Current hepatocellular carcinoma (HCC) status in Pakistan: a systematic review

Hepatocellular carcinoma is the most common primary liver cancer and the sixth leading cause of death worldwide. HCC incidence numbers are constantly increasing in Pakistan and are mainly caused by chronic HBV and HCV associated cirrhosis. Two Pakistani population-based studies reported that the frequency of HCV induced HCC was high compared to HBV and alcohol-induced HCC. In Pakistan, the reported incidence of alcohol-induced HCC is very low. Therefore, the number of alcohol-induced HCC cases is deficient. Literature was searched using ScienceDirect, PubMed, Google Scholar, Springer, and BMC. Pakistani population studies based on HBV induced HCC, HCV induced HCC, HBV + HCV co-infection induced HCC, and alcohol induced HCC were included. A total of 98 studies on HCC were included; among them, 32 were related to HCV induced HCC, 20 were related to HBV induced HCC, 20 were associated with HBV + HCV co-infection induced HCC, and 6 were related to alcohol induced HCC. We further investigated that surgery and radiotherapy are the primary treatments for HCC in Pakistan, with surgery being the most frequently applied treatment in 1820 cases. We conducted this systematic review to highlight the current status of HCC in Pakistan. We found that HCC is most commonly caused by HCV infection compared to HBV infection and alcoholism.