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Liver cancer remains a leading cause of cancer-related mortality worldwide
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Primary liver cancer incidence increased by 75% between 1990 and 2015, and the disease remains one of the leading causes of cancer death in the world, according to a report from the Global Burden of Diseases Study 2015.
Further, hepatitis B virus was the leading cause of new cases of liver cancer in 2015, the research showed.
“The Global Burden of Disease study provides the most current overview of the burden and etiology of liver cancer and can guide investments in targeted liver cancer prevention efforts,” Christina Fitzmaurice, MD, MPH, assistant professor in the department of medicine of Institute for Health Metrics at University of Washington, and colleagues from the Global Burden of Disease Liver Cancer Collaboration wrote.
Previous research of liver cancer incidence and mortality focused on single regions and more commonly known etiologies, like HBV and hepatitis C virus.
In the Global Burden of Disease 2015 study, researchers sought to determine incidence, mortality and disability-adjusted life-years across 195 regions between 1990 and 2015, considering the burden of liver cancer attributable to HBV, HCV, alcohol and other factors.
Researchers used vital registration and cancer registry data to estimate liver cancer mortality, and they adjusted data for age, uninformative causes of death and aggregated causes. They also identified data on the number of liver cancer cases related to various causes through a systematic literature review.
In 2015, liver cancer was the sixth most common incident cancer worldwide and the fourth most common cause of cancer death.
Globally, 854,000 incident cases of liver cancer and 810,000 deaths occurred, which contributed to 20,578,000 disability-adjusted life-years.
These data indicate “liver cancer remains a major public health burden globally,” the researchers wrote.
The highest rates of liver cancer incidence, disability-adjusted life-years and mortality occurred in East Asia. Japan had 75% of incident cases, of which 67% were related to HCV.
Incident cases of liver cancer increased by 75% between 1990 and 2015, driven by changing population age structures (47%), population growth (35%) and changing age-specific incidence rates (–8%).
If the population size and age structure remained the same, incident cases due to HBV would have decreased by 35%, and due to other causes by 25%. However, incident cases increased by 42% due to population growth and 56% due to aging.
HBV accounted for 33% (n = 265,000) of liver cancer deaths globally, followed by 30% (n = 245,000) from alcohol, 21% (n = 167,000) from HCV and 33% (n = 133,000) related to other causes.
Researchers noted substantial variation between countries in underlying etiologies.
For instance, HBV was the least common cause of liver cancer death in Southern Latin America (6%) and the most common in Western sub-Saharan Africa and Andean Latin America (45%). HCV was the least common cause in East Asia (9%) and most common in high-income Asia Pacific (55%). Also, alcohol contributed to the fewest cases in North Africa and the Middle East (13%) and the most in Eastern Europe (53%).
Men demonstrated greater rates of liver cancer prevalence (591,000 vs. 265,000), mortality (577,000 vs. 234,000) and disability-adjusted life-years (15,413,000 vs. 5,165,000). HBV led to more incident cases among men (203,000; 95% uncertainty interval [UI], 171,000-251,000) than woman (70,000; 95% UI, 57,000-86,000).
Further, alcohol led to more incident cases among men (204,000; 95% UI, 177,000-240,000) than woman (45,000; 95% UI, 38,000-54,000).
“Our results show that most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use,” the researchers wrote. “... The identification and elimination of risk factors for liver cancer will be required to achieve a sustained reduction in liver cancer burden.” – by Melinda Stevens
Disclosures: Fitzmaurice reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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This study again confirms that liver cancer is a highly deadly disease and increasing across the world.
Hepatitis B, hepatitis C and alcohol are the leading risk factors and can be reduced with universal HBV vaccination guidelines, effective HCV therapies, safe blood transfusion practices and lifestyle modifications regarding alcohol and IV drug use. Nonalcoholic fatty liver disease (NAFLD) and its detrimental subset, nonalcoholic steatohepatitis (NASH), belong to the category of “other causes.” Although NAFLD/NASH appears to have a small impact on death in this study — 16% or less — and is not widely discussed, it will not stay in this category for long. In the United States, NAFLD/NASH has surpassed alcohol and is currently close behind — or has even surpassed in certain populations — HCV as a major indication for liver transplantation.
In the foreseeable future, with hopefully more affordable and available HCV medications and effective HBV vaccination and treatment programs, we will turn our full attention to better identification and treatment of NAFLD/NASH.
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