Hepatocellular carcinoma attributable to hepatitis B, hepatitis C and other risk factors at global, regional and national levels: an updated systematic review and meta-analysis
5 affiliations
- 1Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- 2Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
- 3Department of Epidemiology, Ministry of Education Key Laboratory of Coal Environmental Pathogenicity and Prevention, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
- 4Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- 5Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Amsterdam, The Netherlands
Abstract
BACKGROUND: Data on the contribution of hepatitis viruses to the burden of hepatocellular carcinoma (HCC) are essential for global hepatitis elimination. OBJECTIVE: To estimate the HCC burden attributable to HBV and HCV by country, region and globally. DESIGN: We performed a systematic review and meta-analysis between 1 October 2014 and 31 December 2023 using studies that reported the prevalence of both HBV and HCV in at least 20 patients with HCC. Pooled prevalence estimates by country were calculated to estimate regional and global HBV and HCV attributable fractions (AFs) and HCC-attributable age-standardised incidence rates (ASIRs). RESULTS: 857 eligible publications from 81 countries or territories were included. HBV and HCV prevalence among patients with HCC varied substantially by country and region. HBV AF was highest in Eastern Asia (70%), with HBV-attributable ASIRs of >10 per 100 000 observed in Mongolia and Viet Nam and was lowest in Northern Europe (6%). HCV AF was highest in Northern Africa (77%), and HCV-attributable ASIRs of >10 per 100 000 were observed in Egypt and Mongolia. Patients with HBV-related HCC were younger than patients with HCV-related HCC. Globally, HBV and HCV AFs were 52% and 21%, corresponding to 345 434 and 134 418 HCC cases, respectively, in 2022. Alcohol and/or metabolic dysfunction-associated steatotic liver disease were present in more than 30% of HCC in certain countries of Europe and South America. CONCLUSION: HBV and HCV contribute to approximately three-quarters of the global HCC burden. These data can inform viral hepatitis prevention strategies. PROSPERO REGISTRATION NUMBER: CRD42023397708.
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BibTeX
@article{cao2026hepatocellular,
title = {{Hepatocellular carcinoma attributable to hepatitis B, hepatitis C and other risk factors at global, regional and national levels: an updated systematic review and meta-analysis}},
author = {Maomao Cao and Feixue Wei and Damien Georges and Catharina J. Alberts and Gary M. Clifford and Catherine de Martel},
journal = {Gut},
year = {2026},
month = may,
doi = {10.1136/gutjnl-2025-337838},
url = {https://doi.org/10.1136/gutjnl-2025-337838},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Hepatocellular carcinoma attributable to hepatitis B, hepatitis C and other risk factors at global, regional and national levels: an updated systematic review and meta-analysis
AU - Maomao Cao
AU - Feixue Wei
AU - Damien Georges
AU - Catharina J. Alberts
AU - Gary M. Clifford
AU - Catherine de Martel
PY - 2026
DA - 2026/05/14
JO - Gut
DO - 10.1136/gutjnl-2025-337838
UR - https://doi.org/10.1136/gutjnl-2025-337838
AB - BACKGROUND: Data on the contribution of hepatitis viruses to the burden of hepatocellular carcinoma (HCC) are essential for global hepatitis elimination. OBJECTIVE: To estimate the HCC burden attributable to HBV and HCV by country, region and globally. DESIGN: We performed a systematic review and meta-analysis between 1 October 2014 and 31 December 2023 using studies that reported the prevalence of both HBV and HCV in at least 20 patients with HCC. Pooled prevalence estimates by country were calculated to estimate regional and global HBV and HCV attributable fractions (AFs) and HCC-attributable age-standardised incidence rates (ASIRs). RESULTS: 857 eligible publications from 81 countries or territories were included. HBV and HCV prevalence among patients with HCC varied substantially by country and region. HBV AF was highest in Eastern Asia (70%), with HBV-attributable ASIRs of >10 per 100 000 observed in Mongolia and Viet Nam and was lowest in Northern Europe (6%). HCV AF was highest in Northern Africa (77%), and HCV-attributable ASIRs of >10 per 100 000 were observed in Egypt and Mongolia. Patients with HBV-related HCC were younger than patients with HCV-related HCC. Globally, HBV and HCV AFs were 52% and 21%, corresponding to 345 434 and 134 418 HCC cases, respectively, in 2022. Alcohol and/or metabolic dysfunction-associated steatotic liver disease were present in more than 30% of HCC in certain countries of Europe and South America. CONCLUSION: HBV and HCV contribute to approximately three-quarters of the global HCC burden. These data can inform viral hepatitis prevention strategies. PROSPERO REGISTRATION NUMBER: CRD42023397708.
SN - 0017-5749
SN - 1468-3288
ER -