Evolving trends in treatment patterns for hepatocellular carcinoma in Korea from 2008 to 2022: a nationwide population-based study

Abstract

Backgrounds/aims: The treatment landscape for hepatocellular carcinoma (HCC) has significantly evolved over the past decade. We aimed to analyze trends in treatment patterns for HCC using a nationwide claims database from the Korean Health Insurance Review and Assessment Service.

Methods: This retrospective population-based cohort study analyzed 171,002 newly diagnosed HCC patients between 2008 and 2022. Etiologies and treatment modalities were categorized based on the ICD-10 codes and insurance data.

Results: The annual incidence decreased from 11,814 in 2008 to 10,443 in 2022. However, patients aged ≥70 increased noticeably, with those aged ≥80 rising from 3.8% in 2008 to 13.1% in 2022. From 2008 to 2022, the predominant cause of hepatitis B virus decreased from 68.9% to 59.7%, whereas nonalcoholic fatty liver disease increased from 8.9% to 15.8%. The initial treatment trends shifted: surgical resection and systemic therapy increased from 12.2% to 21.3% and from 0.2% to 9.6%, whereas transarterial therapy decreased from 49.9% to 36.6%. Best supportive care decreased from 31.7% to 21.3%. In the subgroup analysis, laparoscopic resection rate increased from 10.6% to 60.6% among the surgical resections. Sorafenib initially accounted for 100%, lenvatinib peaked at 36.5% in 2021, and atezolizumab-bevacizumab became the most widely used (63.1%) by 2022 among the systemic therapies.

Conclusions: This study demonstrates the temporal changes in the treatment patterns of Korean HCC patients. Surgical resection, particularly laparoscopic liver resection, and systemic therapy has increased significantly. These changes may have been influenced by reimbursement policies and advances in clinical research.

Keywords: Clinical practice patterns; Hepatocellular carcinoma; Korea.

Figure 1.

Study flow chart regarding initial treatments for HCC. HCC, hepatocellular carcinoma.

Figure 2.

Comparison of the trends in incidence of HCC by age group and etiology between 2008 and 2022. (A) The percentage of HCC incidence by age group. (B) The percentage of HCC incidence by etiology. HCC, hepatocellular carcinoma; HBV, hepatitis B virus; HCV, hepatitis C virus; NAFLD, nonalcoholic fatty liver disease.

Figure 3.

Initial treatments for HCC from 2008 to 2022. (A) Total cases and percentages of each treatment. (B) Comparison of initial treatment percentages between 2008 and 2022. HCC, hepatocellular carcinoma.

Figure 4.

Subgroup analysis by each initial treatment modality. (A) Percentages of open and laparoscopic resections among surgical resections. (B) Percentages of RFA, MWA, and cryoablation among local ablation treatments. (C) Percentages of cTACE, DEB-TACE, TARE, and other treatments among transarterial therapies. (D) Number and percentage of patients who received sorafenib, lenvatinib, and atezolizumab-bevacizumab. RFA, radiofrequency ablation; MWA, microwave ablation; cTACE, conventional transarterial chemoembolization; DEB-TACE, drug-eluting bead transarterial chemoembolization; TARE, transarterial radioembolization.

Figure 5.

Status of first-line systemic therapy in patients with HCC regardless of prior loco-regional therapy. (A) Annual number of patients who received sorafenib, lenvatinib, and atezolizumab-bevacizumab from 2008 to 2022. (B) Number of patients and the percentages of each regimen by quarter, from the first quarter of 2019 to the first quarter of 2023. (C) Comparison of the percentages of each regimen between the first quarter of 2019, the second quarter of 2020, and the first quarter of 2023. HCC, hepatocellular carcinoma.