Résumé
Background The burden of hepatocellular carcinoma (HCC) increases worldwide. We report the current landscape of HCC, in France. Methods Carcinome HépatocellulaIrE en France (CHIEF) is a national, prospective, observational cohort initiated in 2019 with the aim of including 5000 patients with HCC, with a 5-year follow-up for each. CHIEF Epidemio 2000, is the first global analysis. Results In September 2021, 2043 patients were included in 32 centers. We analyzed 1640 patients, 86% men, 68-year-old, BMI 26.8. 70.8% of patients had cirrhosis (MELD score 9, Child–Pugh A in 77.8%, and portal hypertension in 39%. Liver disease was related to alcohol 58.5%, metabolic syndrome 39%, and virus 23.3%. HCC was confirmed by histology in 46.3%. The Milan criteria fulfilled 32.9%, median AFP 39 ng/ml, 5.9% portal thrombosis, and 10.7% metastases. BCLC classes 0, A, B, C, and D were 6.1, 29.8, 28.8, 32.1, and 3.2%, respectively. HCC was detected during a surveillance program in 35.2% associated with better survival ( P < 0.001). Median follow-up was 17.76 months (29.1% deaths). The 6, 12, and 18 months overall survival rates were 84.9% (95% CI: 82.8–87), 76.7% (95% CI: 74.2–79.2), 69.3% (95% CI: 66.4–72.3). One-year survival for BCLC 0, A, B, C, and D was at 95.6, 89.7, 81.7, 54.9, and 40%, respectively ( P < 0.0001). First-line treatment was curative, locoregional, or systemic in 40.5, 36.2, and 19.2%, with 1-year survival at 92.9, 82.2, and 57.8%, respectively ( P < 0.0001). Atezolizumab–bevacizumab yielded a median overall survival of 17.05 months versus nine for TKI ( P < 0.0001). Conclusion In real-life data, metabolic syndrome becomes the second cause of HCC in France. The 1-year survival rates are high for all treatments applied, and Immunotherapy yields similar results than in trials.