Liver cancer in 2021: Global burden of disease study

En Ying Tan; Pojsakorn Danpanichkul; Jie Ning Yong; Zhenning Yu; Darren Jun Hao Tan; Wen Hui Lim; Benjamin Koh; Ryan Yan Zhe Lim; Ethan Kai Jun Tham; Kartik Mitra; Asahiro Morishita; Yao-Chun Hsu; Ju Dong Yang; Hirokazu Takahashi; Ming-Hua Zheng; Atsushi Nakajima; Cheng Han Ng; Karn Wijarnpreecha; Mark D Muthiah; Amit G Singal; Daniel Q Huang

doi:10.1016/j.jhep.2024.10.031

Liver cancer in 2021: Global burden of disease study

J Hepatol. 2024 Oct 30:S0168-8278(24)02652-7. doi: 10.1016/j.jhep.2024.10.031. Online ahead of print.

Authors

En Ying Tan¹, Pojsakorn Danpanichkul², Jie Ning Yong³, Zhenning Yu³, Darren Jun Hao Tan³, Wen Hui Lim³, Benjamin Koh³, Ryan Yan Zhe Lim³, Ethan Kai Jun Tham³, Kartik Mitra³, Asahiro Morishita⁴, Yao-Chun Hsu⁵, Ju Dong Yang⁶, Hirokazu Takahashi⁷, Ming-Hua Zheng⁸, Atsushi Nakajima⁹, Cheng Han Ng¹⁰, Karn Wijarnpreecha¹¹, Mark D Muthiah¹², Amit G Singal¹³, Daniel Q Huang¹⁴

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore.
² Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA.
³ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴ Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan.
⁵ Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
⁶ Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁷ Liver Center, Faculty of Medicine, Saga University Hospital, Saga University, Saga, Japan.
⁸ MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁹ Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
¹⁰ Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore; Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
¹¹ Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA.
¹² Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹³ Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.
¹⁴ Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: daniel_huang@nus.edu.sg.

PMID: 39481652
DOI: 10.1016/j.jhep.2024.10.031

Abstract

Background & aims: The epidemiology of adult primary liver cancer continues to evolve, owing to the increasing prevalence of metabolic disease, rising alcohol consumption, advances in vaccination for HBV, and antiviral therapy for HCV. Disparities in care and the burden of liver cancer between populations persist. We assess trends in the burden of liver cancer and contributions by various etiologies across 204 countries and territories from 2010 to 2021.

Methods: Utilizing the methodological framework of the Global Burden of Disease Study 2021, we analyzed global and regional temporal trends in incidence and mortality, and the contributions of various etiologies of liver disease.

Results: In 2021, there were an estimated 529,202 incident cases and 483,875 deaths related to liver cancer. From 2010 to 2021, global liver cancer incident cases and deaths increased by 26% and 25%, respectively. Global age-standardized incidence rates (ASIRs) and death rates (ASDRs) for liver cancer declined but rose in the Americas and Southeast Asia. HBV remained the dominant cause of global incident liver cancer cases and deaths. MASLD (metabolic dysfunction-associated steatotic liver disease) was the only etiology of liver cancer with rising ASIRs and ASDRs. By contrast, ASIRs and ASDRs remained stable for alcohol-related liver cancer, and declined for HBV- and HCV-related liver cancer.

Conclusions: While age-adjusted incidence and deaths from liver cancer have started to decline, the absolute number of incident cases and deaths continues to increase. Population growth and aging contribute to the observed disconnect in the temporal trends of absolute cases and rates. Disparities remain, and MASLD-related liver cancer continues to surge.

Impact and implications: Liver cancer remains a major cause of death globally, but its causes and burden in various regions are changing. This study highlights that new diagnoses and deaths related to liver cancer continue to rise. Age-adjusted death rates of liver cancer related to viral hepatitis are declining but remain high. By contrast, age-adjusted death rates of liver cancer related to MASLD (metabolic dysfunction-associated steatotic liver disease) are rising. Sustained efforts and resources are needed to eliminate viral hepatitis, reverse current trends in heavy alcohol use, and tackle the metabolic risk factors of MASLD.

Keywords: alcohol; hepatitis B; hepatitis C; hepatocellular carcinoma; hepatoma; metabolic dysfunction-associated steatohepatitis; metabolic dysfunction-associated steatotic liver disease; steatotic liver disease.