We read with great interest the editorial by Hwang and Yang,1 which provided valuable insights into the evolving trends in hepatocellular carcinoma (HCC) epidemiology, etiology, and treatment patterns. The detailed analysis of the National Health Insurance Service database highlights significant changes in HCC management over time.2 However, we believe further exploration using comprehensive national data could deepen our understanding of the association between evolving treatment patterns and improved patients’ outcomes, which is in line with the conclusion of the editorial.

One critical area for further investigation is a focus on survival data. While our analysis could not delve into survival trends, a prior report suggested that survival rates have been increasing over time in South Korea,3 reflecting advancements in early detection and treatment modalities. A previous survey showed that early detection of HCC was higher in the surveillance group compared to the non-surveillance group in South Korea.4 Nevertheless, whether changes in initial treatment patterns over time would have a positive impact on patient outcomes needs to be elucidated, considering advancements in minimally invasive surgeries5 and systemic treatments, including immune checkpoint inhibitors. To elucidate these associations, combining national survival statistics with treatment and patient-level data could be instrumental.

More specifically, subgroup analyses exploring survival outcomes according to initial treatment patterns would identify advancements in each treatment modality in terms of technical, pharmacological aspects, or patient selection. For example, survival of transarterial chemoembolization-treated patients gradually improved over time in an Italian Liver Cancer database.6 Analyses regarding baseline liver function at diagnosis and investigating treatment patterns in each subgroup would also be helpful, considering a previous study that showed treatment patterns can impact patient survival in HCC patients with Child-Pugh class B.7 Moreover, the influence of second-line systemic treatment on patient outcomes warrants closer examination. As systemic therapies diversify, understanding patterns of second-line treatment adoption and their impact on survival could guide future therapeutic strategies.

If integrated with survival data, analyses of treatment pattern changes could provide even more meaningful insights to inform evidence-based treatment strategies and guide future clinical research on HCC. This approach underscores the importance of utilizing comprehensive datasets to enhance both clinical and policy-making frameworks, ultimately improving patient care and advancing HCC research.