Characteristics of hepatocellular carcinoma in a Saudi tertiary care center: a 10-year retrospective study

To evaluate the clinical and pathological characteristics of hepatocellular carcinoma (HCC) diagnosed at a tertiary care center in Saudi Arabia over a 10-year period. This retrospective observational study included 44 patients diagnosed with HCC between January 2014 and December 2023. Demographic data, risk factors, tumor characteristics, and histopathological findings were extracted from medical records and pathology reports. The cohort showed a male predominance (77.3%), with a mean age of 65.8 years. Nearly half of patients (45.5%) had negative viral hepatitis tests. Vascular invasion and portal vein thrombosis occurred in 25.0% and 22.7%, respectively. The trabecular growth pattern predominated, and many patients presented with advanced disease features and substantial tumor burden. HCC was frequently diagnosed at an advanced stage, with a substantial proportion of viral-negative cases. These exploratory findings are consistent with an evolving epidemiologic profile of HCC in Saudi Arabia but do not establish a causal relationship between metabolic factors and HCC. Despite its retrospective single-center design and small sample size, this study provides contemporary real-world data and highlights the need for improved surveillance, earlier detection, and larger multicenter studies. Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and remains a major cause of illness and death worldwide. Understanding how this disease presents in different populations can help improve early detection and treatment. This study reviewed 44 patients diagnosed with HCC at a tertiary care center in Saudi Arabia between 2014 and 2023. Most patients were older adults, and the majority were male. Many patients were diagnosed when the disease was already advanced, with features such as large tumors, vascular invasion, or spread beyond the liver. As a result, many were not eligible for potentially curative treatments. An important finding was that almost half of the patients did not have evidence of hepatitis B or hepatitis C infection, which have traditionally been the main causes of HCC. Many patients also had metabolic conditions such as diabetes and hypertension. These observations are consistent with growing evidence that nonviral and metabolic risk factors may be becoming increasingly relevant to the epidemiology of liver cancer in Saudi Arabia; however, this study cannot establish a causal relationship. Although this was a relatively small study from a single institution, it provides recent real-world information about liver cancer in Saudi Arabia. The findings highlight the importance of improving surveillance programs, identifying high-risk individuals earlier, and strengthening strategies for prevention and early diagnosis to improve patient outcomes. This study evaluated the clinicopathological characteristics of 44 patients with hepatocellular carcinoma (HCC) diagnosed at a Saudi tertiary care center over a 10-year period.Most patients presented with advanced disease, including large tumor burden, vascular invasion, and portal vein thrombosis.Nearly half of the cohort lacked identifiable viral hepatitis infection, suggesting that nonviral risk factors warrant further investigation in this population.Metabolic comorbidities, particularly diabetes mellitus and hypertension, were common among affected patients.The coexistence of a substantial proportion of viral-negative HCC and common metabolic comorbidities is consistent with evolving regional epidemiologic patterns, although causal associations cannot be established from this study.Palliative therapy was the most frequently documented treatment approach, reflecting late-stage presentation.This study provides contemporary real-world data on HCC characteristics at a Saudi tertiary care center and helps address an important regional knowledge gap.Improved surveillance, earlier detection, and multidisciplinary management may increase access to curative treatment and improve patient outcomes. This study evaluated the clinicopathological characteristics of 44 patients with hepatocellular carcinoma (HCC) diagnosed at a Saudi tertiary care center over a 10-year period. Most patients presented with advanced disease, including large tumor burden, vascular invasion, and portal vein thrombosis. Nearly half of the cohort lacked identifiable viral hepatitis infection, suggesting that nonviral risk factors warrant further investigation in this population. Metabolic comorbidities, particularly diabetes mellitus and hypertension, were common among affected patients. The coexistence of a substantial proportion of viral-negative HCC and common metabolic comorbidities is consistent with evolving regional epidemiologic patterns, although causal associations cannot be established from this study. Palliative therapy was the most frequently documented treatment approach, reflecting late-stage presentation. This study provides contemporary real-world data on HCC characteristics at a Saudi tertiary care center and helps address an important regional knowledge gap. Improved surveillance, earlier detection, and multidisciplinary management may increase access to curative treatment and improve patient outcomes.