Diagnostic routes for hepatocellular carcinoma in the UK: a multicentre evaluation

Objective Hepatocellular carcinoma (HCC) prognosis remains poor due to typically advanced stages at presentation. 6-monthly surveillance is recommended for detecting cases at earlier and more treatable stages using imaging and blood testing. This multicentre service evaluation aimed to determine the proportion of HCC patients detected through different diagnostic routes (surveillance, incidental and symptomatic) and describe their demographic characteristics and staging. Methods This was a retrospective service evaluation of consecutive patients with first diagnosis of HCC between January 2020 and January 2024 across 14 centres. Data collected included demographics, diagnostic route, index imaging modality, liver disease aetiology, radiological findings on cross-sectional imaging and deaths. Results 723 patients were included (79% (570/723) male, median age=71 years (IQR 64, 77)). Although 51% (369/723) of patients had known cirrhosis prior to HCC diagnosis, only 36% (257/723) were known to a surveillance programme prediagnosis. Of those enrolled, 71% (182/257) were diagnosed via surveillance, accounting for an overall 28% (201/723) of patients, with 24% (176/723) diagnosed incidentally and the majority (48%, 346/723) through symptomatic presentation. Of those enrolled previously in surveillance, 88% (226/257) had attended surveillance in the 3 years prediagnosis, of which 75% (169/226) were ultimately diagnosed via surveillance. Mortality, ascites, vascular invasion and metastases were highest in the symptomatic group and lowest in the surveillance-diagnosed group. Conclusions Most HCC patients are still diagnosed symptomatically or incidentally. This is likely to reflect multifactorial deficits in (1) identifying high-risk patients; (2) enrolling these patients in surveillance and (3) delivering effective surveillance.