HCC and no statistically significant change was seen over time (p= 0.353). Nevertheless, a clear upward trend in the number of NASH cases was evident over time (n= 15,n= 28, respectively). Nearly half of the patient population had a normal AFP (<7 µg/L) level at the time of diagnosis (n= 116, 42.6%). The survival time for HCC patients remained similar between time periods, with a median overall survival time of 20.5 months (95% CI 16.8–24.2,p= 0.841), despite improvements in management strategies and the availability of new systemic treatments. More advanced-stage HCC cases were documented in the second period (BCLC-C,n= 23 ton= 46,p= 0.051). An increased number of HCC patients without liver cirrhosis were identified during the second time period (n= 22,n= 47, respectively,p= 0.005). NASH was the most common underlying etiology in patients without liver cirrhosis (50%) compared to alcohol use in being the primary cause in cirrhotic patients (65%,p< 0.001). Conclusion: HCC continues to be an important health concern in our society. The number of HCC patients without liver cirrhosis is steadily increasing, with NAFLD/NASH, due to underlying lifestyle diseases playing an important etiological role. Continued efforts should be made to prevent HCC and to screen at-risk population groups. Preventative strategies and screening techniques should be adjusted in light of the changing epidemiological landscape of HCC, where more focus will have to be placed on detecting HCC in patients without underlying cirrhosis.
背景：肝细胞癌（HCC）是癌症相关死亡的主要原因之一，仍是全球医疗系统的重大负担。尽管已采取预防措施，HCC的全球发病率仍在持续上升。目的：本研究旨在探讨2012年至2023年间在沃尔特湖畔克拉根福医院观察到的HCC患者病因学及生存结局的流行病学变化。方法：本研究为一项回顾性单中心队列研究。为便于比较，将研究时间划分为两个时段（2012-2017年和2018-2023年）。采用IBM SPSS软件进行统计分析。结果：第二时段诊断的HCC患者数量更多（n=128 vs n=148）。诊断中位年龄为72.5岁（标准差8.6）。第二时段患者平均年龄较第一时段年轻2岁（p=0.042）。酒精始终是HCC的主要潜在病因，且随时间推移未出现统计学显著变化（p=0.353）。然而，非酒精性脂肪性肝炎（NASH）病例数呈现明显上升趋势（分别为n=15和n=28）。近半数患者在诊断时甲胎蛋白（AFP）水平正常（<7 µg/L）（n=116，42.6%）。尽管治疗策略有所改进且新的系统治疗方案已可及，但两个时段HCC患者的中位总生存期保持相似，为20.5个月（95% CI 16.8-24.2，p=0.841）。第二时段记录了更多晚期HCC病例（BCLC-C期，n=23增至n=46，p=0.051）。第二时段无肝硬化的HCC患者数量显著增加（分别为n=22和n=47，p=0.005）。在无肝硬化患者中，NASH是最常见的潜在病因（50%），而肝硬化患者的主要病因仍是酒精性肝病（65%，p<0.001）。结论：HCC仍然是社会面临的重要健康问题。无肝硬化的HCC患者数量持续增加，其中非酒精性脂肪性肝病/非酒精性脂肪性肝炎（NAFLD/NASH）因其潜在的生活方式疾病背景发挥着重要病因学作用。应持续加强HCC预防及高危人群筛查工作。鉴于HCC流行病学格局的变化，预防策略和筛查技术需相应调整，未来应更注重在无基础肝硬化的患者中检测HCC。
Changes in the Epidemiology of Hepatocellular Carcinoma in Carinthia, Austria, 2012–2023
肿瘤(癌症)患者之家