image: Global, regional, and national burden of hepatocellular carcinoma and contribution of nine modifiable risk factors across 185 countries/territories in 2022
Credit: ©Science China Press
An international collaborative study published in Science Bulletin reveals that over 680,000 new cases of hepatocellular carcinoma (HCC) were estimated worldwide in 2022, with 78.4% (nearly 537,000 cases) attributable to nine modifiable risk factors. This comprehensive analysis, spanning 185 countries and territories, highlighting the urgent need for strengthening country-specific preventive strategies.
Led by researchers from the Second Military Medical University, the National Cancer Center of China, and Sydney University, the study retrieved data from GLOBOCAN 2022, CI5, GBD 2021, and other major databases. The nine major modifiable risk factors were categorized as infections (hepatitis B or C virus [HBV, HCV], or C. sinensis), metabolic factors (obesity, type 2 diabetes mellitus, and metabolic dysfunction-associated steatotic liver disease [MASLD]), and behavioral/toxic factors (high alcohol use, smoking, and aflatoxin B1)
Globally, infections contributed most HCC cases (population attributable fraction [PAF] 65.9%), followed by behavioral/toxic factors (22.4%) and metabolic factors (19.7%). The research underscores significant regional variations in risk distribution: HBV is the leading cause in Eastern Asia, while smoking is predominant in Northern America and high alcohol use in Western Europe. Between 1990 and 2022, the study observed a global decline in HCC burden linked to infectious and behavioral/toxic factors, accompanied by a steady increase associated with metabolic factors, reflecting the evolving impact of lifestyle changes.
“These findings clearly demonstrate that the majority of HCC cases are preventable,” emphasized corresponding author Professor Guangwen Cao. “Our study provides the evidence to support policymakers and healthcare planners in prioritizing and implementing high-impact, etiology-specific preventive programs at both national and global levels.”
The researchers advocate for multifaceted, targeted strategies to mitigate HCC global health burden, including strengthening HBV/HCV vaccination and screening in high-burden regions (e.g. Africa), implementing stricter tobacco and alcohol control measures in America and Europe, and addressing the escalating metabolic risk factors worldwide.
Authorship: The paper was co-corresponded by Professors Guangwen Cao, Hongmei Zeng, and Xue Qin Yu. Ping Li, Zhan Ding, Yuqi Feng, Xiangyu Ren, and Yongyue Wei are co-first authors. The collaboration includes researchers from institutions in China, the USA, the Netherlands, and Australia.
Funding: This work was supported by the National Nature Science Foundation of China [grant number 82473715 (GC)], Noncommunicable Chronic Disease-National Science and Technology Major Project [2024ZD0525401, (HZ), 2023ZD0500100 (GC)], and 3-year public health program of Shanghai Municipal Health Commission [grant number GWVI-11.1-10 (GC)].
Journal
Science Bulletin