The prevalence and associated factors of viral hepatitis and cryptogenic related hepatocellular carcinoma at King Abdulaziz Medical city-Riyadh

Abdulaziz H. Alhaqbani, Abdulaziz Almusalam, Abdulaziz Alnadhari, Abdulmalik Alsalem, Meshal Alrasheed, Abduljaleel Alalwan, Bander Aldamkh


Background: Worldwide, viral hepatitis is the major risk factor for HCC with hepatitis B (HBV) being more than hepatitis C (HCV). Saudi Arabia is one of the endemic areas of viral hepatitis. Cryptogenic HCC is thought to arias from unknown causes of liver cancers. Thus, the purpose of this study was to find the prevalence of viral and cryptogenic HCC in King Abdulaziz Medical City-Riyadh (KAMC-R).

Methods: A retrospective chart review was performed for all HCC patients diagnosed between 2010 to 2017 at KAMC-R. Information regarding age, gender, comorbidity, alcohol consumption, serology tests, liver enzymes, body mass index, model for end-stage liver disease score, alpha-fetoprotein and Child-Turcotte-Pugh score were included. The Chi-square test was used to determine the differences between categorical data. A p<0.05 was considered statistically significant.

Results: Total of 294 patients with HCC charts were reviewed. HCV and HBV were found in 42.85% and 20.74% of the patients, respectively. Co-infection with HBV and HCV were reported in 1.7% whereas cryptogenic HCC was found in 32.65% of the patients. High BMI and DLP were noticeably higher in cryptogenic group (p=0.045 and p=0.022 respectively). Multiple lesions were noticed more in HCV group whereas single lesion was more in the cryptogenic group (p=0.0343). Also, large lesions (>5 cm) were remarkably found more in cryptogenic HCC whereas small lesions were more in HCV group (p=0.006).

Conclusions: Hepatitis C was the major risk factor associated with HCC, followed by Cryptogenic HCC. High BMI and DLP were common features of cryptogenic HCC.


Hepatitis C, Hepatitis B, Cryptogenic, Hepatocellular carcinoma, HCC

Full Text:



Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2014;136(5):359-86.

Saudi Health Council, Saudi Cancer Registry. Cancer Incidence Report Saudi Arabia. 2017: 45-46. Available at: Documents/2014.pdf. Accessed on 4 November 2018.

Sanyal AJ, Yoon SK, Lencioni R. The etiology of hepatocellular carcinoma and consequences for treatment. Oncologist. 2010;15(4):14-22.

Pinter M, Trauner M, Peck-Radosavljevic M, Sieghart W. Cancer and liver cirrhosis: implications on prognosis and management. ESMO Open. 2016;1(2):e000042.

Abdo AA, Sanai FM, Al-Faleh FZ. Epidemiology of Viral Hepatitis in Saudi Arabia: Are We Off the Hook? Saudi J Gastroenterol. 2012;18(6):349-57.

Song H, Lee H, Lee J, Kim J, Yim Y, Song T, et al. Risk Factors of Cryptogenic Hepatocellular Carcinoma in Patients with Low Body Mass Index or without Metabolic Syndrome. Korean J Internal Med. 2012;27(1):47.

Aljohani N. Metabolic syndrome: Risk factors among adults in Kingdom of Saudi Arabia. J Family Community Med. 2014;21(3):170.

Alswat K, Sanai F, Altuwaijri M, Albenmousa A, Almadi M, Al-Hamoudi W, et al. Clinical Characteristics of Patients with Hepatocellular Carcinoma in a Middle Eastern Population. Hepatitis Monthly. 2013;13(5).

Qari Y, Mosli M. Epidemiology and clinical features of patients with hepatocellular carcinoma at a tertiary hospital in Jeddah. Nigerian J Clin Pract. 2017;20(1):43.

Aljumah A, Kuriry H, AlZunaitan M, Al Ghobain M, Al Muaikeel M, Al Olayan A, et al. Clinical Presentation, Risk Factors, and Treatment Modalities of Hepatocellular Carcinoma: A Single Tertiary Care Center Experience. hindawi. 2016. Available at: grp/2016/1989045/cta/. Accessed on 16 September 2018.

Keng V, Largaespada D, Villanueva A. Why men are at higher risk for hepatocellular carcinoma? J Hepatol. 2012;57(2):453-4.

D’Arcy L. A Review of Acute Viral Hepatitis in the Elderly. Geriatrics Aging. 2013;6(3):17-20.

Brunot A, Le Sourd S, Pracht M, Edeline J. Hepatocellular carcinoma in elderly patients: challenges and solutions. J Hepatocellular Carcinoma. 2016;3:9-18.

Alfaleh F, Alshehri S, Alansari S, Aljeffri M, Almazrou Y, Shaffi A, et al. Long-term protection of hepatitis B vaccine 18 years after vaccination. J Infect. 2008;57:404-9.

Testino G, Leone S, Borro P. Alcohol and hepatocellular carcinoma: A review and a point of view. World J Gastroenterol. 2014;20(43):15943.

Larsson S, Wolk A. Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies. Br J Cancer. 2007;97(7):1005-8.

Wang Y, Wang B, Shen F, Fan J, Cao H. Body Mass Index and Risk of Primary Liver Cancer: A Meta-Analysis of Prospective Studies. Oncologist. 2012;17(11):1461-8.

Nair S, Mason A, Eason J, Loss G, Perrillo R. Is obesity an independent risk factor for hepatocellular carcinoma in cirrhosis? Hepatology. 2002;36(1):150-5.

Mantovani A, Targher G. Type 2 diabetes mellitus and risk of hepatocellular carcinoma: spotlight on nonalcoholic fatty liver disease. Ann Translational Med. 2017;5(13):270-270.

Kasmari A, Welch A, Liu G, Leslie D, McGarrity T, Riley T. Independent of Cirrhosis, Hepatocellular Carcinoma Risk Is Increased with Diabetes and Metabolic Syndrome. American J Med. 2017;130(6):746.e1-746.e7.

Siegel A, Zhu A. Metabolic syndrome and hepatocellular carcinoma: two growing epidemics with a potential link. Cancer. 2009;115(24):5651-61.

Lee S, Jeong S, Byoun Y, Chung S, Seong M, Sohn H, et al. Clinical features and outcome of cryptogenic hepatocellular carcinoma compared to those of viral and alcoholic hepatocellular carcinoma. BMC Cancer. 2013;13(1):335.

Kwak H, Park J, Koh Y, Lee J, Yu A, Nam B. Clinical Characteristics of Patients with Cryptogenic Hepatocellular Carcinoma in a Hepatitis B Virus-Endemic Area. Liver Cancer. 2015;5(1):21-36.

Giannini E, Marabotto E, Savarino V, Trevisani F, di Nolfo M, Poggio P, et al. Hepatocellular Carcinoma in Patients With Cryptogenic Cirrhosis. Clin Gastroenterol Hepatol. 2009;7(5):580-5.

Bialecki E, Di Bisceglie A. Diagnosis of hepatocellular carcinoma. HPB. 2005;7(1):26-34.

Abelev G. Alpha-Fetoprotein in Ontogenesis and its Association with Malignant Tumors. Adv Cancer Res. 1971;14:295-358.

Akeyama T, Koyama T, Kamada T. Alpha-Fetoprotein in Acute Viral Hepatitis. New England J Med. 1972;287(19):989-9.

El-Serag HB, Rudolph KL. Hepatocellular carcinoma: Epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557-76.

Poon D, Anderson BO, Chen LT, et al. Management of hepatocellular carcinoma in Asia: Consensus statement from the Asian Oncology Summit. 2009.

Khullar V, Firpi R. Hepatitis C cirrhosis: New perspectives for diagnosis and treatment. World J Hepatol. 2015;7(14):1843-55.

Hsu CY, Lee YH, Liu PH, Hsia CY, Huang YH, Lin HC, et al. Decrypting cryptogenic hepatocellular carcinoma: clinical manifestations, prognostic factors and long-term survival by propensity score model. PLoS One. 2014;9(2):e89373.