Global disparities in hepatocellular carcinoma care: insights from the ESGAR Global Abdominal Imaging Forum

OBJECTIVES: To analyze the intercontinental differences and inequities in the management of hepatocellular carcinoma (HCC), including surveillance, diagnosis, and treatment, through the survey responses from the participants of the Global Abdominal Imaging Forum on HCC, organized by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). MATERIALS AND METHODS: An online anonymous survey was distributed to the attendees of the Global Abdominal Imaging Forum on HCC. The survey consisted of 14 multiple-choice questions, covering demographic, epidemiological and occupational data, and information on the management of HCC. Global differences and differences between European and non-European countries were analyzed. RESULTS: Of 1963 attendees from 110 countries, 408 (20.8%) from 67 countries responded to the survey. Multidisciplinary HCC meetings were reported with the highest frequency in North America (83.3%) and the lowest in Africa (41.2%). The most commonly reported tools for HCC surveillance were ultrasound (86.8%) and serum alpha-fetoprotein (79.4%). Global inequities were reported for contrast-enhanced ultrasound (p < 0.001, lowest access in South America, Africa, and Asia), MRI (p < 0.001, lowest access in Africa) and PET/CT (p < 0.001, lowest access in Africa). LI-RADS was the most common algorithm used for HCC diagnosis (83.6%), with the highest use reported in North America (94.4%). Heterogeneity in treatment availability was observed, with respondents from Africa reporting limited availability of surgery (41.2%), locoregional treatments (23.5%), liver transplantation (0%), and immunotherapy (17.6%). CONCLUSION: Although the surveillance strategy for HCC is similar at a global level, disparities exist in access to CEUS, MRI, PET/CT, and treatments for HCC. KEY POINTS: Question What are the global disparities in hepatocellular carcinoma surveillance, diagnosis, and treatment reported by doctors working in different continents? Findings The survey from the Global Abdominal Imaging Forum on HCC revealed significant global variability with disparities regarding access to advanced imaging modalities and treatments, particularly affecting Africa. Clinical relevance Global efforts should focus on improving access to advanced imaging techniques (including MRI and PET/CT) and treatments (including transplantation and immunotherapy). Guidelines for the management of HCC should consider the existing regional disparities in healthcare infrastructure and resource availability to ensure more equitable HCC care worldwide.