Hepatocellular Carcinoma Survival in Iran (2011 - 2017): A National Registry-Based Report

Abstract

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide and is generally associated with a poor prognosis. However, nationwide population-based survival data on patients with HCC in Iran remain limited. Objectives: This study aimed to estimate overall survival among patients diagnosed with HCC in Iran between 2011 and 2017 using national cancer registry data. Methods: This retrospective, registry-based cohort study included clinically and pathologically diagnosed HCC cases identified using the International Classification of Diseases for Oncology, third edition (ICD-O-3), topography, morphology, and diagnostic-method fields. Vital status and dates of death were ascertained primarily through linkage with the national registration office and, when linkage was unavailable, through telephone follow-up. Overall survival was estimated using the Kaplan–Meier method, and factors associated with survival were evaluated using a multivariable Cox model stratified by diagnostic method. Results: The final analytic cohort included 1,079 patients, of whom 1,048 (97.1%) had conventional HCC. At the last follow-up in October 2024, 141 patients (13.1%) were alive, and 938 had died. The mean and median survival times were 30.0 ± 1.6 months and 5.0 ± 0.5 months, respectively. The 1-, 3-, and 5-year overall survival rates were 37.5%, 21.0%, and 16.2%, respectively. Kaplan–Meier survival was significantly better among patients younger than 65 years and among those with a pathological diagnosis. In the Cox model stratified by diagnostic method, older age was independently associated with poorer survival, whereas sex and tumor pathology were not. Conclusions: This national registry-based study provides descriptive overall survival estimates for Iranian patients diagnosed with HCC between 2011 and 2017. These findings may serve as a national benchmark; however, they should be interpreted in light of the absence of data on disease stage, treatment, liver function, performance status, comorbidities, and liver-disease etiology.