Md Yasir Arafat, Md Shahidur Rahman, Md Abdul Mumit Sarkar, A K M Jubaere, Mohammed Tozammel Haque, Mohammad Shahidul Islam, Md Saiful Malek, Ratan Chandra Bhowmik, Khondoker Monirul Alam
Hepatocellular carcinoma (HCC) remains a major health burden in low- and middle-income countries, where delayed diagnosis and limited healthcare access worsen outcomes. The aim of this study was to characterize HCC presentation at diagnosis, identify factors associated with advanced-stage disease, and assess disparities between guideline-recommended and delivered treatment in Bangladesh. In this multicenter cross-sectional study, 267 consecutively diagnosed patients were assessed for eligibility, of whom 245 were included in the final analysis. Demographic, clinical, diagnostic, and treatment data were collected. Investigator-assigned guideline-recommended treatment based on AASLD/BCLC criteria was compared with delivered treatment. Multivariable logistic regression was performed to identify factors associated with advanced-stage HCC (BCLC C/D). Median age was 50 years, 85.3% were male, and hepatitis B was the predominant etiology (69.8%). Advanced-stage HCC was present in 69.0%, whereas only 6.9% had early-stage disease (BCLC 0/A). Child–Turcotte–Pugh class C (aOR 6.61), ECOG 3 (aOR 64.97), and portal vein tumor thrombosis (aOR 5.78) were independently associated with advanced-stage presentation. Treatment was initiated in 71.8% of patients; systemic therapy and best supportive care were the treatments most frequently recommended and received. Among patients with documented treatment initiation, concordance between recommended and received treatment was 73.3%, with the greatest discrepancies observed for curative and locoregional interventions. In Bangladesh, HCC is predominantly diagnosed at an advanced stage, with limited access to curative options and significant treatment gaps. These findings underscore the need for enhanced surveillance, timely referral, and expanded specialized care.