Temporal trends of liver cancer burden, comparative analysis of risk factors and trend forecasts to 2024 in China, USA, the Republic of Korea, and Mongolia: an analysis based on multiple data sources from Global Burden of Disease 2019, the Global Cancer Observatory, and Cancer Incidence in Five Continents.

Abstract

Background: Liver cancer represents a significant burden of disease globally, with variations in liver cancer status among countries. In this study, we aimed to evaluate the epidemiological burden of liver cancer in four representative countries - China, the USA, the Republic of Korea, and Mongolia - and cover the highest number of incidence cases, the highest prevalence rates and the burden in developed countries. In addition, we intended to predict the trends in liver cancer in these countries over the next six years.

Methods: We collected epidemiological data on liver cancer from the Global Burden of Disease 2019, the Global Cancer Observatory, and Cancer Incidence in Five Continents databases to conduct data source triangulation. We calculated time trends using Joinpoint regression and predicted incidence rates using an autoregressive integrated moving average model. Aetiological studies were conducted for different countries based on changes in incidence causes.

Results: Between 1990-2019, age-standardised rates (ASR) values for liver cancer declined globally. The downward trend was most pronounced in China, where the average annual percentage change of age-standardised incidence rate (ASIR) reached -3.13 (95% confidence interval (CI) = -2.90, -3.35), much higher than the world average of -1.16 (95% CI = -0.96, -1.36). The ASIR in the USA continued improving and reached 5.23 × 10⁵ in 2019. With age, the ASR for liver cancer in various countries generally shows an upward trend. Hepatitis B virus (HBV) remains the main causative agent of liver cancer in China and Korea. In Mongolia, both HBV and hepatitis C virus account for a large proportion of liver cancer. In the USA, the proportion of liver cancer cases from alcohol consumption has increased annually.

Conclusions: The ASR for liver cancer has declined over the past 30 years in most countries but has worsened in some due to ageing and unhealthy lifestyles.