Hepatocellular carcinoma (HCC) is the sixth most common tumor in the world. The multicenter study Evolving Epidemiology of HCC in Spain concludes that alcohol consumption accounts for 55% of cases, followed by metabolic syndrome —a combination of risk factors such as excess abdominal fat, high blood pressure, elevated blood sugar, and abnormal lipid levels— (23%). Hepatitis C virus infection (17.3%) and hepatitis B virus (4.5%) are less common causes. In the case of hepatitis C, although many individuals have been cured thanks to direct-acting antivirals, the risk of HCC remains for those who already had cirrhosis or advanced liver damage before treatment.
The first author of the study is Margarita Sala, consultant in the Digestive System Department – Hepatology Unit at Hospital Trueta, and senior researcher in the Digestive Diseases and Microbiota Research Group at IDIBGI and the Liver and Digestive Diseases area of CIBEREHD. The last author is María Varela (Central University Hospital of Asturias and University of Oviedo).
The study analyzed data from 784 patients diagnosed with HCC between October 2022 and January 2023 at 52 Spanish hospitals. Additionally, results were compared with two previous registries from 2008–2009 and 2013–2014, allowing for an assessment of the evolution of risk factors in Spain.
Among the most significant findings is the decline in hepatitis C as a cause of HCC (17.3% vs. 43% in the first registry), largely attributed to its eradication through antiviral treatment. Conversely, there has been a clear increase in cases attributable to metabolic diseases (24% vs. 4.9%). An increase in diagnoses among non-cirrhotic patients has also been observed, especially those with metabolic causes.
The analysis also includes a comparative study of the clinical characteristics of patients according to the etiological factor (alcohol, metabolic syndrome, or hepatitis C). Regarding screening programs, diagnosis occurred within such programs in 48.5% of cases, a rate similar to previous studies. However, only one in four at-risk patients is currently included in a screening program, often due to unawareness of underlying liver disease, especially in alcohol-related cirrhosis.
On the other hand, among already diagnosed cirrhotic patients, 84% of HCC cases are detected through screening programs and mostly at early stages, allowing access to potentially curative treatments.
The research team concludes that “the results of this third prospective multicenter registry reflect the evolution of HCC epidemiology in Spain. These findings highlight the need to strengthen prevention and early detection of HCC, especially regarding alcohol and liver disease related to metabolic syndrome, and to encourage greater involvement of health authorities to improve participation of at-risk patients in screening programs.”
In this collaborative multicenter study, led by the Spanish Association for the Study of the Liver, eight CIBEREHD groups participated: Hospital Germans Trias i Pujol, Institute of Health and Biomedical Research of Alicante; August Pi i Sunyer Biomedical Research Institute; University of Salamanca; Parc Taulí Research and Innovation Institute Foundation; Hospital de la Santa Creu i Sant Pau Research Institute Foundation; University of Navarra; and Vall d’Hebron University Hospital Foundation - Research Institute (VHIR).
Reference Article: Sala M, Pascual S, Rota Roca MR, Matilla AM, Campos M, Delgado M, Ferrer MT, Montero JL, González-Santiago JM, Guerrero A, Aracil C, Rodríguez-Lope C, Romero-Gutiérrez M, Sogbe M, Vázquez-Rodríguez S, Olmo JF, Mínguez B, Cortés-García L, Vallejo-Senra N, Unceta PR, Clos A, Díaz-Bethencourt D, Sánchez AG, Castro RQ, Bustamante J, Perelló C, Urquijo Ponce JJ, Serra HA, Llamoza-Torres CJ, Montoliu S, Fernández-Marcos C, Guiberteau A, Hernández-Guerra M, Vergara M, Fernández-López AM, Valer López-Fando MP, Gutiérrez-García ML, Hernáez-Alsina T, Coll S, Cuyás B, Morillas MJ, Olmedo SR, Fernández-Bermejo M, Roget M, Ramos IC, Pacheco Del Río G, Rifà R, Gacho PC, Barrio ML, Gómez-Rubio M, Peñas I, Serra I, Cachero A, Reig M, Giraldez Á, Guerrero M, Segarra JX, Lledó JL, Díaz-González Á, Delgado C, Iñarrairaegui M, Rodríguez-González MM, Lázaro M, Bermúdez-Ramos M, Lué A, Molina E, Macías-Rodríguez MA, Rodríguez M, Chiminazzo V, Varela M. Evolving epidemiology of HCC in Spain. JHEP Rep. 2025 Jan 30;7(5):101336. doi: 10.1016/j.jhepr.2025.101336. PMID: 40248605; PMCID: PMC12005282.
