Evidence map›Paper›PMID 36940070›Full record

ArticleHepatology international2023

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

Tushar Prabhakar, Kanica Kaushal, Manya Prasad, Ekta Gupta, Ajit Sood, Ajay K Jain, Akash Shukla, Ashish Goel, Ajay Duseja, Anoop Saraya and 3 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Hepatology international, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
4.9field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 23 citations in OpenAlex.

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  11. Global Epidemiology of Hepatocellular Carcinoma.Journal of clinical and experimental hepatology
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  15. Systemic Therapies for Hepatocellular Carcinoma in India.Journal of clinical and experimental hepatology
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 8 institutions in 1 country.

Tushar PrabhakarDepartment of Clinical Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India.
Kanica KaushalDepartment of Clinical Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India.
Manya PrasadDepartment of Clinical Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India.
Ekta GuptaDepartment of Virology, Institute of Liver and Biliary Science, New Delhi, India.
Ajit SoodDepartment of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.
Ajay K JainDepartment of Gastroenterology, Choithram Hospital and Research Centre, Indore, India.
Akash ShuklaDepartment of Gastroenterology, GS Medical College and KEM Hospital, Mumbai, India.
Ashish GoelDepartment of Hepatology, Christian Medical College, Vellore, India.
Ajay DusejaDepartment of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Anoop SarayaDepartment of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Samir ShahDepartment of Transplant Hepatology, HPB, Liver Intensive Care, Global Hospital, Mumbai, India.
Guresh KumarDepartment of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.
Shiv Kumar SarinDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India. shivsarin@gmail.com.ORCID http://orcid.org/0000-0002-0544-5610
Institute of Liver and Biliary Sciences · INAll India Institute of Medical Sciences · INChoithram Hospital and Research Centre · INChristian Medical College, Vellore · INDayanand Medical College & Hospital · INGlobal Hospitals · INKing Edward Memorial Hospital and Seth G.S. Medical College · INPost Graduate Institute of Medical Education and Research · IN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHepatocellular cancer (HCC) typically arises in the background of cirrhosis. The epidemiology of HCC has changed in recent years due to availability of newer antivirals, changing life-styles and greater possibility for early detection. We undertook a multicentric national sentinel surveillance for liver cirrhosis and HCC to assess the attributable risk factors for the development of HCC, both with and without a background of cirrhosis.

methodsData from January 2017 till August 2022 from hospital-based records of eleven participating centers were included. Diagnosed cases of cirrhosis [radiological (multiphase and/or histopathological] and HCC [as per AASLD 2018] were included. History of significant alcohol intake was elicited by AUDIT-C questionnaire.

resultsAltogether 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 non-cirrhotic 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 following factors were associated with an occurrence of cirrhotic HCC: male gender (OR 1.372 and 95% CI 1.070-1.759), age above 60 years (OR 1.409 and 95% CI 1.176-1.689), HBV (OR 1.164 and 95% CI 0.928-1.460), HCV (OR 1.228 and 95 CI 0.964-1.565) and harmful consumption of alcohol (OR 3.472 and 95% CI 2.388-5.047). The adjusted odds of non-cirrhotic patients having NAFLD was 1.553 (95% CI 1.290-1.869).

conclusionThis 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.

Indexed as

Carcinoma, HepatocellularHepatitis BLiver NeoplasmsNon-alcoholic Fatty Liver DiseaseAgedFemaleFibrosisHumansLiver CirrhosisMaleMiddle AgedRisk FactorsChronic liver diseaseCirrhosisCirrhotic HCCEpidemiologyHCCIndiaLiver cancerNAFLDNon-cirrhotic HCCRisk factor

Identifiers

PMID36940070
OpenAlexW4327901968

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.