Objective: Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide. In this review we aimed at investigating the severe and challenging risk factors for HCC in Eastern Mediterranean region.

Materials and Methods: A systematic search was conducted from 2000 to December 2022 using the Scopus, PubMed, and Web of Science databases. Joanna Briggs Institute Critical appraisal checklist served as the basis for assessing quality. For the analysis, CMA software version 3 was used.

Results: Finally, the meta-analysis included 16 articles. Based on the development, the incidence of HCC significantly decreased from 2000 to 2022 in EMRO countries. There was a significant association between HCC and viral hepatitis (OR=7.8, 95% CI: 4.7-12.9, p<0.001). Also, no meaningful correlation was observed between alcohol users and the development of HCC based on the results. Cigarettes play a non-significant protective role in HCC development (OR: 0.90, 95% CI: 0.55-1.48, p=0.7).

Conclusions: Alcohol consumption and smoking, unlike the virus, have no significant relationship with HCC. There is a possibility that the effect of factors affecting HCC may vary in different geographical areas.