Background: This cross-sectional cohort study aimed to estimate the incidence of hepatocellular carcinoma (HCC) and evaluate population-based net survival (NS) and relative survival ratios (RSR) among HCC patients in Kuwait.
Methods: Data from confirmed HCC cases diagnosed between 2008 and 2020, along with population data, were used to calculate age-standardized incidence rates (ASIR) per 10⁵ person-years using the world standard population as the reference. The Pohar-Perme estimator and annual all-cause mortality life tables were used to compute 1-, 3-, and 5-year NS, while the life table approach was applied to estimate RSR.
Results: A total of 439 HCC patients were included. The overall ASIR (per 10⁵ person-years) was 7.66 (95% CI: 6.97-8.40), higher in males (9.14; 95% CI: 8.22-10.13) than females (3.71; 95% CI: 3.69-5.63). Cumulative NS estimates (%) decreased over time and were consistently lower among males (1-year: 47.1; 95% CI: 41.1-54.1; 3-year: 23.5; 95% CI: 17.2-32.0; 5-year: 10.8; 95% CI: 5.4-21.7) than females (1-year: 54.6; 95% CI: 43.8-69.6; 3-year: 40.9; 95% CI: 26.6-62.8; 5-year: 26.3; 95% CI: 10.4-66.7). Similarly, RSRs were lower among males than females at 1-year (0.45 vs. 0.67), 3-year (0.22 vs. 0.56), and 5-year (0.15 vs. 0.25).
Conclusion: Marked sex differences were observed in HCC incidence, NS, and RSR, with female patients demonstrating more favorable survival outcomes at 1-, 3-, and 5-year. Further studies are needed to clarify the biological, clinical, and health-system factors contributing to these disparities.
Keywords: Age-standardized incidence rate; Cumulative net survival; Hepatocellular carcinoma; Pohar-Perme method; Relative survival ratio.
© 2026. The Author(s).