Treatment patterns and outcomes in hepatocellular carcinoma: Real-world experience in Greece from the retrospective OPAL study

John Koskinas; Spyridon Pantzios; Melanie Deutsch; Emmanuel Koullias; Alexandra Alexopoulou; Hariklia Kranidioti; Elisavet Michailidou; Ioannis Goulis; Ioanna Papagiouvanni; Ioannis Koutroubakis; Dimitrios Samonakis; Ioannis Drygiannakis; Eleni Magafouraki; Evdokia Tsaliki; Spilios Manolakopoulos; Ioannis Elefsiniotis; Georgios Papatheodoridis

Authors John Koskinas, Spyridon Pantzios, Melanie Deutsch, Emmanuel Koullias, Alexandra Alexopoulou, Hariklia Kranidioti, Elisavet Michailidou, Ioannis Goulis, Ioanna Papagiouvanni, Ioannis Koutroubakis, Dimitrios Samonakis, Ioannis Drygiannakis, Eleni Magafouraki, Evdokia Tsaliki, Spilios Manolakopoulos, Ioannis Elefsiniotis, Georgios Papatheodoridis.

Abstract

Background Newer advances involving immunotherapies are changing the hepatocellular carcinoma (HCC) landscape. In the multinational OPAL study, we described the characteristics of patients with HCC during 2014-2021 in Greece.

Methods This was a retrospective chart review study of adults (alive/dead) with newly diagnosed HCC between 2014-2021.

Results Of 406 patients, 37.7%, 33.0%, 25.9% and 3.4% had Barcelona Clinic Liver Cancer (BCLC) stage 0/A, B, C and D, respectively. Common etiologies were hepatitis B virus (32.9%), alcohol use (31.6%), hepatitis C virus (27.6%), and metabolic dysfunction-associated steatotic liver disease (26.3%); viral+non-viral: 15.5%. The first treatment was resection, embolization, ablation, systemic therapy and transplant, in 35.5%, 30.7%, 22.9%, 3.3% and 0.7% of BCLC-0/A; 14.9%, 48.5%, 9.0%, 15.7% and 0% of BCLC-B; and 4.8%, 18.1%, 3.8%, 49.5% and 0% of BCLC-C patients; 7.2%, 11.9% and 23.8% of patients in the respective BCLC groups remained untreated. Tyrosine-kinase inhibitor monotherapy was the commonest systemic therapy (76.7%). Among BCLC-0/A, BCLC-B, and BCLC-C patients, median progression-free survival was 15.8, 8.0 and 3.2 months, and overall survival (OS) was 45.7, 21.8 and 7.9 months from treatment initiation, respectively. Among BCLC-D patients, median OS was 3.4 months from HCC diagnosis. By multivariate Cox regression analysis, hepatitis B virus etiology (P=0.016) and Eastern Cooperative Oncology Group performance status ≥1 (P=0.015) were independent factors associated with poorer OS among BCLC-C patients.

Conclusion Real-life clinical practice in Greece is aligned with European guidelines, while poor clinical outcomes underscore the need for implementation of new therapies.

Keywords Hepatocellular carcinoma, risk factors, survival, treatment patterns

Ann Gastroenterol 2025; 38 (2): 195-207