HEPATOCELLULAR CARCINOMA incidence in the Netherlands increased steadily between 2014 and 2022, with the greatest rise seen in cases linked to metabolic dysfunction-associated steatotic liver disease (MASLD), according to a nationwide cohort study.
Although alcohol-related liver disease (ALD) remained the leading cause of hepatocellular carcinoma (HCC), researchers found overall survival remained poor, highlighting the need for increased clinical awareness and further evaluation of surveillance strategies.
HCC, the most common form of primary liver cancer, accounts for approximately 90% of primary liver cancers worldwide. It typically develops in people with chronic liver disease, including viral hepatitis, ALD and MASLD. While HCC incidence has fallen in some regions, it continues to increase in traditionally low-endemic countries such as the Netherlands.
MASLD Drives Changes in HCC Incidence
The analysis included 6,526 people newly diagnosed with HCC and recorded in the Netherlands Cancer Registry between January 2014 and December 2022. They used average annual percentage change to evaluate trends in age-adjusted HCC incidence and Cox regression analyses to identify predictors of overall mortality.
During the study period, the age-adjusted HCC incidence rate increased from 3.5 to 4.1 cases per 100,000 person-years, representing an average annual increase of 2.3%.
Although ALD remained the most common underlying cause of HCC, MASLD-related HCC showed the fastest growth, with an average annual increase of 8.3%. The findings reflect broader shifts in liver disease patterns as virus-related HCC declines and metabolic liver disease becomes more common.
Survival Remains Poor Despite Treatment Benefits
Survival outcomes remained unfavourable, with one-, three- and five-year survival rates of 46.5%, 26.1% and 18.8%, respectively.
Patients with ALD-related HCC had a lower probability of survival than those with MASLD-related disease. Treatment allocation emerged as the strongest predictor of mortality. Patients receiving curative-intent treatment had the greatest survival advantage, while other tumour-directed therapies also improved outcomes. By contrast, distant metastases were a major predictor of poorer survival.
Child-Pugh C liver disease and multifocal disease were also linked to higher overall mortality.
Findings Highlight Need for Earlier Detection
The sustained rise in HCC incidence, particularly MASLD-related HCC, underscores the need for greater clinical awareness and further investigation into surveillance strategies. The findings also highlight the importance of early diagnostic evaluation of underlying liver disease to facilitate timely detection and appropriate management. This may be especially relevant because MASLD-related HCC can develop without cirrhosis in approximately 40% of cases, potentially limiting detection through current surveillance programmes.
Reference
Van Son KC et al. Increasing incidence and changing trends in etiology & survival rates in HCC in a European cohort. JHEP Rep. 2026;DOI:10.1016/j.jhepr.2026.101924
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