The Lancet Commission on addressing the global hepatocellular carcinoma burden: comprehensive strategies from prevention to treatment

Abstract

Section snippets

Executive summary

Liver cancer is the sixth most common cancer and the third leading cause of cancer-related mortality globally. The number of new liver cancers will nearly double, from 0·87 million in 2022 to 1·52 million in 2050, if there is no change in the current trend. Hepatocellular carcinoma, the most prevalent histological subtype of liver cancer, accounts for approximately 80% of all primary liver cancers. In response to this issue, a Commission comprising a broad spectrum of experts in clinical

Section 1: The current and future burden of liver cancer

According to the Global Cancer Observatory prediction for 2050, the global burden of new liver cancer cases and liver cancer-related deaths is projected to increase substantially in 2050 if current ASIRs do not change (figure 1). The total number of liver cancer cases is estimated to reach 1·52 million, with liver cancer-related deaths increasing to 1·37 million if the current trend continues. This increase is driven by demographic shifts, including population growth and ageing.¹ The largest

How preventable is hepatocellular carcinoma? A look at the risk factors

As highlighted in our analyses, many hepatocellular carcinoma cases can be attributed to risk factors that are potentially preventable or treatable. In this Commission, we conducted a literature review on the risk factors and their control measures.The lifetime risk of developing hepatocellular carcinoma among HBV carriers ranges from 10% to 25%. Factors that increase this risk include demographic characteristics (eg, male sex, older age, Asian or African ancestry, and family history of

Current approaches

Hepatocellular carcinoma is frequently diagnosed at an advanced stage worldwide, with real-world data indicating that over half of patients present with late-stage disease.⁵ For hepatocellular carcinoma, surveillance refers to the regular detection of cancer in individuals at high risk during its asymptomatic state.¹⁶¹ Because curative treatment is typically only possible when hepatocellular carcinoma is detected early, timely identification of hepatocellular carcinoma through surveillance is

Section 4: Advancement in treatments and their clinical impact

Treatment of hepatocellular carcinoma is divided into resectable and unresectable categories. Although the definition of resectable tumours varies widely among different health-care centres, 30–40% of patients are considered ideal candidates for surgery or transplantation.²⁴⁸ The remaining 60–70% of patients are offered locoregional therapy, radiotherapy, or systemic therapy, depending on factors such as the intrahepatic cancer burden, the presence of distant metastases, hepatic function, and

Section 5: Advancing health equality

Hepatocellular carcinoma presents considerable disparities in its global burden, disproportionately affecting populations in LMICs. Over 80% of hepatocellular carcinoma cases occur in LMICs, with east Asia and sub-Saharan Africa, where medical and social care resources are often limited, having particularly high rates of hepatocellular carcinoma cases.³⁷⁵ However, these disparities are not confined to resource-constrained settings. In HICs such as the USA, substantial inequalities persist

Recommendations from the Commission

The Commission has already generated data regarding the goal of reducing the severity of hepatocellular carcinoma over the next two decades. We also reviewed the state-of-the-art practices for prevention, detection, and treatment of hepatocellular carcinoma, followed by an assessment of the effectiveness of current measures and identification of barriers hindering progress. Based on these insights, the Commission believes it is essential to develop recommendations aimed at decreasing the burden

Conclusion

This Commission has generated evidence-based projections and strategic recommendations to address the rising burden of hepatocellular carcinoma. We hope this Commission will successfully raise awareness within society on the severity of this growing health issue. One of the proposed targets is tailored to the existing ASIR trends in each country: a 2% reduction in HCC should be achieved in countries with a rising trend, while a 2–5% reduction should be the goal in countries where the ASIR is

Declaration of interests

JZ reports consulting fees from AstraZeneca; honoraria from the Asia-Pacific Primary Liver Cancer Expert Association (APPLE) and Asian-Pacific Association for the Study of the Liver (APASL); travel support from the Beijing Life Oasis Public Service Center, Beijing Medical Award Foundation, Chronic Disease Prevention and Treatment of Traditional Chinese Medicine Promotion Association, and Beijing Health Alliance Charitable Foundation; participation on a data safety monitoring board/advisory

Acknowledgments

We thank Zhao-You Tang and Ye-Qin Yu for their monumental and groundbreaking contributions to the fields of liver cancer research and patient management. We thank Carmen C M Cho for providing the image data, and Xing Yao for conducting the literature review and creating illustrations. We also thank Zejun Jia and Shaolai Zhou for editing and proofreading the report and references. This Commisssion was supported by grants from the Natural Science Foundation of China (82488101), Non-communicable