Clinical and Epidemiologic Characteristics of Patients with Hepatocellular Carcinoma in South Asia: A Systematic Review and Meta-analysis.

Comprehensive data on hepatocellular carcinoma (HCC) in South Asia remains limited. This systematic review and meta-analysis describe characteristics and risk factors associated with HCC among South Asian adults. We surveyed PubMed/MEDLINE and Scopus for articles on descriptive studies on HCC in South Asia. The search terms included "hepatocellular carcinoma" AND "South Asia" AND individual South Asian countries ("Afghanistan", "Bangladesh", "Bhutan", "India", "Maldives", "Nepal", "Pakistan", and "Sri Lanka"). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. All the selected studies fulfilled the diagnostic criteria for HCC. We used the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies to assess the quality of the studies. The data extracted from the selected studies were used to produce pooled estimates for the HCC characteristics and associations. Only 28 publications (Bangladesh-1, India-16, Nepal-2, Pakistan-7, Sri Lanka-2) were selected. HCC is more common in men (81%) and is diagnosed around the age of 56 years in South Asia. Most cases (82%) develop in patients with cirrhosis. Chronic HBV infection (27%) is the leading risk factor, followed by chronic HCV infection (21%) and alcohol-related liver disease (21%). HCC is often detected at advanced stages (BCLC-B 29% and BCCL-C 43%), presenting as large (5-10 cm in 57%), single tumours with frequent blood vessel involvement (39%). Sorafenib (33%) is the most common treatment, followed by TACE (22%). The median overall survival is 17.3 months. Hepatocellular carcinoma occurs more often among males and in the sixth decade of life. Most cases develop in patients with cirrhosis due to HBV, HCV or alcohol excess. Hepatocellular carcinoma presents at an advanced stage as an aggressive disease, with a median overall survival of one and a half years in South Asia.