Hepatocellular Carcinoma Situation in Indonesia: A Systematic Review of ClinicalStaging and Histological Characteristics at the Time of Diagnosis

Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. However, systematic data on HCC characteristics in Indonesia are limited.Objective:To summarize the body of literature on the characteristics of HCC in Indonesia.Methods:A comprehensive search was conducted in MEDLINE, ScienceDirect, Scopus, Web of Science, andGoogle Scholar databases without date restrictions. Clinical studies investigating the characteristics of HCC exclusively in Indonesia were eligible for inclusion. Risk-of-bias assessments were conducted, and results were presented descriptively.Results:Ten studies comprising 1,389 HCC patients were included. The Barcelona Clinic Liver Cancer (BCLC) staging system, reported in 5 studies, revealed a predominance of intermediate to advanced stages (B and C) at diagnosis. Child-Pugh scores, available for 7 studies, indicated variability in liver function, with Child-Pugh A ranging from 12.0% to 85.7%. Hepatitis B virus (HBV) infection was the primary etiological factor, with prevalence ranging from 53.8% to 84.0%. Hepatitis C virus (HCV) infection was less common (1.0% to 25.21%). Non-viral etiologies represented a substantial proportion, reaching up to 37.4% of cases. The mean age at diagnosis ranged from 52.43 to 63.1 years.Conclusion:This review highlights the late-stage presentation of HCC in Indonesia,the predominance of HBV as an etiological factor, and a significant burden of non-viral HCC. The findings underscore the need for improved early detection strategies, strengthened HBV prevention efforts, and increased attention to metabolic risk factors. Regional variations in HCC characteristics suggest the need for tailored approaches to HCC management across different parts of Indonesia.