Exploring the Etiology and Management of Intermediate Stage Hepatocellular Carcinoma in a Tertiary Care Center in South India

Background: Intermediate-stage hepatocellular carcinoma (HCC) is characterized by a Child–Pugh score of A or B, indicating preserved liver function and the presence of a larger or multifocal tumor. The management of intermediate-stage HCC is complex and often involves a heterogeneous approach. The objective of the present study was to investigate the etiological factors and treatment modalities for intermediate-stage HCC at a tertiary care center in South India. Methods: This retrospective observational study was conducted at Apollo Hospitals, Chennai, India, between March 2021 and March 2024. Patients diagnosed with intermediate-stage HCC during this period were included in the study. Data were collected retrospectively from electronic health records, radiology reports, and pathology records. Results: The majority of patients (48%) were aged 60 years or older, and 90% were male. The most common etiological factor for HCC was infection (44.2%), followed by hepatitis B virus infection (34.6%) and metabolic-associated fatty liver disease (MAFLD) (32.7%). Transarterial chemoembolization (TACE) was the most frequently used locoregional treatment modality (65.4%), followed by a combination of TACE and radiofrequency ablation (13.5%). 5.3% of participants were downstaged for liver transplantation. Conclusions: Our findings indicate that viral hepatitis and MAFLD are the primary etiological factors for intermediate HCC. TACE emerged as the most commonly employed locoregional treatment modality. A multidisciplinary approach involving hepatologists, radiologists, and oncologists is crucial to provide tailored treatment plans for individuals with intermediate-stage HCC.