Evolving Global Etiology of Hepatocellular Carcinoma (HCC): Insights and Trends for 2024

Abstract

The epidemiology of HCC is changing all over the world and the incidence of HCC is expected to continue increasing over the next 30 years. The changes are in the predisposing factors. Hepatitis B and hepatitis C as predisposing etiologies are decreasing while NAFLD/MAFLD is increasing. The increase in MAFLD is so great that despite the decrease in hepatitis B and C, the overall incidence of HCC is increasing. HCC in persons below the age of 20 years has distinct characteristics different from that of HCC in adults. The changing etiology of hepatocellular carcinoma has implications for the early detection, prevention, the stage of HCC at time of detection and in the treatment of HCC. The extent of these changes and their significance are discussed.

Keywords: alcohol; cancer; diabetes mellitus; liver; obesity.

Figure 1

Global cancer site ranking.

Figure 2

Estimated numbers from 2022 to 2050, Males and Females, age [0-85+] Liver and intrahepatic bile ducts,.

Figure 3

Age-standardized rate (Asia) per 100,000, Incidence, Both sexes, in 2022 Liver and intrahepatic bile ducts. ASR, Age-Standardized Rate.

Figure 4

Postulated hormonal mechanism to explain why HCC is more common in men than in women. Adapted from Greten TF. J Exp Med. 2019;216:1014-1015.

Figure 5

Age at detection of HCC in India,.^,

Figure 6

Incidence of HCC from 1973 to 2014 in Shanghai City.

Figure 7

Treatment of HBV with antivirals reduces incidence of HCC.^, HBV, hepatitis B virus; HCC, hepatocellular carcinoma; ETV, entecavir; LAM, lamivudine; TDF, tenofovir disoproxil fumarate.

Figure 8

Treatment of HCV with antivirals reduces incidence of HCC.^, HCC, hepatocellular carcinoma; HCV, hepatitis C virus; SVR, sustained viral response.

Figure 9

Global trend in obesity.

Figure 10

Age-standardized global rate of diabetes.

Figure 11

Global prevalence of NAFLD increasing over time, %.^,

Figure 12

NASH HCC. ALD, alcohol-associated liver disease; CHB, chronic hepatitis B; CHC, chronic hepatitis C; NASH, non-alcoholic steatohepatitis.

Figure 13

NCCR database. All ICCC Sites Combined Incidence Rates by Age at Diagnosis, 2016–2020. ICCC, International Classification of Childhood Cancer; NCCR, National Childhood Cancer Registry.

Figure 14

Reduction in HCC in age group 6–19 after universal HBV vaccination in Taiwan. Pre-HBV vaccination (PreVac), 1973 to 1984, Post-HBV vaccination (PostVac), 1984 to 2004.