PO3-23-YI The changing epidemiology of patients with HCC receiving a first-line systemic therapy: insights from ARPES and ARTE databases (2008- 2024)

Background and aims: The epidemiological characteristics of patients starting first-line systemic therapy for hepatocellular carcinoma (HCC) have changed over time. This study examines shifts in demographics and disease profiles since the first systemic therapy was introduced. Method: We compared baseline characteristics of patients receiving frontline systemic treatments from two Italian multicenter nationwide datasets of systemic treatments: ARPES (sorafenib, 656 patients, 2008-2019) and ARTE (atezolizumab and bevacizumab [atezo/bev], 393 patients, 2022-2024). ARPES included cardiometabolic risk factors, allowing reclassification from NAFLD to MASLD. Results: Compared to ARPES, patients in ARTE showed a higher prevalence of females (19.9% vs. 15.1%; p=0.047), a trend toward older age, and an increase in single-etiology MASLD (17.6% vs. 8.8%, p<0.001), with fewer viral cases. More patients with HCV were in sustained virologic response at treatment start (72.8 vs 9.1%, p<0.001). Additionally, patients included in ARTE had better liver function (ALBI grade-1: 52.6 vs 18.7%, p<0.001), highest rate of no prior surgical/locoregional HCC treatments (38.5% vs. 28.1%, p<0.001), less prevalent BCLC-C stage due to fewer cases with macrovascular invasion (31.0% vs. 43.1%, p<0.001) and similar rate of metastatic disease. Lower likelihood of previous surgical/locoregional treatments was confirmed in the intermediate-stage subgroup (19.9 vs 35.2%, p<0.001). Tumors larger>6 cm (14.9% vs. 10.0%, p<0.001) and ECOG-PS>0, (32.0% vs. 23.3%, p<0.001) were also more common in the ARTE database. Conclusion: The increased prevalence of MASLD, a decline in viral cases, high SVR rates in HCV, and less previous locoregional treatments are likely to contribute to better liver function and more patients with intermediate stage. The challenges of surveillance in patients with MASLD may explain the increase in cases with no prior treatment, larger tumors, and higher ECOG-PS scores.