Care pathway for patients with hepatocellular carcinoma: the importance of standardizing care pathways and coordinating care between centers, the example of the FACIL program

Hepatocellular carcinoma (HCC) accounts for approximately 70% of primary liver cancers and remains a major global health concern due to its high incidence and mortality, which are nearly equivalent. Overall 5-year survival remains poor (18%), strongly influenced by early detection and timely access to curative treatments. In France, HCC affects about 11,600 individuals annually, with stable incidence in men but rising incidence in women, partly driven by the increasing prevalence of metabolic liver disease. National health insurance data indicate a median overall survival of 12.1 months, showing only modest improvement, particularly since only 23% of patients receive curative treatment. Prognosis is determined by several factors: underlying liver disease etiology, center experience, access to curative options, and persistent social and geographical disparities. Improving early detection requires systematic identification of risk factors and regular surveillance of cirrhotic or high-risk patients using abdominal ultrasound and AFP measurement every six months. Recent AFEF guidelines emphasize standardized use of multiphasic contrast-enhanced imaging according to LI-RADS® criteria, along with strict timelines between diagnostic assessment, multidisciplinary tumor board (MTB) review, and treatment initiation. To streamline a care pathway that remains fragmented, the FACIL program was launched in 2024. Its goal is to structure regional networks, clarify the roles of all stakeholders, harmonize referral processes, and reinforce HCC-focused MTBs. FACIL aims to shorten diagnostic and therapeutic timelines, increase access to curative treatment, reduce geographical disparities, and improve access to therapeutic innovations. This organizational approach offers a promising strategy to improve HCC outcomes and promote more consistent, timely, and effective patient care nationwide.