Context: We aimed to assess temporal changes in the presentation and survival of patients with hepatocellular carcinoma (HCC) in the northern Egypt region, one of the regions reporting the highest incidence of the disease globally. Method: We conducted a monocentric retrospective study. Patients presenting at the Damietta Oncology referral center between 2007 and 2019 with a diagnosed HCC were eligible. Individual, clinical and tumor characteristics at HCC diagnosis, including the Barcelona Clinic Liver Cancer (BCLC) staging, were retrieved from medical files and patients final vital status was ascertained by combining various data sources. Patients were divided into 2 groups based on diagnosis period: pre- and post-2014. Survival was analysed based on Kaplan-Meier curves and differences in restricted mean survival time (RMST). Results: Data from 5,097 patients (among 5,210 eligible, 97.8%) wereere analyzed. We observed a significant trend toward HCC diagnosed at earlier stage in the post- vs. pre-2014 period (BCLC stage 0/A or B: 37.2% vs. 27.1%, p<10-3). Overall patient's survival after the HCC diagnosis was poor, with a median of 8.1 months. The BCLC staging system performed well in predicting survival (median survival for patients diagnosed with BCLC stage 0/A, B, C, and D: 28, 25, 7, and 4 months, respectively, p<10-3). Despite a trend toward HCC diagnosed at earlier stages, we did not observe a significant improvement in survival over time. Overall, treatments offered in this medical center were in line with international guidelines, and 16.1% of the patients who received a curative treatment had an improved survival (30.7 months in median). However, HCC recurrence was frequent among patients cured for HCC, with a median time to recurrence of 22 months. Conclusion: Overall survival after HCC diagnosis in Egypt remains poor but is significantly improved by curative therapy. Despite a trend toward earlier diagnosis of HCC, we did not observe a general improvement in survival over time, which remains to be clearly understood.

The authors have declared no competing interest.

This research has been funded by the Pasteur Foundation. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the article.

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This study received approval from the Research Ethics Committee for Human Subject Research at Air Force Specialized Hospital and from the Egyptian Ministry of Health on 31st Jul 2019 and on October, 9th 2019 respectively.

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