Across the liver/HCC Phase II–III geography dataset, operational activity is concentrated in a relatively small number of European hepatology-oncology hubs. France and Spain lead the aggregate planned participant footprint, while Institut Gustave Roussy, Hospital Universitari Vall d’Hebron, Assistance Publique–Hôpitaux de Paris, Hopital Beaujon, and Centre Georges François Leclerc appear as the most repeatedly activated sites.
The top site ranking shows repeated activation of specialist French and Spanish liver-cancer centers, supported by Italian and German hepatobiliary oncology institutions. Institut Gustave Roussy leads with 7 observed appearances, followed by Hospital Universitari Vall d’Hebron with 6.
| Rank | Site | Country | Appearances |
|---|---|---|---|
| 1 | Institut Gustave Roussy | France | 7 |
| 2 | Hospital Universitari Vall d’Hebron | Spain | 6 |
| 3 | Assistance Publique–Hôpitaux de Paris | France | 5 |
| 4 | Hopital Beaujon | France | 5 |
| 5 | Centre Georges François Leclerc | France | 4 |
| 6 | Centre Hospitalier Universitaire de Montpellier | France | 4 |
| 7 | Clinica Universidad de Navarra | Spain | 4 |
| 8 | Azienda Ospedaliero-Universitaria di Bologna IRCCS | Italy | 4 |
| 9 | Universitaetsklinikum Frankfurt / Goethe University Frankfurt | Germany | 3 |
| 10 | Centre Hospitalier Universitaire de Bordeaux | France | 3 |
The highest-frequency sites are not simply large oncology centers; they are hepatobiliary oncology hubs where digestive oncology, liver units, interventional expertise, and HCC-specific trial experience overlap.
Country-level planned participant allocation is now aggregated correctly by summing the participant field across all country records. France accounts for 400 of 886 summed participants, or 45.1%, followed by Spain with 214 of 886, or 24.2%. Together, France and Spain account for 614 of 886 summed planned participants, or 69.3%.
The corrected aggregation shows that participant allocation is much more concentrated than simple site listing suggests. France and Spain together account for nearly seven in ten planned country-level participants, indicating that these countries are the dominant enrollment-weighted anchors for liver/HCC trials in this dataset.
The four largest countries — France, Spain, Italy, and Germany — account for 785 of 886 summed planned participants, or 88.6%. The remaining countries account for 101 of 886 participants, or 11.4%.
The operational center of gravity is not evenly distributed across Europe. Liver/HCC trial execution in this dataset depends heavily on a small set of countries with mature hepatology-oncology infrastructure.
Phase II geography records account for 30 of 49 records, or 61.2%. Phase III geography records account for 19 of 49 records, or 38.8%. This indicates a stronger observed footprint in exploratory, expansion, and signal-validation settings than in purely confirmatory Phase III settings.
The Phase II skew is consistent with the active development environment in HCC, where combinations, biomarker-informed populations, liver-function constraints, and early efficacy signals often require specialist networks before broader Phase III expansion.
HCC means hepatocellular carcinoma. Site appearance means a named institution appears as a participating site in a trial geography record. Planned participants by country means the sum of the `number_of_participants` field across country-level geography rows, not the highest single-study country allocation.