Hepatocellular carcinoma risk, net survival and relative survival ratio in a high-income country of the Eastern Mediterranean Region: 2008–2020

This cross-sectional cohort study aimed to estimate the incidence of hepatocellular carcinoma (HCC) and evaluate population-based net survival (NS) and relative survival ratios (RSR) among HCC patients in Kuwait. Data from confirmed HCC cases diagnosed between 2008 and 2020, along with population data, were used to calculate age-standardized incidence rates (ASIR) per 10⁵ person-years using the world standard population as the reference. The Pohar-Perme estimator and annual all-cause mortality life tables were used to compute 1-, 3-, and 5-year NS, while the life table approach was applied to estimate RSR. A total of 439 HCC patients were included. The overall ASIR (per 10⁵ person-years) was 7.66 (95% CI: 6.97–8.40), higher in males (9.14; 95% CI: 8.22–10.13) than females (3.71; 95% CI: 3.69–5.63). Cumulative NS estimates (%) decreased over time and were consistently lower among males (1-year: 47.1; 95% CI: 41.1–54.1; 3-year: 23.5; 95% CI: 17.2–32.0; 5-year: 10.8; 95% CI: 5.4–21.7) than females (1-year: 54.6; 95% CI: 43.8–69.6; 3-year: 40.9; 95% CI: 26.6–62.8; 5-year: 26.3; 95% CI: 10.4–66.7). Similarly, RSRs were lower among males than females at 1-year (0.45 vs. 0.67), 3-year (0.22 vs. 0.56), and 5-year (0.15 vs. 0.25). Marked sex differences were observed in HCC incidence, NS, and RSR, with female patients demonstrating more favorable survival outcomes at 1-, 3-, and 5-year. Further studies are needed to clarify the biological, clinical, and health-system factors contributing to these disparities.