Letter: Global Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease-Related Liver Cancer—Results From the Global Burden of Disease Study 2021

Abstract

We read with great interest the study by Danpanichkul et al. [1], which conducted an in-depth analysis of the burden of primary liver cancer (PLC) in the United States from 2000 to 2021. The results revealed that PLC incidences increased by 141% and deaths by 136%. The age-standardised incidence rate (ASIR) and age-standardised death rate (ASDR) for PLC also rose, primarily driven by alcohol-related liver disease and metabolic dysfunction–associated steatotic liver disease (MASLD). Additionally, with the rising prevalence of obesity and metabolic syndrome, the prevalence of MASLD has risen substantially, fuelling a rise in MASLD-related liver cancer [2, 3]. These findings highlight the necessity for further in-depth research into the global burden of MASLD-related liver cancer.

Using the Global Burden of Disease Study 2021 database, we analysed incident cases, deaths, ASIR and ASDR for MASLD-related liver cancer globally from 1990 to 2021. We assessed these by country, region, year, age and sex and measured trends using the average annual percentage change (AAPC). Additionally, we employed the Bayesian age-period-cohort (BAPC) model to forecast the disease burden from 2022 to 2045.

In 2021, global incident cases and deaths of MASLD-related liver cancer were 42,291 (95% uncertainty interval [UI] 34,032.6–51,129.5) and 40,925 (95% UI: 32,961–49,610), respectively. From 1990 to 2021, ASIR and ASDR increased, with AAPCs of 0.99 (95% confidence interval [CI] 0.95–1.03) and 0.82 (95% CI: 0.72–0.92). East Asia recorded the highest incident cases and deaths, while Australasia showed the most significant increases in ASIR and ASDR (Figure 1A,B). Nationally, China, Japan and the United States had the highest burdens, with over 60% of countries showing rising ASIR and ASDR trends (Figure 1C,D). The 65–74 age group had the highest cases and deaths, while ASIR and ASDR peaked in the 85–89 and 90–94 age groups, respectively (Figure 1E,F). BAPC modelling predicts rising incident cases and deaths in both sexes (Figure 1G,H), though ASIR and ASDR are projected to decline in females and stabilise in males over the next 24 years.

FIGURE 1

Open in figure viewerPowerPoint

(A) The average annual percentage change (AAPC) of the burden of age-standardised incidence rate (ASIR) for metabolic dysfunction-associated steatotic liver disease (MASLD)-related liver cancer, globally, in five sociodemographic index (SDI) regions and 21 GBD regions, 1990–2021. (B) The AAPC of the burden of age-standardised deaths rate (ASDR) for MASLD-related liver cancer, globally, infive SDI regions and 21 GBD regions, 1990–2021. (C) AAPCs for ASIR of MASLD-related liver cancer in 204 countries and territories from 1990 to 2021. (D) AAPCs for ASDR of MASLD-related liver cancer in 204 countries and territories from 1990 to 2021. (E) The incident cases and rates of MASLD-related liver cancer by age and sex in 2021. (F) The deaths and rates of MASLD-related liver cancer by age and sex in 2021. (G) Global projections of MASLD-related liver cancer incident cases and ASIR from 2022 to 2045. (H) Global projections of MASLD-related liver cancer deaths and ASDR from 2022 to 2045.

In conclusion, the burden of MASLD-related liver cancer varies significantly across regions, underlining the need for region-specific strategies to address the growing problem. While the age-standardised burden is expected to stabilise over the next 24 years, the global incidence and prevalence of MASLD will continue to increase, exacerbated by metabolic factors [4]. In addition, our previous studies have shown that ageing as a major factor in the increasing burden of MASLD-related liver cancer [5]. Notably, according to the world population ageing report released by the United Nations in 2019, the size of the elderly population (≥ 65 years) will increase in all regions of the world over the next three decades, and the number of elderly people worldwide is expected to more than double to more than 1.5 billion by 2050 [6]. It is therefore necessary for policymakers in regions with significant population ageing to make policy adjustments in line with these trends in order to meet the needs and challenges of an ageing population.