Authoritative Research Reveals: MASLD Is Becoming the Primary "Culprit" of Liver Cancer

Recently, research teams led by Professor Cao Guangwen of Naval Medical University and Professor Zeng Hongmei of the National Cancer Center published a paper in Science Bulletin (IF = 21.1), titled "Global, regional, and national burden of hepatocellular carcinoma and contribution of nine modifiable risk factors across 185 countries/territories in 2022."

Based on authoritative data including GLOBOCAN 2022, the study reveals for the first time the latest hepatocellular carcinoma (HCC) incidence and mortality burden across 185 countries/territories in 2022, precisely quantifying the population attributable fractions (PAF) of the nine modifiable risk factors and their regional differences.

■ Global Status of Liver Cancer: Viruses Still the Leading Cause Today, but a "Change of Guard" Is Imminent

In 2022, there were 684,659 new liver cancer cases and 597,434 deaths worldwide, with age-standardized incidence and mortality rates of 6.8 and 5.9 per 100,000, respectively, and a male-to-female ratio of 3.3:1. Notably, 45.2% of new cases and 44.6% of deaths worldwide occurred in China — making it the epicenter of liver cancer. (Embedded figure in the original web page: incidence/mortality map across 185 countries)

(Embedded figure in the original web page: incidence/mortality map across 185 countries)

The study classifies the nine modifiable liver cancer risk factors into three major categories — infection, metabolic, and behavioral/toxic — with the data showing:

Infection (hepatitis B, hepatitis C, liver flukes): still the leading cause, with a PAF of 65.9%, but continuously declining from 1990 to 2022 — hepatitis B falling 1.58% per year and hepatitis C 0.68% per year.

Metabolic (MASLD, obesity, T2DM): currently accounting for 19.7% with striking growth — obesity, T2DM, and MASLD growing at annual rates of 3.17%, 2.22%, and 0.66%, respectively — the only risk category on a sustained rise.

Behavioral/toxic (alcohol consumption, smoking, aflatoxin): accounting for 22.4%, showing an overall downward trend.

  (Embedded figure in the original web page: share of each risk factor in liver cancer cases globally/by region, 2022)

The data show that infection-related liver cancer is gradually receding, while metabolic-related liver cancer (obesity, T2DM, MASLD) is rising strongly and will become the core focus of future liver cancer prevention and control.

(Embedded figure in the original web page: prevalence/SEV trends of major risk factors across five regions, 1990–2022)

■ MASLD: From "Fatty Liver" to Liver Cancer — the Most Hidden Carcinogenic Chain

Many people regard fatty liver as a minor "sub-health" issue, unaware that MASLD is no longer merely fat accumulation in the liver, but a core "precursor lesion" of liver cancer.

The study shows that MASLD's PAF for liver cancer reaches 13.4%, far exceeding obesity (5.3%) and type 2 diabetes (4.4%), making it the highest-contributing single metabolic risk factor.

In Europe and North America, metabolic-related liver cancer has already surpassed virus-related liver cancer overall. Moreover, obesity, T2DM, and MASLD are highly comorbid; when combined, they multiply liver cancer risk by 2–3 times, forming a "metabolic vicious cycle" — the core reason global metabolic risk continues to climb.

 (Embedded figure in the original web page: PAF of the nine risk factors for HCC, 2022)

■ Global Trends: Developed Countries Lead the Way, China Follows Quickly

The study shows that the etiological transition of liver cancer varies markedly by region, yet the trend is highly consistent:

High-income countries in Europe and North America: metabolic factors have long surpassed infection as the leading cause of liver cancer; the proportion of MASLD-related liver cancer in North America and Europe has risen year by year, exceeding 30% in some regions.

Current status in China: hepatitis B still dominates liver cancer etiology (PAF 69.7%), but the MASLD prevalence rate is as high as 30%, and metabolic risk is growing far faster than the global average. It is projected that within the next 10–20 years, MASLD will replace hepatitis B as the leading cause of liver cancer in China.

■ 78.4% of Liver Cancer Is Preventable — Halting MASLD Is the Key

Globally, 78.4% of liver cancer cases can be prevented by managing risk factors, and halting MASLD progression is the most cost-effective and readily implementable prevention pathway.

Routine imaging and basic liver function tests cannot precisely distinguish the degree of hepatocyte damage or inflammatory activity, and cannot predict the trajectory of the disease in advance.

To fill the gap in early MASLD screening and disease assessment and support standardized clinical management of chronic disease, Hotgen Biotech — with deep expertise in the liver disease field — has launched the "Fatty Liver Duo" (CK18-M30/M65) test, providing a professional and reliable testing solution for MASLD management. (Embedded figure in the original web page: introduction to the Fatty Liver Duo test)

The era of liver cancer causation is shifting from the "viral era" toward the "metabolic era." MASLD is not a minor ailment but the core "seed" for future liver cancer prevention and control. Paying attention to fatty liver screening and reversing metabolic disorders is the first line of defense for safeguarding liver health and staying far from liver cancer.

Reference：

Li P, Ding Z, Feng Y, Ren X, Wei Y, et al. Global, regional, and national burden of hepatocellular carcinoma and contribution of nine modifiable risk factors across 185 countries/territories in 2022. Sci Bull (Beijing). 2026 Feb 28;71(4):838-849.