Temporal trends and regional variations in hepatocellular carcinoma etiology: a multinational study across Asia.
Journal
Hepatology international
ISSN
1936-0541
Date Issued
2026-02-05
Author(s)
Takeuchi, Yasuto
Tateishi, Ryosuke
Obi, Shuntaro
Otsuka, Motoyuki
Mochizuki, Hitoshi
Jazag, Amarsanaa
Yokosuka, Osamu
Ogasawara, Sadahisa
Kanogawa, Naoya
Gonchig, Erdenebayar
Matsushita, Yuki
Kekilli, Murat
Bilican, Gulden
Kim, Yoon Jun
Hur, Moon Haeng
Yu, Ming-Lung
Huang, Chung-Feng
Morishita, Asahiro
Oura, Kyoko
Komori, Atsumasa
Motoyoshi, Yasuhide
Siregar, Lianda
Loho, Imelda
Yang, Ming
Okabe, Shuichirou
Ueno, Yoshiyuki
Katsumi, Tomohiro
Sato, Takahisa
Kogure, Hirofumi
Masuzaki, Ryota
Lesmana, Cosmas Rinaldi
Nababan, S H H
Nimanong, Supot
Huang, Yi-Hsiang
Nagamatsu, Hiroaki
Yoshida, Hideo
Uchino, Koji
Hasan, Irsan
Kitiyakara, Taya
Akamatsu, Masatoshi
Okamoto, Makoto
Kondo, Mayuko
Moriyama, Makoto
Sukeepaisarnjareon, Wattana
Tangkijvanich, Pisit
Thanapirom, Kessarin
Yalcin, Kendal
Kızıl, Hayriye Dilan
Adali, Gupse
Akdogan, Meral
Gokce, Dilara Turan
Balaban, Yasemin
Gokcan, Hale
Coşar, Arif Mansur
Harputluoglu, Murat
Bahçecioğlu, İbrahim Halil
Atasoy, Alp
Kockar, Muhammet Cem
Dursun, Hakan
Eminler, Ahmet Tarik
Sollano, Jose
Su, Dong Jin
Piratvisuth, Teerha
Crawford, Darrell
Hou, Jinlin
Sharma, Barjesh Chander
Payawal, Diana Alcantara
Gani, Rino Alvani
Tanwandee, Tawesak
Yang, Jin Mo
Lin, Han-Chieh
Shiina, Shuichiro
Jia, Ji-Dong
Lau, George
Örmeci, Necati
Dokmeci, A Kadir
Wei, Lai
Sarin, Shiv Kumar
Omata, Masao
Abstract
Background: Hepatocellular carcinoma (HCC) remains a major health burden in Asia. Advances in antiviral therapies are reshaping the etiological landscape of HCC. This study evaluated temporal shifts in HCC etiology across Asian countries and their clinical implications.
Methods: This multinational study analyzed 6,261 newly diagnosed HCC patients registered in the APASL Hepatology/Oncology Consortium (A-HOC) from 19 centers across seven Asian countries and regions between 2013 and 2023. Data on demographics, tumor characteristics, etiology, and treatment patterns were collected. Etiologies included hepatitis B virus (HBV), hepatitis C virus (HCV), alcoholic liver disease (ALD), metabolic dysfunction-associated fatty liver disease (MAFLD), MAFLD plus excess alcoholic intake (MAFLD + eAL), autoimmune liver disease, cryptogenic, and others. Temporal trends and regional variations were assessed.
Results: In many countries, HBV remained predominant (43.3%-69.5%) and relatively stable throughout the period, while HCV showed only modest reductions. In Japan, HCV was the leading cause of HCC (33.1%), with a significant decline over time, accompanied by a rise in MAFLD-related HCC. ALD-related HCC increased in South Korea, and MAFLD-related HCC rose in Turkey. Tumor size and stage at diagnosis varied by etiology and region, affecting treatment strategies. Early-stage diagnosis was more frequent in Japan and Taiwan, whereas advanced-stage HCC was common in China and Indonesia.
Conclusions: Distinct regional patterns and temporal changes in HCC etiology across Asia highlight the need for tailored prevention and surveillance measures. The growing burden of MAFLD-related HCC emphasizes its emerging role in liver cancer development, particularly in regions with declining viral hepatitis.
Subjects
Asia
Epidemiology
Hepatocellular carcinoma
Temporal trend
Type
journal article