Etiology of hepatocellular carcinoma- Indian scenario - A changing landscape

• Author Details:   
• Aprajita Mall ^*
• Tejinder Kataria

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Background: Recent studies from both India and abroad have shown a change in the etiological profile of hepatocellular carcinoma (HCC). 
Aims: We aim to analyze the etiological spectrum and changing trends of HCC etiology in India at our tertiary centre.
Materials and Methods: The records of all patients diagnosed with HCC between May 2012 and November 2024 were extracted from the hospital-based electronic database. Medical records were reviewed for 430 patients who received treatment for HCC. Patient characteristics and demographics were recorded. Data was captured and analysed for the patients who recieved radiation therapy.  
Results: Total number of patients analysed were 429 who were diagnosed as HCC. There was a male preponderance of 90.6%. HBV/HCV cases initially increased from 22.2% (2012-2015) to 42.2% (2016-2019) but later dropped to 35.6% (2020-2024). In contrast, NASH/Alcohol cases steadily increased from 13.8% (2012-2015) to 24.5% (2016-2019) and then sharply rose to 61.6% (2020-2024), making it the leading cause in recent years. The Chi-square value (27.517) and p-value (<0>
Conclusions: Rising HCC incidence rate is a cause for concern in India with viral hepatitis being the main cause. However, the increased incidence of non-viral HCC, particularly NASH-related, has been involved in the changing etiologies of HCC. Globally Nonalcoholic fatty liver disease (NAFLD) is swiftly becoming the most important cause of HCC. Effective strategies are needed to improve surveillance and early diagnosis in patients with high risk of developing hepatocellular cancer. NAFLD preventive strategies are an urgent need for public health in India.

Keywords: HCC, SBRT, PVTT, Nash, hepatitis B virus, hepatitis C virus