Global incidence trends in primary liver cancer by age at diagnosis, sex, region, and etiology, 1990-2017.

BACKGROUND: The incidence of primary liver cancer (PLC) continues to increase worldwide. The incidence trends and patterns of PLC associated with different age at diagnosis remain unknown.

METHODS: We collected detailed information on PLC between 1990 and 2017 from Global Burden of Disease Study 2017. Estimated annual percentage changes in the PLC age-standardized incidence rate (ASR) diagnosed by age, sex, region, and etiology were calculated to quantify the temporal trends in PLC ASR.

RESULTS: Globally, the number of PLC cases for which the age at diagnosis was <30 years decreased from 17,381 in 1990 to 14,661 in 2017, whereas the number of PLC cases diagnosed at age 30 to 59 and ≥60 years old increased from 216,561 and 241,189 in 1990 to 359,770 and 578,344 in 2017, respectively. The ASR of PLC cases with age at diagnosis <30 years and between 30 and 59 years decreased in both sexes, whereas the ASR of PLC with age at diagnosis ≥60 years increased in males and remained stable in females at the global level. Males had a more dramatic increase in PLC diagnosed at age ≥60 years but a milder decrease in PLC diagnosed between 30 and 59 years of age. This decrease was attributed largely to the reduction in PLC caused by hepatitis B and hepatitis C and was consistent in most regions except for developed countries, in which the ASR of PLC increased irrespective of sex and age. The ASR of PLC due to nonalcoholic steatohepatitis (NASH) increased by the greatest magnitude in most regions.

CONCLUSION: PLC in highly endemic regions has been partly alleviated due to the potent control of hepatitis, especially among young and middle-aged people. However, an unfavorable trend was observed in most developed countries and in elderly populations. As such, PLC prevention schedules should give more attention to NASH and elderly patients.