S2929 Temporal Trends in the Etiology of Liver Cancer in the Middle East and North Africa Over the Past 3 Decades

Introduction: Liver cancer imposes a significant global health burden due to the associated morbidity and mortality. Different etiologies of liver cancer exists such as hepatitis B, hepatitis C, metabolic dysfunction-associated steatohepatitis (MASH), and alcohol-associated liver disease (ALD). Accordingly, evaluating the trends in the etiology of liver cancer in the Middle East and North Africa (MENA) region is of vital importance as it enables risk stratification. Methods: Data from the Global Burden of Disease database was retrieved to evaluate the trends in the age-standardized incidence rate (ASIR) of liver cancer due to hepatitis B, hepatitis C, MASH, and ALD in the MENA region for the period 1990-2019. The annual percent change (APC) and the average annual percent change (AAPC) were calculated using Joinpoint analysis. Stratification by gender was performed to evaluate for any differences between men and women. Results: Over the past 3 decades, an estimated total of 374,348 liver cancer cases were reported in the MENA region. The leading etiology was hepatitis C (51.6%) followed by hepatitis B (28.7%), MASH (10.6%) and ALD (9.1%). A statistically significant decline in the ASIR of liver cancer due to hepatitis C was noted in the MENA region with an AAPC of -0.04 (95% CI -0.06 to -0.02, P < 0.001). Similarly, liver cancer due to hepatitis B experienced a statistically significant decline in the ASIR (AAPC -0.12, 95% CI -0.15 to -0.09, P < 0.001). Liver cancer due to MASH witnessed a statistically significant increase in the ASIR (AAPC 1.59, 95% CI 1.57 to 1.62, P < 0.001). Regarding liver cancer due to ALD, a statistically significant incline in the ASIR was noted (AAPC 0.73, 95% CI 0.71 to 0.75, P < 0.001). Interestingly, stratification by gender revealed contrasting trends between both genders in liver cancer due to hepatitis B, hepatitis C, and ALD where men were found to experience a statistically significant increase in the ASIR while women experienced a statistically significant decline. However, both men and women experienced a statistically significant increase in the ASIR of liver cancer due to MASH with an AAPC of 2.26 and 1.02, respectively. Conclusion: Overall, the MENA region witnessed a significant decline in the incidence of liver cancer due to viral hepatitis while also experiencing an increase in the incidence of liver cancer due to ALD and MASH. Gender differences pose a significant concern that mandates further evaluation.