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Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis

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Abstract

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer mortality worldwide. Incidence rates of liver cancer vary widely between geographic regions and are highest in Eastern Asia and sub-Saharan Africa. In the United States, the incidence of HCC has increased since the 1980s. HCC detection at an early stage through surveillance and curative therapy has considerably improved the 5-year survival. Therefore, medical societies advocate systematic screening and surveillance of target populations at particularly high risk for developing HCC to facilitate early-stage detection. Risk factors for HCC include cirrhosis, chronic infection with hepatitis B virus (HBV), hepatitis C virus (HCV), excess alcohol consumption, non-alcoholic fatty liver disease, family history of HCC, obesity, type 2 diabetes mellitus, and smoking. Medical societies utilize risk estimates to define target patient populations in which imaging surveillance is recommended (risk above threshold) or in which the benefits of surveillance are uncertain (risk unknown or below threshold). All medical societies currently recommend screening and surveillance in patients with cirrhosis and subsets of patients with chronic HBV; some societies also include patients with stage 3 fibrosis due to HCV as well as additional groups. Thus, target population definitions vary between regions, reflecting cultural, demographic, economic, healthcare priority, and biological differences. The Liver Imaging Reporting and Data System (LI-RADS) defines different patient populations for surveillance and for diagnosis and staging. We also discuss general trends pertaining to geographic region, age, gender, ethnicity, impact of surveillance on survival, mortality, and future trends.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

APASL:

Asian Pacific Association for the Study of the Liver

EASL-EORTC:

European Association for the Study of the Liver-European Organization for Research and Treatment of Cancer

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

JSH:

Japan Society of Hepatology

KLCSG-NCC:

Korean Liver Cancer Study Group and the National Cancer Center

LI-RADS:

Liver Imaging Reporting and Data System

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

WHO:

World Health Organization

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Funding

This work was supported by a clinical research scholarship by the Fonds de recherche du Québec—Santé and Fondation de l’association des radiologistes du Québec (Career Award #26993) to An Tang.

Conflict of Interest

An Tang, Victoria Chernyak, Aya Kamaya and Claude B. Sirlin are members of the LI-RADS Steering Committee. Oussama Hallouch declares that he has no conflict of interest. Aya Kamaya receives royalties from Elsevier/Amirsys. Claude B. Sirlin has industry research grants from Bayer, Guerbet, Siemens, GE, Philips, Supersonic, and Arterys and consulting and service agreements with Alexion, AstraZeneca, Bioclinica, BMS, Bracco, Celgene, Fibrogen, Galmed, Genentech, Genzyme, Gilead, Icon, Intercept, Isis, Janssen, NuSirt, Perspectum, Pfizer, Profil, Sanofi, Shire, Synageva, Tobira, Takeda, and Virtual Scopics.

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Authors and Affiliations

  1. Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal and CRCHUM, 1058 rue Saint-Denis, Montréal, QC, H2X 3J4, Canada

    An Tang & Oussama Hallouch

  2. Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada

    An Tang

  3. Department of Radiology, Montefiore Medical Center, Bronx, NY, USA

    Victoria Chernyak

  4. Stanford University Medical Center, Stanford, CA, USA

    Aya Kamaya

  5. Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, CA, USA

    Claude B. Sirlin

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Correspondence to An Tang.

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Tang, A., Hallouch, O., Chernyak, V. et al. Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis. Abdom Radiol 43, 13–25 (2018). https://doi.org/10.1007/s00261-017-1209-1

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