Global Incidence Trends in Very-Early-, Early-, and Late-Onset Primary Liver Cancer by Sex, Region, and Aetiology: A Study Based on Global Burden of Disease Study 2017

Abstract

Background: The incidence of liver cancer continues to increase worldwide. The incidence trends and onset patterns of liver cancer associated with different onset ages remain unknown. Methods: We collected detailed information on liver cancer between 1990 and 2017 from the Global Burden of Disease Study (GBD) study 2017. Estimated annual percentage changes (EAPCs) in the liver cancer age-standardized incidence rate (ASR) by onset age, sex, region, and aetiology were calculated to quantify the temporal trends in liver cancer ASR. Findings: The ASR of very-early-onset (onset at < 30 years) and earlyonset (onset from 30-59 years) liver cancer decreased in both sexes, whereas the ASR of late-onset (onset at ≥ 60 years) liver cancer increased in males (EAPC = 0.64, 95% confidence interval [CI] 0.52, 0.75) and remained stable in females at the global level. Males had a more dramatic increase in late-onset liver cancer but a milder decrease in early-onset liver cancer than females. The decrease was largely ascribed to the reduction in liver cancer caused by hepatitis B and hepatitis C and was consistent in most regions except in developed countries, in which the ASR of liver cancer increased irrespective of sex and onset age. The ASR of liver cancer due to non-alcoholic steatohepatitis (NASH) increased by the greatest magnitude in most regions. Interpretation: Liver cancer in highly endemic regions has been partly alleviated due to the potent control of hepatitis, especially among young and middle-aged people. However, an unfavourable trend was observed in most developed countries and in elderly populations. NASH and older people deserve more attention in liver cancer primary prevention schedules. Funding Statement: This work was supported by the National Key Research and Development Program of China (grant number: 2017YFC0907002, 2017YFC0907501, 2017YFC211700); the National Natural Science Foundation of China (grant numbers: 81772170, 81502870); the key basic research grants from the Science and Technology Commission of Shanghai Municipality (grant number: 16JC1400500); the International ST and Shanghai Municipal Science and Technology Major Project (2017SHZDZX01). Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: Missing.