Introduction and objectives Dutch guidelines for hepatocellular carcinoma (HCC) are based on the European Association for the Study of the Liver (EASL) guideline. With the emergence of novel therapies, this study aimed to describe real-world first-line treatment practices in the Netherlands and assess their alignment with the EASL 2018 and 2025 recommendations. Methods Between 2019 and 2024, treatment-naive patients with HCC were prospectively enrolled across six Dutch tertiary referral centres as part of a cohort study paired with a biobank. Staging was in accordance with the Barcelona Clinic Liver Cancer (BCLC) 2022 classification. Results A total of 619 patients (79% male; median age 71 years) were included. Cirrhosis was registered in 65%. BCLC stage distribution was 11% BCLC-0, 53% BCLC-A, 14% BCLC-B, 18% BCLC-C, 2.9% BCLC-D, and 1.1% missing data. First-line therapy was most commonly thermal ablation (TA) in BCLC-0/A (48%), transarterial chemoembolization (TACE) in BCLC-B (46%), and systemic therapy in BCLC-C (41%). Adherence to first-line treatment recommendations was 46% per EASL 2018 and 63% per EASL 2025 guidelines. TACE, transarterial radioembolization and atezolizumab + bevacizumab were applied across all stages, ahead of guideline integration. One-year overall survival was 97% (BCLC-0), 91% (BCLC-A), 79% (BCLC-B), 70% (BCLC-C), and 33% (BCLC-D). Conclusion Treatment practices in the Netherlands adapt in response to emerging evidence. Guideline-adherent first-line treatment was observed in 46% of patients according to the EASL 2018 guidelines and 63% according to the EASL 2025 guidelines. Although guidelines remain the foundational framework for clinical decision-making, treatment decisions in real-world practice often extend beyond guideline recommendations.
Alcohol-associated liver disease (ALD) is an increasingly important contributor to liver-related morbidity and mortality in the United States, yet its burden among Asian Americans remains poorly defined. Most national datasets aggregate Asian Americans into a single racial category, obscuring important differences across East Asian, Southeast Asian, and South Asian populations. This approach reinforces assumptions that Asian Americans uniformly have low-risk alcohol use and low rates of alcohol-related disease, potentially concealing vulnerable subgroups. Emerging evidence suggests considerable heterogeneity in liver disease burden among Asian American populations. Differences in alcohol metabolism, metabolic risk profiles, and sociocultural factors may influence susceptibility to ALD. South Asian populations, in particular, have high rates of insulin resistance, central adiposity, and type 2 diabetes, conditions that may exacerbate alcohol-related liver injury even at modest levels of consumption. Cultural stigma surrounding alcohol use, concealed drinking behaviors, acculturative stress, and delayed engagement with addiction services may further contribute to underrecognition and late presentation. At the same time, provider assumptions shaped by aggregated data and the model minority stereotype may reduce opportunities for routine alcohol screening and contribute to diagnostic misclassification. Disaggregated analyses are needed to identify high-risk populations, improve surveillance, and guide equitable clinical and public health interventions. Standardized subgroup reporting, culturally responsive screening approaches, and community-engaged prevention strategies are essential to better address ALD disparities among diverse Asian American populations.
INTRODUCTION AND OBJECTIVES Clinical trials in advanced hepatocellular carcinoma (HCC) typically include patients with preserved liver function (Child-Pugh A), without adequately considering cirrhosis or clinically significant portal hypertension (CSPH). We aimed to compare prognostic models in Child-Pugh A patients. PATIENTS AND METHODS This prospective multicenter cohort study included patients with advanced HCC treated with systemic therapy (2018-2024) in Latin America. Survival was analyzed using Kaplan-Meier and Cox proportional multivariate hazards models and competing risk analysis for cause-specific mortality and hepatic decompensation. RESULTS From 306 patients receiving systemic therapy, 79.1% (n=242) were Child-Pugh A (sorafenib 60.3%, atezolizumab plus bevacizumab 30.6%, and lenvatinib 8.7%). Among these, cirrhosis was observed in 78.9%, and CSPH in 51.6%. No survival differences were observed between ALBI 1 vs 2-3 grades (HR 1.08; P=0.685), or Child-Pugh A5 vs A6. In multivariable analysis, atezolizumab plus bevacizumab was independently associated with improved OS (HR 0.64, 95% CI 0.42-0.99), adjusted for AFP ≥400 ng/mL and CSPH. Other models, including the ALBI score as a continuous or categorical variable, showed no significant independent association with mortality, nor did they improve model performance. In a competing risk regression analysis accounting for death due to tumor progression as a competing event, CSPH was the only independent variable associated with hepatic decompensation, sHR 1.98 (95% CI 1.01-3.89). CONCLUSIONS Accurate reporting of cirrhosis and CSPH is essential, even for Child-Pugh A patients, as both are independent prognostic factors that should be considered for therapeutic decision-making in advanced HCC.
