ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Epidemiology and Prevention
What can claims data tell us about risk factors and survival of patients with hepatocellular carcinoma? Insights from a German population-based study
Provisionally accepted
Selina Becht1*
Najib Ben Khaled2,3,4
Simone Schrodi1
Michael Von Bergwelt-Baildon1,3,4Peter Buggisch5Alexander Crispin6Wolf-Peter Hofmann7Ursula Marschall8
Julia Mayerle2,3,4Bernhard Mörtl1Sami Orabi1Alexander Philipp2
Joerg Trojan9Tobias Weiglein1
Enrico De Toni2Karin Berger-Thürmel1- 1LMU Klinikum Medizinische Klinik und Poliklinik III, Munich, Germany
- 2LMU Klinikum Medizinische Klinik und Poliklinik II, Munich, Germany
- 3Bayerisches Zentrum fur Krebsforschung, Munich, Germany
- 4Deutsches Konsortium fur Translationale Krebsforschung, Munich, Germany
- 5ifi-Institut für Interdisciplinäre Medizin, Hamburg, Germany
- 6Ludwig-Maximilians-Universitat Munchen Institut fur medizinische Informationsverarbeitung Biometrie und Epidemiologie, Munich, Germany
- 7Gastroenterologie am Bayerischen Platz, Berlin, Germany
- 8BARMER, Wuppertal, Germany
- 9Universitatsklinikum Frankfurt Klinik I Gastroenterologie Hepatologie Pneumologie Allergologie Endokrinologie, Frankfurt, Germany
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Geographic and temporal variations in the incidence and treatment of chronic viral hepatitis and trends in the development of metabolic and behavioral risk factors result in heterogeneous incidences of hepatocellular carcinoma (HCC). Therefore, national epidemiological information should be evaluated to identify the need for action. Methods: This retrospective observational study included adult patients with incident HCC (2016-2020). A network analysis was performed to investigate inter-relationships among risk factor diagnoses before HCC. Kaplan-Meier method and Cox proportional hazard model were used to analyze survival. Findings: A total of 2,778 patients were included. Mean age was 71.9 years (SD ±9.7); 69% were male. Most frequently documented risk factor diagnoses diseases were diabetes mellitus (76%), obesity (56%), liver fibrosis/cirrhosis (44%), and alcohol abuse (36%). Hepatitis B and C were documented in 4% and 11% of patients. Behavioral and metabolic risk factors were 1.1-1.9-fold more frequent in men. Diabetes mellitus was the most central risk factor diagnosis co-occurring with other metabolic and behavioral risk factors. Median survival was 8.7 months. Interpretation: In this German cohort, risk factor diagnoses before HCC were multifactorial, with metabolic diseases most frequently co-occurring. Survival after HCC was poor. Controlling metabolic risk factors and surveilling at-risk populations are crucial to mitigating the incidence and improving the survival of HCC patients in Germany. Analyzing claims data enabled efficient and effective generation of epidemiological real-world evidence.
Keywords: Hepatocellular Carcinoma, Secondary data, cancer epidemiology, Real-world evidence, metabolic risk factors
Received: 20 Jun 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Becht, Ben Khaled, Schrodi, Von Bergwelt-Baildon, Buggisch, Crispin, Hofmann, Marschall, Mayerle, Mörtl, Orabi, Philipp, Trojan, Weiglein, De Toni and Berger-Thürmel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Selina Becht, selina.becht@med.uni-muenchen.de
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.