Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related death in Ethiopia, with a 100% fatality rate. Despite its significance, data on its epidemiology and clinical predictors remain scarce. This study aimed to determine the epidemiology, clinical presentation, and predictors of HCC among patients with liver disease in northern Ethiopia.

Methods: We conducted a retrospective cross-sectional chart review of patients evaluated for liver disease at the regional hepatology clinic of Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, between September 2017 and December 2020. A total of 350 patient records meeting the inclusion criteria were analyzed. Binary and multivariable logistic regression models were used to identify predictors of HCC, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Statistical significance was set at p < 0.05.

Results: Of the 350 liver disease patients, 51 (14.6%, 95% CI 10.9–18.3) had HCC. The mean age was 47.3 ± 14.5 years, and 74.5% of HCC cases were male. Independent predictors of HCC included hepatitis C virus infection (AOR = 3.34, 95% CI 1.04–10.74), liver cirrhosis (AOR = 7.04, 95% CI 2.82–17.56), right upper quadrant pain (AOR = 2.77, 95% CI 1.22–6.27), loss of appetite (AOR = 2.37, 95% CI 1.11–5.02), and hepatomegaly (AOR = 2.63, 95% CI 1.11–6.24).

Conclusion: HCC accounted for a considerable proportion of liver disease in this resource-limited setting, predominantly affecting middle-aged men. Hepatitis C virus infection and cirrhosis were strongly associated factors. Clinical features such as right upper quadrant pain, anorexia, and hepatomegaly are significant indicators. Strengthening early detection and management of chronic liver diseases is crucial to reducing the burden of HCC in Ethiopia.
Implications for practice or policy:The findings highlight the need to strengthen early detection and management of chronic liver diseases, particularly hepatitis C and cirrhosis, in resource-limited settings. Integrating risk-based HCC screening into routine hepatology care, improving access to basic diagnostic tools, and enhancing clinician awareness of key clinical indicators may enable earlier diagnosis. At the policy level, developing national HCC surveillance guidelines and expanding hepatitis prevention and treatment programs are critical to reducing HCC-related morbidity and mortality in Ethiopia.