Aprajita Mal and Tejinder Kataria

Department of Radiation Oncology, Medanta Medicity Gurugram, India

*Corresponding Author: Aprajita Mall, Department of Radiation Oncology, Medanta Medicity Gurugram, India.

Received: April 14, 2025; Published:May 06, 2025

Abstract

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 (<0.001) indicate a statistically significant association between disease type and time interval.

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 unmet need in India.

Keywords: HCC; SBRT; PVTT; Nash; Hepatitis B Virus; Hepatitis C Virus

References

1. Ferlay J., et al. “Cancer statistics for the year 2020: An overview”. International Journal of Cancer (2021).
2. Sung H., et al. “GlobalCancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries”. Ca-A Cancer Journal for Clinicians 71 (2021): 209-249.
3. Balducci L and Extermann M. “Management of cancer in the older person: a practical approach”. Oncologist3 (2000): 224-237.
4. Kulkarni AV., et al. “Lenvatinib for unresectable hepatocellular carcinoma: the first Indian experience”. Gastroenterology and Hepatology 3 (2021): 407-408.
5. Giri S and Singh A. “Epidemiology of Hepatocellular Carcinoma in India - An Updated Review for 2024”. Journal of Clinical and Experimental Hepatology 6 (2024): 101447.
6. National Comprehensive Cancer Network. Hepatobiliary cancer (version 4.2024) Plymouth Meeting, PA: National Comprehensive Cancer Network (2024).
7. Schaub SK., et al. “Stereotactic body radiation therapy for hepatocellular carcinoma: current trends and controversies”. Technology in Cancer Research and Treatment 17 (2018): 1533033818 790217.
8. Dawson LA., et al. “Radiation Therapy Oncology Group (RTOG) 1112Randomized Phase Iii Study of Sorafenib Versus Stereotactic Body Radiation Therapy”. Followed By Sorafenib in Hepatocellular Carcinoma (2012).
9. WHO: Hepatitis B. World Hepatitis Day 2016 (2016).
10. Kar P. “Risk factors for hepatocellular carcinoma in India”. Journal of Clinical and Experimental Hepatology 4 (2014): S34-S42.
11. Chavda HJ. “Hepatocellular carcinoma in India”. Indian Journal of Surgery 83 (2021): 959-966.
12. Sarin SK., et al. “Liver diseases in the Asia-Pacific region: A Lancet Gastroenterology and Hepatology Commission”. The Lancet Gastroenterology and Hepatology 5 (2020): 167-228.
13. Goel A., et al. “Burden of hepatitis C virus infection in India: A systematic review and meta-analysis”. The Gastroenterology and Hepatology 34 (2019): 321-329.
14. Rajasekaran M., et al. “Injection practices in Southern part of India”. Public Health 117 (2003): 208-213.
15. Soin Arvinder S., et al. “Experience With LDLT in Patients With Hepatocellular Carcinoma and Portal Vein Tumor Thrombosis Postdownstaging”. Transplantation11 (2020): 2334-2345.
16. Tohra S., et al. “Experience with changing etiology and nontransplant curative treatment modalities for hepatocellular carcinoma in a real-life setting-A retrospective descriptive analysis”. Journal of Clinical and Experimental Hepatology 11 (2021): 682-690.
17. Prabhakar T., et al. “Etiologic fractions in patients of hepatocellular carcinoma in India with and without a background of cirrhosis: A multi-centric study”. Hepatology International (2023).v
18. Bhadoria AS and Pathak V. “Non-alcoholic fatty liver disease (NAFLD) in India: Challenges and the ways forward”. Journal of the Indian Medical Association 120 (2022): 52-55.
19. Musunuri B., et al. “Profile of patients with hepatocellular carcinoma: An experience from a tertiary care center in India”. Indian Journal of Gastroenterology 41 (2022): 127-134.
20. Sarin SK., et al. “Liver diseases in the Asia-Pacific region: A Lancet Gastroenterology and Hepatology Commission”. The Lancet Gastroenterology and Hepatology 5 (2020): 167-228.
21. Marrero JA., et al. “Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases”. Hepatology 68 (2018): 723-750.
22. Yang JD., et al. “A global view of hepatocellular carcinoma: Trends, risk, prevention and management”. Nature Reviews Gastroenterology and Hepatology 16 (2019): 589-604.
23. Hung YW., et al. “Redefining tumor burden in patients with intermediate-stage hepato- cellular carcinoma: the seveneleven criteria”. Liver Cancer6 (2021): 629-640.
24. Matsuo Y. “Stereotactic Body Radiotherapy for Hepatocellular Carcinoma: A Brief Overview”. Current Oncology 2 (2020): 2493-2500.
25. Sanuki N., et al. “Stereotactic body radiotherapy for small hepatocellular carcinoma: A retrospective outcome analysis in 185 patients”. Acta Oncology 53 (2014): 399-404.
26. Su TS., et al. “Stereotactic body radiation therapy for small primary or recurrent hepatocellular carcinoma in 132 Chinese patients”. Journal of Surgical Oncology 113 (2016): 181-187.
27. Ntandja Wandji LC., et al. “Combined alcoholic and non-alcoholic steatohepatitis”. JHEP Reports 23 (2020): 100101.
28. Romero-Gómez M., et al. “Treatment of NAFLD with diet, physical activity and exercise”. Journal of Hepatology 67 (2017): 829-846.
29. Younossi Z and Henry L. “Contribution of Alcoholic and Nonalcoholic Fatty Liver Disease to the Burden of Liver-Related Morbidity and Mortality”. Gastroenterology 150 (2016): 1778-1785.

Citation

Citation: Aprajita Mall and Tejinder Kataria. “Etiology of Hepatocellular Carcinoma- Indian Scenario “A Changing Landscape”".Acta Scientific Gastrointestinal Disorders 8.6 (2025): 03-11.

Copyright

Copyright: © 2025 Aprajita Mall and Tejinder Kataria. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.