Etiologic fractions in patients of hepatocellular carcinoma in India with and without a background of cirrhosis: a multi-centric study

Abstract

Background: Hepatocellular cancer (HCC) typically arises in the background of cirrhosis. Its epidemiology has been changing due to availability of antivirals, changing life-styles and early detection. We undertook a multicentric national sentinel surveillance for liver cirrhosis and HCC to assess the attributable risk factors for development of HCC, both with and without a background of cirrhosis.Methods: Data from January 2017 till August 2022 from hospital-based records of eleven participating centres was included. Diagnosed cases of cirrhosis [radiological (multiphase and/or histopathological] and HCC [as per AASLD 2018] were included. History of signi cant alcohol intake was elicited by AUDIT-C questionnaire.Results: Altogether 5798 enrolled patients were assessed, of which 2664 patients had HCC. The mean age was 58.2±11.7 years and 84.3% (n=2247) were males. Diabetes was found in over a third of those with HCC (n=1032;39.5%). The most common etiology of HCC was NAFLD (n=927;35.5%) followed by viral hepatitis B and C and harmful levels of alcohol. Among those with HCC, 27.9% (n=744) had no cirrhosis. Higher proportion of cirrhotic HCC patients had alcohol as an etiological factor as compared to non-cirrhotic (17.5% Vs 4.7%, p= <0.001). NAFLD was an etiological factor for a higher proportion of noncirrhotic HCC patients as compared to cirrhotic HCC (48.2% Vs 30.6%, p=< 0.001). Diabetics more commonly had non-cirrhotic HCC (50.5% vs 35.2%). The odds of having cirrhotic HCC was 1.409 times greater for >60 years, 1.372 times for males and 3.472 times for harmful alcohol consumption. Those with NAFLD were 1.553 times more likely to develop non-cirrhotic HCC.Conclusion: This large multi-centric study demonstrates that NAFLD is the most important risk factor for development of both cirrhotic and non-cirrhotic HCC in India and has overtaken viral hepatitis. Awareness campaigns and large-scale screening are required to reduce the high burden of NAFLD related HCC in India.

Rifaximin Alfa and Liver Diseases: More Than a Treatment for Encephalopathy, a Disease Modifier

“…However, the levels of IL-6, IL-10, and TNFα are decreased in patients with alcohol cirrhosis, NAFLD cirrhosis, and HE cirrhosis which are treated with rifaximin, in treatment periods ranging from 4 to 12 weeks. 28 [5][6][7][8][9][10][11] A compensated cirrhosis has alteration in intestinal biota, permeability, chronic inflammation, and portal hypertension. During the phase of compensated damage, the liver is subjected to numerous acute insults (alcohol, infections, bleeding, medications, etc) which at some point progress to Acute on Chronic Liver Failure (ACLF), organic failure, and high mortality.…”

“…In the total group, the most frequent causes associated with hepatocellular carcinoma were non-alcoholic fatty liver disease, hepatitis B, hepatitis C and alcoholism, in that order. 5 Approximately half of patients with liver cirrhosis in the first five years develop some evidence of decompensation, due to alterations caused by portal hypertension or liver failure, or both, 50% of those who decompensate die in around 36 months and 80% do not reach 10 years of survival. 6 The most common complications that affect survival are infections, including spontaneous bacterial peritonitis (SBP), bleeding from esophageal varices, ascites and hepatic encephalopathy (HE).…”

“…Figure2Complications of cirrhosis and progression of compensated cirrhosis to ACLF [5][6][7][8][9][10][11]. A compensated cirrhosis has alteration in intestinal biota, permeability, chronic inflammation, and portal hypertension.…”

Role and Elevating Prognostic Precision of Pivka-Ii as a Superior Biomarker in HCC Diagnosis, Surpassing Afp

“…According to the World Health Organization, liver cancer is becoming more common, and by 2030, it is expected to be responsible for over one million fatalities per year (Steinmann et al, 2023) .The majority of HCC cases are the result of prolonged liver damage induced by the hepatitis type B or C virus. Cirrhosis of the liver, of any cause, is adeterminant for causing liver Carcinoma (Prabhakar et al, 2023). HCC is classified according on its outcome status,as well as the degree of liver dysfunction and conventional TNM staging.Both the AASLD and the one used by the Barcelona Clinic Liver Cancer (BCLC) staging approach are advised For the monitoring of HCC, there are two primary groups of diagnostics that are frequently used:…”