Prevalence of viral infection and its impact on early-stage hepatocellular carcinoma: Insights from Mongolia, a developing country

Background : Hepatocellular carcinoma (HCC) is a significant global health challenge, especially in regions with high viral hepatitis prevalence. This study establishes the significance of this burden by evaluating the prevalence of viral hepatitis infections and their direct impact on tumor severity in early-stage HCC. Methods : A retrospective, cross-sectional study was conducted utilizing data from 609 patients diagnosed with early-stage HCC at the National Cancer Center of Mongolia between January 1, 2018, and December 31, 2022. Data regarding single and co-infections of hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV), alongside clinical and demographic variables, were analyzed. The primary statistical approach utilized multivariable logistic regression to identify independent predictors for tumor size and lesion number. Results : The overall prevalence of viral infections in the cohort was 81.1% (n = 494). HCV and HBV were the dominant single infections, observed in 51.7% and 38.4% of patients, respectively, while viral co-infections (≥ 2 viruses) were present in 19.2%. Significant demographic disparities were identified, with viral infections generally presenting in older patients (mean age 62.3 vs. 59.6 years, P = 0.012) and females (P = 0.015). Crucially, multivariable regression demonstrated that viral co-infection is an independent predictor for worse tumor burden; after adjusting for clinical and demographic covariates, co-infection was significantly associated with larger tumor size (> 3.0 cm: adjusted odds ratios [aOR] = 3.14, 95% confidence intervals [CIs]: 1.74–5.66, P < 0.001) and the presence of multiple lesions (≥ 3 lesions: aOR = 7.60, 95% CI: 1.60–35.99, P = 0.011). Conclusion : The profound burden of viral hepatitis and its strong association with aggressive tumor characteristics highlight a critical health crisis in Mongolia. These findings necessitate immediate, comprehensive public health interventions, including sustaining universal HBV vaccination programs, expanding equitable access to affordable antiviral therapies for HBV and HCV, initiating targeted screening programs for high-risk demographics, and aggressively preventing HDV superinfection among chronic HBV carriers.