Abstract
Background & AimsThe incidence of primary liver cancer (PLC) is increasing in Western Europe. To understand trends over time and the current burden in the UK, a detailed analysis of the epidemiology of PLC and its subtypes was conducted.MethodsData on PLCs diagnosed during 1997–2017 were obtained from population-based, nationwide registries in the UK. European age-standardised incidence (ASR) and incidence-based mortality rates (ASMR) per 100,000 person-years were calculated overall and by sex and UK-nation. Annual percentage change in rates was estimated using Joinpoint regression. One-, 2-, and 5-year age-standardised net survival was estimated.ResultsA total of 82,024 PLCs were diagnosed. Both hepatocellular carcinoma (HCC) incidence and mortality rates trebled (ASR 1.8–5.5 per 100,000, ASMR 1.3–4.0). The rate of increase appeared to plateau around 2014/2015. Scottish men consistently had the highest HCC incidence rates. PLC survival increased, driven by a substantial increase in the proportion that are HCC (as prognosis is better than other PLCs) and in HCC survival (change in 1-year survival 24–47%). Intrahepatic cholangiocarcinoma was the most common PLC in women and 1-year survival improved from 22.6% to 30.5%.ConclusionsPLC incidence has been increasing rapidly but, as most risk factors are modifiable, it is largely a preventable cancer. This rate of increase has slowed in recent years, possibly attributable to effective treatment for hepatitis C. As other risk factors such as obesity and diabetes remain prevalent in the UK, it is unlikely the considerable burden of this disease will abate. While improvements in survival have been made, over half of patients are not alive after 1 year, therefore further progress in prevention, early detection, and treatment innovation are needed.Lay summaryMany more people are getting liver cancer, particularly the subtype hepatocellular carcinoma, than 20 years ago. Men in Scotland are most likely to get liver cancer and to die from it. Survival after liver cancer diagnosis is getting longer but still less than half are alive after 1 year.
Highlights
Primary liver cancer (PLC) is the fourth leading cause of cancerrelated mortality worldwide, causing an estimated 800,000 deaths in 2018.1 Incidence rates have been rising in many countries globally but rapidly in Western Europe, Australasia, and North America.[2]
Primary liver cancer (PLC) is the fourth leading cause of cancerrelated mortality worldwide, causing an estimated 800,000 deaths in 2018.1 Incidence rates have been rising in many countries globally but rapidly in Western Europe, Keywords: Primary liver cancer; Hepatocellular carcinoma; Intrahepatic cholangiocarcinoma; Incidence; Mortality; Survival
Over 60% of PLCs were in men (77% of hepatocellular carcinoma (HCC), 47% of intrahepatic cholangiocarcinoma (ICCA), and 58% of other liver tumours) and PLC incidence rates were over twice as high in men than in women (10.5 vs. 4.7 per 100,000, respectively)
Summary
Primary liver cancer (PLC) is the fourth leading cause of cancerrelated mortality worldwide, causing an estimated 800,000 deaths in 2018.1 Incidence rates have been rising in many countries globally but rapidly in Western Europe, Australasia, and North America.[2]. The main PLC subtype, hepatocellular carcinoma (HCC), is an epithelial tumour which shows hepatocytic differentiation and primarily occurs against a backdrop of cirrhosis, caused by factors such as chronic viral hepatitis, alcohol consumption, and nonalcoholic fatty liver disease. Results: A total of 82,024 PLCs were diagnosed Both hepatocellular carcinoma (HCC) incidence and mortality rates trebled (ASR 1.8–5.5 per 100,000, ASMR 1.3–4.0). Conclusions: PLC incidence has been increasing rapidly but, as most risk factors are modifiable, it is largely a preventable cancer. This rate of increase has slowed in recent years, possibly attributable to effective treatment for hepatitis C.
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