肝细胞癌（HCC）通常与肝硬化背景有关。近年来，随着新型抗病毒药物的问世、生活方式的改变和早期检测的可能性增加，HCC的流行病学发生了变化。我们进行了多中心国家哨兵监测，评估与肝硬化背景有无开发HCC的可归因风险因素。包括11个参与中心的从2017年1月到2022年8月的医院记录的数据。包括被诊断出的肝硬化[放射学（多期和/或组织病理学）]和HCC [根据AASLD 2018]。通过AUDIT-C问卷调查了饮酒史。共评估了5798名入院患者，其中2664名患有HCC。平均年龄为58.2±11.7岁，84.3%（n=2247）为男性。糖尿病在患有HCC者中超过三分之一（n=1032;39.5%）。HCC最常见的病因是NAFLD（n=927;35.5%），其次是病毒性乙肝和丙肝和有害酒精水平。在具有HCC的人群中，27.9%（n=744）没有肝硬化。肝硬化HCC患者中，具有酒精病因的比例高于非肝硬化患者（17.5 vs. 4.7%，p≤0.001）。与肝硬化HCC相比，非肝硬化HCC患者中NAFLD是病因因素的比例更高（48.2 vs. 30.6%，p≤0.001）。糖尿病患者更常见于非肝硬化HCC（50.5 vs. 35.2%）。男性（OR 1.372和95% CI 1.070-1.759）、年龄在60岁以上（OR 1.409和95% CI 1.176-1.689）、HBV（OR 1.164和95% CI 0.928-1.460）、HCV（OR 1.228和95% CI 0.964-1.565）和有害饮酒（OR 3.472和95% CI 2.388-5.047）与肝硬化HCC发生有关。非肝硬化患者具有NAFLD的调整比值为1.553（95% CI 1.290-1.869）。这项大规模多中心研究表明，在印度，NAFLD是发展肝硬化和非肝硬化HCC的最重要的风险因素，并已超过病毒性肝炎。需要开展宣传活动和大规模筛查，以减少印度NAFLD相关HCC的高负担。©2023年。亚太肝脏研究协会。

Hepatocellular cancer (HCC) typically arises in the background of cirrhosis. The epidemiology of HCC has changed in recent years due to availability of newer antivirals, changing life-styles and greater possibility for early detection. We undertook a multicentric national sentinel surveillance for liver cirrhosis and HCC to assess the attributable risk factors for the development of HCC, both with and without a background of cirrhosis.Data from January 2017 till August 2022 from hospital-based records of eleven participating centers were included. Diagnosed cases of cirrhosis [radiological (multiphase and/or histopathological] and HCC [as per AASLD 2018] were included. History of significant alcohol intake was elicited by AUDIT-C questionnaire.Altogether 5798 enrolled patients were assessed, of which 2664 patients had HCC. The mean age was 58.2 ± 11.7 years and 84.3% (n = 2247) were males. Diabetes was found in over a third of those with HCC (n = 1032;39.5%). The most common etiology of HCC was NAFLD (n = 927;35.5%) followed by viral hepatitis B and C and harmful levels of alcohol. Among those with HCC, 27.9% (n = 744) had no cirrhosis. Higher proportion of cirrhotic HCC patients had alcohol as an etiological factor as compared to non-cirrhotic (17.5 vs. 4.7%, p ≤ 0.001). NAFLD was an etiological factor for a higher proportion of non-cirrhotic HCC patients as compared to cirrhotic HCC (48.2 vs. 30.6%, p ≤0.001). Diabetics more commonly had non-cirrhotic HCC (50.5 vs. 35.2%). The following factors were associated with an occurrence of cirrhotic HCC: male gender (OR 1.372 and 95% CI 1.070-1.759), age above 60 years (OR 1.409 and 95% CI 1.176-1.689), HBV (OR 1.164 and 95% CI 0.928-1.460), HCV (OR 1.228 and 95 CI 0.964-1.565) and harmful consumption of alcohol (OR 3.472 and 95% CI 2.388-5.047). The adjusted odds of non-cirrhotic patients having NAFLD was 1.553 (95% CI 1.290-1.869).This large multi-centric study demonstrates that NAFLD is the most important risk factor for development of both cirrhotic and non-cirrhotic HCC in India and has overtaken viral hepatitis. Awareness campaigns and large-scale screening are required to reduce the high burden of NAFLD-related HCC in India.© 2023. Asian Pacific Association for the Study of the Liver.