Global burden of liver cancer in males and females: Changing etiological basis and the growing contribution of NASH

Tan, Darren Jun Hao; Setiawan, Veronica Wendy; Ng, Cheng Han; Lim, Wen Hui; Muthiah, Mark; Tan, Eunice X.; Dan, Yock Young; Roberts, Lewis R.; Loomba, Rohit; Huang, Daniel Q.

doi:10.1002/hep.32758

Cited by 70 publications

(53 citation statements)

References 47 publications

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“…NAFLD encompasses both non-alcoholic fatty liver and non-alcoholic steatohepatitis (NASH), the inflammatory form of NAFLD that can progress to fibrosis, cirrhosis and subsequent decompensation 3–7. The incidence of NASH cirrhosis and NAFLD-related hepatocellular carcinoma (HCC) are projected to increase rapidly in the next decade 8–13…”

Section: Introductionmentioning

confidence: 99%

Liver stiffness thresholds to predict disease progression and clinical outcomes in bridging fibrosis and cirrhosis

Loomba

Huang

Sanyal

et al. 2022

Gut

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ObjectiveIn retrospective studies, liver stiffness (LS) by vibration-controlled transient elastography (VCTE) is associated with the risk of liver decompensation in patients with non-alcoholic steatohepatitis (NASH), but prospective data in biopsy-confirmed cohorts with advanced fibrosis are limited. We aimed to establish thresholds for LS by VCTE that predict progression to cirrhosis among patients with bridging fibrosis and hepatic decompensation among patients with cirrhosis due to NASH.DesignWe used data from four randomised placebo-controlled trials of selonsertib and simtuzumab in participants with advanced fibrosis (F3–F4). The trials were discontinued due to lack of efficacy. Liver fibrosis was staged centrally at baseline and week 48 (selonsertib study) or week 96 (simtuzumab study). Associations between LS by VCTE with disease progression were determined using Cox proportional hazards regression analysis.ResultsProgression to cirrhosis occurred in 16% (103/664) of participants with bridging fibrosis and adjudicated liver-related events occurred in 4% (27/734) of participants with baseline cirrhosis. The optimal baseline LS thresholds were ≥16.6 kPa for predicting progression to cirrhosis, and ≥30.7 kPa for predicting liver-related events. Baseline LS ≥16.6 kPa (adjusted HR 3.99; 95% CI 2.66 to 5.98, p<0.0001) and a ≥5 kPa (and ≥20%) increase (adjusted HR 1.98; 95% CI 1.20 to 3.26, p=0.008) were independent predictors of progression to cirrhosis in participants with bridging fibrosis, while baseline LS ≥30.7 kPa (adjusted HR 10.13, 95% CI 4.38 to 23.41, p<0.0001) predicted liver-related events in participants with cirrhosis.ConclusionThe LS thresholds identified in this study may be useful for risk stratification of NASH patients with advanced fibrosis.

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Section: Introductionmentioning

confidence: 99%

Liver stiffness thresholds to predict disease progression and clinical outcomes in bridging fibrosis and cirrhosis

Loomba

Huang

Sanyal

et al. 2022

Gut

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“…These studies collectively emphasize that women are more susceptible to alcohol-induced liver injury than men. However, as alcohol consumption is substantially higher in men, ASDRs of alcohol-associated liver cancer are higher in men compared with women, globally 75 .…”

Section: Risk Factorsmentioning

confidence: 99%

Global epidemiology of alcohol-associated cirrhosis and HCC: trends, projections and risk factors

Huang

Maury

Cortez‐Pinto

et al. 2022

Nat Rev Gastroenterol Hepatol

256

104

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Heavy alcohol consumption is a major cause of morbidity and mortality. Globally, alcohol per-capita consumption rose from 5.5 litres in 2005 to 6.4 litres in 2016 and is projected to increase further to 7.6 litres in 2030. In 2019, an estimated 25% of global cirrhosis deaths were associated with alcohol. The global estimated age-standardized death rate (ASDR) of alcohol-associated cirrhosis was 4.5 per 100,000 population, with the highest and lowest ASDR in Africa and the Western Pacific, respectively. The annual incidence of hepatocellular carcinoma (HCC) among patients with alcohol-associated cirrhosis ranged from 0.9% to 5.6%. Alcohol was associated with approximately one-fifth of global HCC-related deaths in 2019. Between 2012 and 2017, the global estimated ASDR for alcohol-associated cirrhosis declined, but the ASDR for alcohol-associated liver cancer increased. Measures are required to curb heavy alcohol consumption to reduce the burden of alcohol-associated cirrhosis and HCC. Degree of alcohol intake, sex, older age, obesity, type 2 diabetes mellitus, gut microbial dysbiosis and genetic variants are key factors in the development of alcohol-associated cirrhosis and HCC. In this Review, we discuss the global epidemiology, projections and risk factors for alcohol-associated cirrhosis and HCC.

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“…Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide [ 1 , 2 ]. Despite surveillance programs, the majority of patients with HCC are diagnosed at an advanced stage [ 3 - 7 ].…”

Section: Introductionmentioning

confidence: 99%

Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: Systematic review and meta-analysis

et al. 2022

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Background:Depression and anxiety are associated with poorer outcomes in patients with hepatocellular carcinoma (HCC). However, the prevalence of depression and anxiety in HCC are unclear. We aimed to establish the prevalence of depression and anxiety in patients with HCC. Methods:MEDLINE and Embase were searched and original articles reporting prevalence of anxiety or depression in patients with HCC were included. A generalized linear mixed model with Clopper-Pearson intervals was used to obtain the pooled prevalence of depression and anxiety in patients with HCC. Risk factors were analyzed via a fractional-logistic regression model. Results:17 articles involving 64,247 patients with HCC were included. The pooled prevalence of depression and anxiety in patients with HCC was 24.04% (CI 13.99-38.11%) and 22.20% (CI 10.07-42.09) respectively. Subgroup analysis determined that the prevalence of depression was lowest in studies where depression was diagnosed via clinician-administered scales (16.07%, CI 4.42-44.20%) and highest in self-reported scales (30.03%, CI 17.19-47.01%). Depression in patients with HCC was lowest in the Americas (16.44%, CI 6.37-36.27%) and highest in South-East Asia (66.67%, CI 56.68-75.35%). Alcohol consumption, cirrhosis, and college education significantly increased risk of depression in patients with HCC. The prevalence of anxiety in HCC was 22.20% (CI 10.07-42.09). Conclusion:One in four patients with HCC have depression, while one in five have anxiety. Further studies are required to validate these findings, as seen from the wide confidence intervals in certain subgroup analyses. Screening strategies for depression and anxiety should also be developed for patients with HCC.

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Global burden of liver cancer in males and females: Changing etiological basis and the growing contribution of NASH

Cited by 70 publications

References 47 publications

Liver stiffness thresholds to predict disease progression and clinical outcomes in bridging fibrosis and cirrhosis

Liver stiffness thresholds to predict disease progression and clinical outcomes in bridging fibrosis and cirrhosis

Global epidemiology of alcohol-associated cirrhosis and HCC: trends, projections and risk factors

Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: Systematic review and meta-analysis

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