Prognosis of hepatocellular carcinoma in the French overseas territories and comparison with a tertiary center in mainland France.

Introduction and objectives: Limited data are available on the prognosis of hepatocellular carcinoma (HCC) in the French overseas territories (FOT). This study aimed to describe the characteristics and outcomes of patients diagnosed with HCC in FOT, comparing them to those from a tertiary center located in Île-de-France (IDF).

Materials and methods: We retrospectively included all patients with HCC diagnosis between 2013 and 2023 in the FOT and IDF. Socio-demographic and medical data were collected, with the first treatment performed and survival data. Overall survival was analyzed using Kaplan- Meier methods and Cox proportional hazards models.

Results: A total of 1114 patients were included (FOT 11%, IDF 89%). FOT patients had higher rates of hepatitis B (36% vs. 16%, p<0.001) and worse liver function (defined by higher MELD scores and fewer Child A cases) at HCC diagnosis. In contrast, IDF patients had a higher prevalence of MASLD (29% vs. 16%, p=0.004). HCC was diagnosed at more advanced stages in FOT compared to IDF, with 71% vs. 49% (p<0.001) of cases outside Milan criteria and 29% vs. 5% (p<0.001) in BCLC-D, leading to a significantly lower survival in FOT (median 9 vs. 23 months, p=0.02).

Conclusions: HCC patients in FOT have a poorer prognosis compared to IDF, with diagnoses at more advanced stages, limiting curative treatment options. These findings highlight the need for improved access to care and screening strategies for earlier diagnosis of HCC in FOT.