The Burden and Trends of Primary Liver Cancer Caused by Specific Etiologies from 1990 to 2017 at the Global, Regional, National, Age, and Gender Level Results from the Global Burden of Disease Study 2017

Background: Liver cancer is one of the leading causes of cancer-related deaths worldwide. The primary causes of liver cancer include hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol consumption, non-alcoholic fatty liver disease, and other factors. The objective of this study was to evaluate the global, and gender-, age-, region-, country- and etiology-related liver cancer burden, as well as the trends in liver cancer caused by different etiologies. Methods: The causes of liver cancer from 1990 to 2017, including global, regional and national liver cancer incidence, mortality and etiology, were collected from the Global Burden of Disease study 2017, and the time-dependent change in the trends of liver cancer burden was evaluated by annual percentage change. Findings: The global liver cancer incidence and mortality have been increasing. There were 950,000 newly-diagnosed liver cancer cases and over 800,000 deaths in 2017, which are more than twice the numbers recorded in 1990. HBV and HCV are the major causes of liver cancer, and responsible for nearly 70% of the global liver cancer-related deaths and incidents. HBV is the major risk factor of liver cancer in Asia, while HCV and alcohol abuse are the major risk factors in the high SDI and high HDI regions. Liver cancer incidence and mortality are three times higher in males than in females, and the global liver cancer burden is highest among individuals order than 50 years. HBV is the main cause of liver cancer in individuals younger than 20 years. The mean onset age and incidence of liver cancer with different etiologies have gradually increased in the past 30 years. Interpretation: Liver cancer is a common malignancy with a high global disease burden. Although the implementation of public health measures such as hepatitis B immunization has reduced the incidence of liver cancer in some countries or territories, the global incidence is still rising and the causes have national, regional or population specificities. Therefore, more targeted prevention strategies must be developed for the different etiological types in order to reduce liver cancer burden. Funding Statement: This study was financially supported by the Fundamental Research Funds for the Central public welfare research institutes (ZXKT17013, ZZ11-092 and ZZ13-YQ059), and Young Elite Scientists Sponsorship Program by CACM(2018QNRC2-C01). Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: Not required.