Global incidence of primary liver cancer by etiology among children, adolescents, and young adults

Global burden of primary liver cancer in 2020 and predictions to 2040Journal of HepatologyVol. 77Issue 6PreviewThe burden of liver cancer varies across the world. Herein, we present updated estimates of the current global burden of liver cancer (incidence and mortality) and provide predictions of the number of cases/deaths to 2040. Full-Text PDF Open Access We read with great interest the study by Rumgay et al., who reported that the global burden of primary liver cancer (PLC) varied across the world and predicted a grim situation over the next 20 years.[1]Rumgay H. Arnold M. Ferlay J. Lesi O. Cabasag C.J. Vignat J. et al.Global burden of primary liver cancer in 2020 and predictions to 2040.J Hepatol. 2022; 77: 1598-1606Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar PLC is the sixth most commonly diagnosed cancer and the third leading cause of cancer death globally.[2]Sung H. Ferlay J. Siegel R.L. Laversanne M. Soerjomataram I. Jemal A. et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2021; 71: 209-249Crossref PubMed Scopus (39335) Google Scholar Rumgay et al. discussed PLC caused by risk factors with large attributable fractions and compared the global burden of PLC between two different databases, GLOBOCAN 2020 and Global Burden of Disease study 2019 (GBD 2019) Data Resources.[1]Rumgay H. Arnold M. Ferlay J. Lesi O. Cabasag C.J. Vignat J. et al.Global burden of primary liver cancer in 2020 and predictions to 2040.J Hepatol. 2022; 77: 1598-1606Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar But the comparison of PLC by etiology between these two databases was absent. Meanwhile, data on PLC caused by different etiologies is available in GBD 2019 data resources, so it would be necessary and important to conduct such a comparison. There have been some studies that analyzed the global burden of PLC due to attributable etiologies[3]Xing Q.Q. Li J.M. Dong X. Zeng D.Y. Chen Z.J. Lin X.Y. et al.Socioeconomics and attributable etiology of primary liver cancer, 1990-2019.World J Gastroenterol. 2022; 28: 2361-2382Crossref PubMed Scopus (9) Google Scholar and the global burden of special populations.[4]Liu Z. Mao X. Jin L. Zhang T. Chen X. Global burden of liver cancer and cirrhosis among children, adolescents, and young adults.Dig Liver Dis. 2020; 52: 240-243Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Notably, Liu et al.'s study mentioned the high prevalence of overweight and obesity[5]NCD Risk Factor Collaboration (NCD-RisC)Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.Lancet. 2017; 390: 2627-2642Abstract Full Text Full Text PDF PubMed Scopus (4536) Google Scholar and low attention to HBV[6]Indolfi G. Easterbrook P. Dusheiko G. Siberry G. Chang M.H. Thorne C. et al.Hepatitis B virus infection in children and adolescents.Lancet Gastroenterol Hepatol. 2019; 4: 466-476Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar/HCV[7]Indolfi G. Easterbrook P. Dusheiko G. El-Sayed M.H. Jonas M.M. Thorne C. et al.Hepatitis C virus infection in children and adolescents.Lancet Gastroenterol Hepatol. 2019; 4: 477-487Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar infections in children, findings which warrant urgent attention. To investigate the global incidence of PLC among children, adolescents, and young adults, we derived data among people aged <40 years from GBD 2019 data resources and analyzed the global incidence in 204 countries and territories by HBV, HCV, alcohol use, non-alcoholic steatohepatitis (NASH), and other causes. In 2019, there were 29,149 new cases of PLC, at a global incidence of 0.59/100,000, among these populations. Compared with other regions, East Asia, Southern Sub-Saharan Africa, and High-income Asia Pacific tended to have greater incidence rates (Fig.1A), which was similar to the pattern of liver cancer caused by HBV (Fig. 1B). For liver cancer caused by HCV, the highest incidence can be seen in Southern Sub-Saharan Africa, followed by High-income Asia Pacific and East Asia (Fig. 1C). The top three highest incidence regions for liver cancer caused by alcohol use were in Southern Sub-Saharan Africa, Australasia, and Western Europe (Fig. 1D). As for NASH and other causes, Southern Sub-Saharan Africa and East Asia had higher incidence rates, followed by East Asia and High-income North America, respectively (Fig. 1E,F). At the national level, the top three countries with the highest incidence of PLC were The Gambia (3.09/100,000), Thailand (2.59/100,000), and Mongolia (2.50/100,000) (Fig. 1A). The highest incidence of liver cancer caused by HBV was observed in The Gambia (2.05/100,000), followed by Thailand (1.89/100,000) and China (1.59/100,000) (Fig. 1B). And the highest incidence of liver cancer caused by HCV was observed in Egypt (0.19/100,000), followed by Mongolia (0.18/100,000) and Andorra (0.11/100,000) (Fig. 1C). As for liver cancer caused by alcohol use and NASH, the highest incidences were observed in Mongolia (0.43/100,000) and The Gambia (0.17/100,000), followed by Thailand (0.36/100,000) and Eswatini (1.17/100,000), respectively (Fig. 1D,E). For the other causes of liver cancer, The Gambia (0.59/100,000), Cambodia (0.52/100,000), and Guinea (0.52/100,000) had the top three highest incidence rates (Fig.1F). For PLC among people aged <40 years attributable to different etiologies, different regions and countries had different incidence rates. Regions and countries that had high incidence rates of liver cancer should pay more attention to specific etiologies and take urgent actions. Besides, although older age is one of the risk factors for liver cancer, the global incidence rates among children, adolescents, and young adults were high, which calls for special attention. This study is independent research funded by no grants. The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details. Study conception and design: Xiaowei Tang and Jieyu Peng. Drafting of manuscript: Jieyu Peng. Revision of manuscript, and final approval of manuscript: Muhan Lü, Yan Peng, Xiaowei Tang. The following are the supplementary data to this article: Download .pdf (.25 MB) Help with pdf files Multimedia component 1