Tan En Ying, Danpanichkul Pojsakorn, Yong Jie Ning, Yu Zhenning, Tan Darren Jun Hao, Lim Wen Hui, Koh Benjamin, Lim Ryan Yan Zhe, Tham Ethan Kai Jun, Mitra Kartik, Morishita Asahiro, Hsu Yao-Chun, Yang Ju Dong, Takahashi Hirokazu, Zheng Ming-Hua, Nakajima Atsushi, Ng Cheng Han, Wijarnpreecha Karn, Muthiah Mark D, Singal Amit G, Huang Daniel Q
Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore.
Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA.
J Hepatol. 2025 May;82(5):851-860. doi: 10.1016/j.jhep.2024.10.031. Epub 2024 Oct 30.
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.
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.
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. Age-standardized incidence rates (ASIRs) and death rates (ASDRs) for liver cancer declined globally, 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.
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 the incidence and mortality associated with MASLD-related liver cancer continue to rise.
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.
由于代谢性疾病患病率上升、酒精消费量增加、乙肝疫苗接种进展以及丙肝抗病毒治疗等因素，成人原发性肝癌的流行病学情况持续演变。不同人群在肝癌治疗及负担方面的差异依然存在。我们评估了2010年至2021年期间204个国家和地区肝癌负担的趋势以及各种病因的贡献。
利用《2021年全球疾病负担研究》的方法框架，我们分析了发病率和死亡率的全球及区域时间趋势，以及肝病各种病因的贡献。
2021年，估计有529,202例肝癌新发病例和483,875例死亡病例。从2010年到2021年，全球肝癌新发病例和死亡病例分别增加了26%和25%。全球肝癌的年龄标准化发病率（ASIRs）和死亡率（ASDRs）有所下降，但在美洲和东南亚地区有所上升。乙肝仍然是全球肝癌新发病例和死亡的主要原因。代谢功能障碍相关脂肪性肝病（MASLD）是唯一一种年龄标准化发病率和死亡率上升的肝癌病因。相比之下，酒精性肝癌的年龄标准化发病率和死亡率保持稳定，而乙肝和丙肝相关肝癌的年龄标准化发病率和死亡率则有所下降。
虽然肝癌的年龄调整发病率和死亡率已开始下降，但新发病例和死亡的绝对数量仍在增加。人口增长和老龄化导致了绝对病例数和发病率时间趋势上的这种脱节。差异仍然存在，与MASLD相关肝癌的发病率和死亡率继续上升。
肝癌仍然是全球主要死因，但其在不同地区的病因和负担正在发生变化。本研究强调，与肝癌相关的新诊断病例和死亡人数持续上升。病毒性肝炎相关肝癌的年龄调整死亡率正在下降，但仍然很高。相比之下，MASLD（代谢功能障碍相关脂肪性肝病）相关肝癌的年龄调整死亡率正在上升。需要持续努力并投入资源来消除病毒性肝炎、扭转当前重度饮酒的趋势以及应对MASLD的代谢风险因素。
