# Incidence of hepatocellular carcinoma in beta thalassemia: a systematic review and meta-analysis

## TL;DR

This study finds a 1.96% incidence of liver cancer in beta thalassemia patients, possibly due to iron overload or infections.

## Contribution

This is the first meta-analysis quantifying hepatocellular carcinoma incidence in thalassemia patients using pooled data from multiple studies.

## Key findings

- The pooled incidence of hepatocellular carcinoma in thalassemia patients is 1.96%.
- Most hepatocellular carcinoma cases were linked to hepatitis C or B infections.
- High variability in incidence suggests other contributing factors beyond iron overload.

## Abstract

Current evidence indicates that iron overload increases the risk of hepatocellular carcinoma. However, the incidence of hepatocellular carcinoma in thalassemia is still unclear. This review aims to summarize the current evidence regarding the incidence of hepatocellular carcinoma in thalassemia patients.

Detailed searches were conducted in several databases, including PubMed, Europe PMC, EBSCOHost, and ProQuest. Keywords such as “thalassemia” and “hepatocellular carcinoma,” along with other relevant synonyms, were used. Articles investigating the incidence of hepatocellular carcinoma in thalassemia patients were included. Pooled estimates were calculated using the DerSimonian Laird inverse-variance random effect model and presented as incidence (%) along with their 95 % confidence intervals and 95 % prediction intervals.

From a total of 318 articles, five studies encompassing a total of 9592 thalassemia patients were included in this study. The cumulative incidence of hepatocellular carcinoma in thalassemia patients was 1.96 % (95 % confidence interval: 0.88 %–4.27 %; prediction interval: 0.12 %–24.74 %; I2 = 86.8 %). Of the 139 hepatocellular carcinoma patients, 121 were reported positive for anti-HCV, 78 for HCV RNA, three for HbsAg, and 50 positive for anti-HBV or had past infections. The liver iron concentration and ferritin level ranges in all studies were 2.95–10.5 mg/g and 3.1–2950 µg/L, respectively.

The present meta-analysis demonstrates that the incidence of hepatocellular carcinoma in thalassemia patients was high (1.96 %). It might be caused by liver infection, iron overload, or something else.