Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths in Germany. National data on the management of HCC remain scarce. OBJECTIVES: This study aims to provide an up-to-date overview of clinical characteristics, treatment modalities, and survival outcomes among patients with HCC in Germany. DESIGN: This is a real-world retrospective study using health insurance data from BARMER. METHODS: Patients with an HCC diagnosis between 2016 and 2020 were identified in the BARMER database. Comorbidities, anticancer therapies, and treatment pathways of those patients were evaluated using descriptive statistics and survival analysis. RESULTS: A total of 2778 patients with HCC were identified. Of these, 1569 (56.5%) received any anticancer therapy. Transarterial chemoembolization (TACE; 22.3%), liver resection (LR; 20.9%), and systemic therapy (18.9%) were the most frequently used approaches. Survival varied significantly, with liver transplantation (LTx) offering the best outcomes, with a 5-year survival rate of 76%, followed by LR with 40%. Treatments with curative intent, including LTx, LR, and ablation, had a median survival of 40.4 months, compared to 9.7 months for non-curative modalities. CONCLUSION: In Germany, a substantial proportion of HCC patients remain untreated. Therapies with curative intent, particularly transplantation, provide relevant survival benefits. Improving surveillance efforts could enhance the proportion of patients eligible for these modalities and may represent a critical step toward improved outcomes for patients with HCC.