Burden of liver cancer in adolescents and young adults aged 15-49 years in China: a comprehensive analysis based on the Global Burden of Disease study (1990-2021)

Background: Liver cancer is one of the leading causes of cancer-related deaths worldwide. The primary causes of liver cancer include hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol consumption, non-alcoholic fatty liver disease, and other factors. The objective of this study was to evaluate the global, and gender-, age-, region-, country- and etiology-related liver cancer burden, as well as the trends in liver cancer caused by different etiologies. Methods: The causes of liver cancer from 1990 to 2017, including global, regional and national liver cancer incidence, mortality and etiology, were collected from the Global Burden of Disease study 2017, and the time-dependent change in the trends of liver cancer burden was evaluated by annual percentage change. Findings: The global liver cancer incidence and mortality have been increasing. There were 950,000 newly-diagnosed liver cancer cases and over 800,000 deaths in 2017, which are more than twice the numbers recorded in 1990. HBV and HCV are the major causes of liver cancer, and responsible for nearly 70% of the global liver cancer-related deaths and incidents. HBV is the major risk factor of liver cancer in Asia, while HCV and alcohol abuse are the major risk factors in the high SDI and high HDI regions. Liver cancer incidence and mortality are three times higher in males than in females, and the global liver cancer burden is highest among individuals order than 50 years. HBV is the main cause of liver cancer in individuals younger than 20 years. The mean onset age and incidence of liver cancer with different etiologies have gradually increased in the past 30 years. Interpretation: Liver cancer is a common malignancy with a high global disease burden. Although the implementation of public health measures such as hepatitis B immunization has reduced the incidence of liver cancer in some countries or territories, the global incidence is still rising and the causes have national, regional or population specificities. Therefore, more targeted prevention strategies must be developed for the different etiological types in order to reduce liver cancer burden. Funding Statement: This study was financially supported by the Fundamental Research Funds for the Central public welfare research institutes (ZXKT17013, ZZ11-092 and ZZ13-YQ059), and Young Elite Scientists Sponsorship Program by CACM(2018QNRC2-C01). Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: Not required.

Global prediction of primary liver cancer incidences and mortality in 2040

Background: Liver cancer is one of the leading causes of cancer-related deaths worldwide. The primary causes of liver cancer include hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol consumption, nonalcoholic fatty liver disease, and other factors. Aims: The objective of this study was to evaluate the global and sex-, age-, region-, country-, and etiology-related liver cancer burden, as well as the trends in liver cancer caused by different etiologies. Methods: The causes of liver cancer from 1990 to 2017, including global, regional, and national liver cancer incidence, mortality, and etiology, were collected from the Global Burden of Disease study 2017, and the time-dependent change in the trends of liver cancer burden was evaluated by annual percentage change. Results: The global liver cancer incidence and mortality have been increasing. There were 950,000 newly-diagnosed liver cancer cases and over 800,000 deaths in 2017, which is more than twice the numbers recorded in 1990. HBV and HCV are the major causes of liver cancer. HBV is the major risk factor of liver cancer in Asia, while HCV and alcohol abuse are the major risk factors in the high sociodemographic index and high human development index regions. The mean onset age and incidence of liver cancer with different etiologies have gradually increased in the past 30 years. Conclusions: The global incidence is still rising and the causes have national, regional, or population specificities. More targeted prevention strategies must be developed for the different etiologic types in order to reduce liver cancer burden.

ImportanceLiver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use.ObjectiveTo report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjusted life-years (DALYs) for 195 countries or territories from 1990 to 2015, and present global, regional, and national estimates on the burden of liver cancer attributable to HBV, HCV, alcohol, and an “other” group that encompasses residual causes.Design, Settings, and ParticipantsMortality was estimated using vital registration and cancer registry data in an ensemble modeling approach. Single-cause mortality estimates were adjusted for all-cause mortality. Incidence was derived from mortality estimates and the mortality-to-incidence ratio. Through a systematic literature review, data on the proportions of liver cancer due to HBV, HCV, alcohol, and other causes were identified. Years of life lost were calculated by multiplying each death by a standard life expectancy. Prevalence was estimated using mortality-to-incidence ratio as surrogate for survival. Total prevalence was divided into 4 sequelae that were multiplied by disability weights to derive years lived with disability (YLDs). DALYs were the sum of years of life lost and YLDs.Main Outcomes and MeasuresLiver cancer mortality, incidence, YLDs, years of life lost, DALYs by etiology, age, sex, country, and year.ResultsThere were 854 000 incident cases of liver cancer and 810 000 deaths globally in 2015, contributing to 20 578 000 DALYs. Cases of incident liver cancer increased by 75% between 1990 and 2015, of which 47% can be explained by changing population age structures, 35% by population growth, and −8% to changing age-specific incidence rates. The male-to-female ratio for age-standardized liver cancer mortality was 2.8. Globally, HBV accounted for 265 000 liver cancer deaths (33%), alcohol for 245 000 (30%), HCV for 167 000 (21%), and other causes for 133 000 (16%) deaths, with substantial variation between countries in the underlying etiologies.Conclusions and RelevanceLiver cancer is among the leading causes of cancer deaths in many countries. Causes of liver cancer differ widely among populations. Our results show that most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use. In line with the Sustainable Development Goals, the identification and elimination of risk factors for liver cancer will be required to achieve a sustained reduction in liver cancer burden. The GBD study can be used to guide these prevention efforts.

Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality and healthcare expenditure in patients with chronic liver disease. There are no consensus guidelines on diagnosis and management of HCC in India. The Indian National Association for Study of the Liver (INASL) set up a Task-Force on HCC in 2011, with a mandate to develop consensus guidelines for diagnosis and management of HCC, relevant to disease patterns and clinical practices in India. The Task-Force first identified various contentious issues on various aspects of HCC and these issues were allotted to individual members of the Task-Force who reviewed them in detail. The Task-Force used the Oxford Center for Evidence Based Medicine-Levels of Evidence of 2009 for developing an evidence-based approach. A 2-day round table discussion was held on 9th and 10th February, 2013 at Puri, Odisha, to discuss, debate, and finalize the consensus statements. The members of the Task-Force reviewed and discussed the existing literature at this meeting and formulated the INASL consensus statements for each of the issues. We present here the INASL consensus guidelines (The Puri Recommendations) on prevention, diagnosis and management of HCC in India.

Liver cancer remains a significant global health concern, with hepatitis B virus (HBV) as the leading cause. This study aims to systematically evaluate the global epidemiological burden, risk factors, and long-term trends of HBV-related liver cancer. Data from the Global Burden of Disease (GBD) study 2021 were used to analyze incidence, deaths, and prevalence rates of HBV-related liver cancer across 204 countries and territories. Age-period-cohort (APC) models were applied to assess age-specific trends, period effects, and cohort impacts on age-standardized disease burden. Pearson correlation analyses examined the relationship between liver cancer burden, the socio-demographic index (SDI), and the universal health coverage (UHC) index. We also evaluated the influence of other concomitant risk factors on HBV-related liver cancer deaths. Projections for future death trends were generated using Bayesian APC models. In 2021, there were 206,366 new cases of HBV-related liver cancer and 181,194 deaths worldwide. Between 1990 and 2021, both the global age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) showed an upward trend. The age-standardized death rate (ASDR) declined, particularly in middle SDI countries, where the ASDR dropped by 21.7%. Incidence rates decreased among individuals under 70 years old, while death rates dropped for those under 75 years. Period trends revealed an increase in incidence and deaths from 1995 to 2000, followed by a sharp decline from 2000 to 2010, with death reductions being more pronounced. The downward trend was most notable among birth cohorts from the 1970s onward. A negative correlation was found between the SDI, the UHC, and liver cancer burden. The number of deaths attributable to risk factors increased by 97.8% from 1990 to 2021. Projections indicate a 30.2% reduction in HBV-related liver cancer deaths globally by 2040. The global burden of HBV-related liver cancer showed significant regional disparities and presented ongoing global health challenges. Socioeconomic factors and healthcare access are closely associated with disease burden. Effective, region-specific interventions are essential to mitigate future HBV-related liver cancer burdens.

Liver cancer remains a significant public health issue in China, exhibiting high incidence, mortality, and burden. Understanding its temporal trends and projections is essential for designing targeted prevention and treatment strategies. This study analyzes long-term trends in liver cancer incidence, prevalence, mortality, and burden from 1990 to 2021, assessing age, period, and cohort effects, and projecting future trends. Data on liver cancer incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were analyzed from 1990 to 2021. Joinpoint regression analysis, age-period-cohort (APC) analysis, and BAPC modeling were applied to examine trends and project future trends. Decomposition analysis examined contributions of aging, epidemiological changes, and population growth. The study also compared China’s liver cancer trends with global data. From 1990 to 2021, China experienced a decrease in age-standardized rates for liver cancer incidence, prevalence, mortality, and burden. Notably, Age-standardized incidence rates (ASIR) exhibited a decline after 2016, with a significant reduction in the male population. In 2021, there were 196,637 new cases of liver cancer in China, with a higher burden in males. ASIR were 14.34 per 100,000 for males and 4.89 per 100,000 for females. Mortality also followed a declining trend, with a notable decrease in age-standardized mortality rates. The age-standardized mortality rate (ASMR) for males was 12.4 per 100,000, significantly higher than for females (4.57 per 100,000) in 2021. Additionally, the age-standardized prevalence rate (ASPR) was 20.0 for males and 6.64 for females, with 265,539 total cases. The burden, measured by DALYs, YLDs, and YLLs, also showed a notable decline in age-standardized rates and significant gender disparities. Despite this, the absolute number of cases, deaths, and DALYs has continued to rise due to population growth and aging, with males bearing a significantly higher burden than females. The study also highlights the impact of aging, population growth, and epidemiological changes on liver cancer incidence and mortality in China. Projections for 2030 suggest a continued decrease in liver cancer incidence, especially among females, reflecting the effectiveness of public health interventions and medical advancements. However, gender disparities remain significant, and further efforts are needed to reduce the overall liver cancer burden, with an emphasis on early detection and prevention strategies.

BACKGROUND With the rising prevalence of obesity, increasing alcohol consumption and the advances in hepatitis B virus (HBV) and C virus (HCV) treatment, liver cancer epidermiology gradually changes. However, the impact of these changes on liver cancer burden in China remains unclear. OBJECTIVE This study aimed to assess temporal trends in liver cancer burden across the whole country and 33 province-level administrative regions and the contributions of various liver cancer etiologies in China from 2010 to 2016. METHODS In this observational trend study, we collected data on incident cases, deaths cases, disability-adjusted life-years (DALYs), and age-standardised incidence/death rate for liver cancer between 2010 and 2016, by sex, age and cause using data from the Global Burden of Disease study 2016. The ASRs of liver cancer-related incidence and mortality in 33 province-level administrative regions of China were obtained from the National Central Cancer Registry (NCCR), which collected registration data from 2016 from a total of 682 cancer registries. The estimated annual percentage changes in the age-standardised incidence/death rate were calculated to quantify the changing trend. RESULTS Between 2010 and 2016, there was a 25% increase in incident liver cancer cases and a 22% increase in liver cancer deaths in China, while the ASIR and ASDR remained stable. South China, especially rural South, had the highest ASIR and ASDR of liver cancer, while North China had the lowest incidence rate and death rate in the whole country in 2016. The proportion of alcohol and non-alcoholic steatohepatitis (NASH)-assoicated liver cancer incidence and death increased, while the proportion of HBV-associated liver cancer incidence and death decreased between 2010 and 2016. NASH was the only etiology with an increase in liver cancer ASIRs, and alcohol also showed the fast growing incidence of liver cancer in some age groups. CONCLUSIONS Urgent measures are required at a national level to tackle the underlying metabolic risk factors and slow down the rising burden of NASH-induced liver cancer.

Liver cancer, a chronic non-communicable disease, represents a serious public health problem. Long-term trends in the burden of liver cancer disease are heterogeneous across regions. Incidence and mortality of liver cancer, based on the Global Burden of Disease, were collected from the Chinese Centre for Disease Control and Prevention. Age–period–cohort model was utilized to reveal the secular trends and estimate the age, period and cohort effects on primary liver cancer due to specific etiologies. Both the age-standardized incidence and mortality rate of liver cancer in Hubei province were on the rise, although there were discrepancies between gender groups. From age–period–cohort analysis, both incidence and mortality of liver cancer due to Hepatitis B virus were the highest in all age groups. The incidence of all liver cancer groups increased with time period in males, while this upward trend was observed in females only in liver cancer due to alcohol use group. Cohort effects indicated the disease burden of liver cancer decreased with birth cohorts. Local drifts showed that the incidence of liver cancer due to specific etiologies was increasing in the age group of males between 40 and 75 years old. The impact of an aging population will continue in Hubei Province. the disease burden of liver cancer will continue to increase, and personalized prevention policies must be adopted to address these changes.

Surveillance for Hepatocellular Carcinoma: Current Best Practice and Future Direction.

Liver cancer remains the leading cause of death and public health threat among the Mongolian population. So far, there has been no in-depth analysis to describe the burden of common attributable factors to liver cancer in Mongolia. Therefore, we aimed to explore the most prevalent causes of liver cancer and its trends from 1990 to 2019. We extracted the primary liver cancer data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to examine the mortality and morbidity of liver cancer by its etiological types, which included alcohol, viral hepatitis B and C, and non-alcoholic steatohepatitis (NASH). The data was extracted by sex and 5-year age intervals from 1990 to 2019. Data included mortality, incidence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of liver cancer among the Mongolian population. Mongolia had the world's highest age-standardized DALYs for liver cancer (2558.1) in 2019. Alcohol-attributable DALYs (786.6) were 29 times higher than the global average (26.1), and liver cancer due to hepatitis C (752.6) and B (763.2) were 21.5 (35.0) and 10.9 (69.1) times higher, respectively. Over the past 30 years, there has been a steady increase in the incidence and number of deaths caused by liver cancer in Mongolia. In 2019, liver cancer incidence due to alcohol consumption was 3.1 times higher for males than females, and hepatitis B was 2.7 times higher for males than females. However, the incidence of hepatitis C and NASH were slightly higher for females. Deaths from liver cancer accounted for 9.51% (2365) of total deaths in Mongolia in 2019, with a continuously increasing trend in the fraction of death compared to 1990, which was 11 times higher than the global average (0.86%), particularly in females with a 319.6% (95% UI 234.9-435.7) increase observed during the study period. Liver cancer due to hepatitis B, C, and alcohol each shared about one-third of liver cancer deaths. A comprehensive analysis of the burden of liver cancer in Mongolia reveals alcohol use as a primary cause of liver cancer mortality, particularly affecting men and significantly impacting the disease burden. Viral hepatitis continues to pose a major public health concern in the country. Although significant milestones have progressed, addressing the unique demographic and geographical challenges requires tailored approaches for specific target populations. The evidence generated from this analysis is crucial to support policy guidance, contribute to evidence-based decisions, guide public health prevention measures, and amplify population health promotion and disease prevention throughout Mongolia.

Changing global epidemiology of liver cancer from 2010 to 2019: NASH is the fastest growing cause of liver cancer

Background: Burden of liver cancer across the world is one of the most concerning. Iran as a developing country lacks a comprehensive review of liver cancer burden during recent years. This study aimed to evaluate the changing burden of liver cancer in Iran from 1990 to 2021. Methods: Data was extracted from global burden of disease study. Age standardized incidence and mortality rates (ASIR, ASMR) were the main metrics used in this study. Average Annual Percent Change (AAPC) was calculated for Iran and each province. Results: Liver cancer incidence rate in Iran increased to 2.70 [2.39 to 3.04] per 100,000 population in 2021 with an AAPC of 0.85 [0.61 to 1.08]. Mortality of liver cancer in 2021 increased to 2.87 [2.55 to 3.23], representing an AAPC of 0.83 [0.32 to 1.35]. Men faced a higher burden than women. The burden of liver cancer became more prominent with increasing age. The Incidence of NASH-related liver cancer shifted remarkably during the studied time period, surpassing trends of other risk factors (AAPC: 1.89 [1.75 to 2.03]). Ardebil showed the most significant increasing trends in incidence and mortality rates compared to other provinces. Incidence of liver cancer remained low in lower SDI provinces but gradually increased when moving towards high SDI ones, suggesting a positive correlation. Conclusion: This study highlights the concern for liver cancer rate and related death in Iran due to increasing shifts in mortality rates and death. Iranian policymakers must implement feasible preventive approaches to control liver cancer major risk factors such as NASH and Alcohol use.

Incidence of liver cancer as one of the most common cancers worldwide and become the significant contributor for the mortality among cancer patients. The disease burden, risk factors, and trends in incidence and mortality of liver cancer globally was described subsequently estimated the projections of liver cancer incidence or mortality by 2040. Data regarding age-standardized incidence and mortality rates for liver cancer was obtained from multiple databases, including GLOBOCAN 2020, CI5 volumes I–XI, WHO mortality database, and Global Burden of Disease (GBD)-2019. Concentrating on worldwide variations, this thorough analysis offers insights into patterns of incidence and mortality based on gender and age. Our findings encompass significant indicators, including age-standardized rates (ASRs), average annual percentage change (AAPC), and future projections extending up to the year 2040. Liver cancer holds the sixth position in terms of most frequently diagnosed cancers and stands as the sixth leading cause of cancer-related deaths worldwide in 2020, accounting for 905,677 new cases and 782,000 fatalities. Additionally, liver cancer contributed to 12,528,421 age-standardized disability-adjusted life years (DALYs), with an age-standardized DALYs rate of 161.92 in 2019 worldwide. The age-specific incidence rates exhibited significant variations across different regions, showing a fivefold difference in males and females. A significant increase in incidence was observed in North Europe and Asia, while North African countries reported a higher mortality burden (ASR, 10 per 100,000) compared to developed countries. Since last few years, the incidence and mortality rates have increased and attained Annual Average Percentage Change (AAPC) incidence rate of 7.7 (95% CI 3.9–11.6) for men and the highest AAPC mortality rate of 12.2 (95% CI 9.5–15.0) for women. In 2019, Western Europe emerged as the high-risk region for DALYs related to smoking and alcohol consumption, while high-income North America carried a high risk for DALYs associated with a high body-mass index. The projected trend indicates a surge in new liver cancer incident cases, expected to rise from around 905,347 to an estimated 1,392,474 by 2040. This study described the evidence pertinent to higher incidence trends in liver cancer, particularly among both young and older adults, encompassing males and females, as well as those who are HIV-infected and HBsAg positive. A significant rise in the young population poses a significant public health concern that warrants attention from healthcare professionals to prioritize the promotion of health awareness and the development of effective cancer prevention strategies, particularly in many developing countries.

ObjectivePrimary liver cancer is not only one of the most common causes of cancer deaths but also the second most common cause of premature death worldwide. Understanding the trends in incidence and mortality of primary liver cancer and its etiologies is crucial for development of effective prevention and mitigation strategies. This study aimed to quantify the trends in incidence and mortality of primary liver cancer and its etiologies at the global, regional and national levels using data from Global Burden of Disease (GBD) study.MethodAnnual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of primary liver cancer and its etiologies, including hepatitis B, hepatitis C, alcohol use, nonalcoholic steatohepatitis, and other causes, between 1990 and 2019 were collected from GBD study 2019. Percentage changes in incident cases and deaths and estimated annual percentage changes (EAPCs) in ASIRs and ASMRs of primary liver cancer and its etiologies were calculated to quantify their temporal trends. Correlations of EAPC in ASIRs and ASMRs with socio-demographic index (SDI) and universal health coverage index (UHCI) in 2019 were separately evaluated by Pearson correlation analyses.ResultsGlobally, the incident cases and deaths of primary liver cancer increased by 43.11% from 373 393 in 1990 to 534 365 in 2019 and 32.68% from 365 213 in 1990 to 484 584 in 2019, respectively. ASIR and ASMR of primary liver cancer decreased by an average of 2.23% (95% CI 1.83%, 2.63%) and 1.93% (95% CI 1.55%, 2.31%) per year between 1990 and 2019 worldwide, respectively. ASIRs and ASMRs of primary liver cancer varied between regions, with an increasing trend in ASIR (EAPC = 0.91; 95% CI 0.47, 1.35) and a stable trend in ASMR (EAPC = 0.42, 95% CI − 0.01, 0.85) of primary liver cancer in high SDI region between 1990 and 2019. Nearly half (91/204) of the countries suffered an increasing trend in ASIR of primary liver cancer and more than one-third (71/204) of the countries suffered an increasing trend in ASIRs of primary liver cancer from all etiologies between 1990 and 2019 worldwide. Positive correlations of EAPC in ASIR and ASMR of primary liver cancer with SDI and UHCI were observed in nations with SDI ≥ 0.7 or UHCI ≥ 70.ConclusionPrimary liver cancer remains a major public health concern globally, with an increasing trend in the numbers of incident cases and deaths in the past three decades. We observed an increasing trend in ASIR of primary liver cancer in nearly half of the countries and an increasing trend in ASIRs of primary liver cancer by etiology in more than one-third of the countries worldwide. In line with the Sustainable Development Goals, the identification and elimination of risk factors for primary liver cancer will be required to achieve a sustained reduction in liver cancer burden.