The global epidemiology of hepatocellular carcinoma.

Abstract

Hepatocellular carcinoma (HCC) remains a major global cause of cancer morbidity and mortality, with marked geographic heterogeneity in incidence and outcomes. The highest age-standardized incidence and mortality rates persist in East Asia and across much of Africa. In contrast, Europe and North America exhibit moderate incidence, while Latin America and Oceania represent intermediate-burden regions with important subregional heterogeneity, with higher mortality concentrated in underserved, rural, Indigenous, and remote populations. Globally, the etiologic landscape of HCC is shifting from predominantly infection-related toward metabolic dysfunction and alcohol-associated liver disease. Rural-urban disparities further exacerbate global HCC burden through gaps in vaccination coverage, antiviral access, diagnostic infrastructure, and specialty care, leading to later-stage presentation and poorer outcomes. In this review, we describe the epidemiological changes in HCC across different areas of the world, focusing on region-specific issues and identifying key aspects of epidemiological transition.