NASH ‘fastest growing cause’ of liver cancer death worldwide
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Despite global declines in liver cancer mortality attributed to hepatitis B and C, liver cancer mortality rose sharply in the Americas, driven by an increase in nonalcoholic steatohepatitis, according to data published in Cell Metabolism.
“NASH is the fastest growing cause of hepatocellular carcinoma in the Americas and the fastest growing cause of age-adjusted liver cancer deaths globally,” study co-author Rohit Loomba, MD, MHSc, professor of medicine, director of hepatology and the NAFLD Research Center, and vice chief of gastroenterology at the University of California, San Diego, told Healio. “Urgent measures are required at a global level to tackle the underlying metabolic risk factors and slow the growing burden of NASH-related liver cancer.”
Using data from the 2019 Global Burden of Disease study, Loomba and colleagues estimated trends in the burden of liver cancer and contributions of liver disease etiologies in 204 countries and territories from 2010 to 2019.
They identified 484,577 deaths worldwide due to liver cancer in 2019 compared with 386,342 deaths in 2010. Although researchers reported a 25% increase in liver cancer deaths and a 27% increase in liver cancer cases during this period, they noted no significant changes in age-standardized death and incidence rates.
“The growth, as well as aging, of the world population may contribute to the observed disconnect in the temporal trends of frequency and age-standardized incidence and death rates,” researchers wrote.
In addition, age-standardized death rates (ASDRs) from liver cancer increased only in the Americas from 2012 to 2019 (annual percent change [APC] = 1.09%; 95% CI, 0.97-1.22).
Globally, NASH was the fastest growing cause of age-adjusted liver cancer deaths (APC = 0.70%; 95% CI, 0.43-0.97) during the study period, followed by alcohol (APC = 0.23%; 95% CI, 0.09-0.37). The highest increase in alcohol-associated liver cancer was reported in the Americas (APC = 1.78%; 95% CI, 1.64-1.93).
“The global alcohol-per-capita consumption is projected to rise further, especially in the Western Pacific and Southeast Asia,” Loomba said. “Implementing policies such as an increased price and taxation for alcohol may be considered at a national level to reduce the burden of alcohol-associated liver cancer in countries with a high alcohol-per-capita consumption.”
Despite global increases in NASH- and alcohol-associated liver cancer deaths, investigators reported that ASDRs of liver cancer due to hepatitis B (APC = –0.20%; 95% CI, – 0.31 to – 0.09) and hepatitis C (APC = –0.62%; 95% CI, – 0.79 to – 0.46) declined.
“The incidence of liver cancer due to NASH is projected to increase further in the next decade in the United States, Europe and Asia,” Loomba said. “We need to better understand gene-environment interaction that is driving the rise of NASH-related HCC globally, [namely] what are the causes of NAFLD-related HCC among non-cirrhotics and how can we intervene to reduce the risk of NASH-related HCC?”
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