Non-liver comorbidity in patients with hepatocellular carcinoma and curative treatments – a Swedish national registry study

Treatment decisions for hepatocellular carcinoma (HCC) involve considering tumour stage, liver function and performance status, including comorbidities, although rarely analysed specifically. This study examines the patterns and prognostic impact of comorbidities in HCC patients. We included patients diagnosed with HCC before undergoing transplantation, resection or ablation, registered in the Swedish Registry for Cancers in the Liver and Bile ducts (SweLiv) 2008–2016. Data were cross-linked with the Swedish National Patient Registry (NPR) to capture International Classification of Diseases (ICD) codes reflecting comorbidities within 10 years before the HCC treatment decision. The Charlson Comorbidity Index (CCI), excluding the liver disease category (CCI-P), was used to estimate accumulated comorbidity. We identified 980 HCC patients with transplantation (225), resection (425) or ablation (330). The comorbidity burden, assessed using the CCI-P, was highest in ablation patients and lowest in the transplanted group (<i>p</i> &lt; 0.001). The CCI-P category distribution varied across treatment groups. After adjusting for age and tumour burden, several CCI-P categories were associated with 5-year mortality, including heart failure, cerebrovascular disease, pulmonary disease, ulcers, and renal disease. ICD diagnoses not included in the CCI, such as trauma, infection, psychiatric disease, anaemia, and obesity, were also linked to 5-year mortality. Comorbidity burden and patterns differed between HCC treatment groups, with CCI-P significantly associated with mortality. Preoperative attention to cardiovascular disease is important, but other comorbid conditions may require vigilance. Given the higher prevalence of comorbidities in ablation and resection patients, efforts to optimize comorbidity in these groups may be warranted.