Epidemiology and etiologic trends of hepatocellular carcinoma in cirrhotic patients in Mexico: a multicenter retrospective study (2018-2024).

Introduction and objectives: Hepatocellular carcinoma (HCC) represents a major complication of chronic liver disease and an emerging public health challenge in Mexico. As the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) continues to increase, a comprehensive understanding of the current epidemiological landscape of HCC has become increasingly important. This study aims to describe the epidemiologic features and etiologic distribution of HCC in patients with cirrhosis in Mexico using multicenter data collected from 2018 to 2024.

Materials and methods: We conducted a multicenter retrospective study of 2182 patients with cirrhosis diagnosed between 2018 and 2024 across 13 tertiary care hospitals in northern, central, and southern Mexico. HCC was identified using standardized imaging and/or histological criteria. Data on demographics, cirrhosis etiology and clinical characteristics were collected.

Results: Among 2182 patients with cirrhosis (mean age 61 ± 12 years; 53.8 % female), 8.8 % (n = 194) developed HCC. Prevalence was higher in women (55.1 %) and in older adults, with 78.3 % of HCC cases occurring in individuals aged ≥60 years. In women, HCC peaked between ages 70-79, while in men it peaked between 60 and 69 years. Regional differences were observed, with the highest prevalence in central Mexico (10.4 %) and the lowest in the south (3.8 %) (p < 0.001). MASLD was the leading etiology (39.1 %), followed by HCV (33.0 %) and ALD (18.6 %).

Conclusions: These findings highlight the growing impact of MASLD as the leading cause of HCC in patients with cirrhosis in Mexico, with notable age, sex and regional disparities. Understanding these patterns is essential to inform targeted prevention and early detection strategies.