Background: Hepatocellular carcinoma (HCC) is the commonest primary cancer of liver. Epidemiologic research exploring risk
factors of HCC is important because of increasing frequency of the disease in Egypt with remarkable rise in noncirrhotic patients.
Identifying risk factors of HCC may help in decreasing its incidence.
Aim: This study was carried out to identify risk factors of HCC among both cirrhotic and noncirrhotic patients in Upper Egypt.
Methods: A case control study of 104 cases with HCC against 104 controls without HCC were recruited from Tropical Medicine
and Gastroenterology Department, Assiut University Hospital; patients were from the governorates of Assiut, Sohag, Qena, and
Aswan. Patients were divided into two groups, cirrhotics and noncirrhotics. For all participants, the following was conducted:
clinical evaluation, abdominal ultrasonography examination, and laboratory investigations. Risk factors of HCC were identified
using univariate then multivariate analysis.
Results: Cirrhotic patients constituted 60.6% of the total sample while noncirrhotic patients constituted 39.4%. Among cirrhotic
patients, higher risk of HCC was observed with underground water use (OR 15.825, 95% CI 4.462-56.128), tobacco smoking
(OR 7.755, 95% CI 2.790-21.558), and metabolic syndrome (OR 5.595, 95% CI 1.565-20.009), While risk factors of HCC in
noncirrhotic patients were found to be positive HBsAg (OR 15.223, 95% CI 2.009-115.352), tobacco smoking (OR 8.349, 95%
CI 2.113-32.982), metabolic syndrome (OR 7.374, 95% CI 1.635-33.266), and manual agricultural job (OR 7.001, 95% CI 1.604-
30.648).
Conclusion: Distinct patterns of HCC risk factors exist among cirrhotic and noncirrhotic patients, with a common ground. The
risk factor of HCC in cirrhotic patients was underground water use while chronic HBV infection and manual agricultural job
were risk factors in noncirrhotic patients. For both cirrhotic and noncirrhotic patients, tobacco smoking and metabolic syndrome
were common risk factors of HCC.