CUHK and mainland scholars formed the first Chinese-led The Lancet Commission on cancer Liver cancer cases are projected to double by 2050, but 60% are preventable
Researchers from The Chinese University of Hong Kong (CUHK)’s Faculty of Medicine (CU Medicine), together with mainland scholars, led the recent Lancet Commission on liver cancer study, revealing that over 60% of liver cancer cases worldwide can be prevented by reducing associated risk factors, which include viral hepatitis, alcohol consumption and metabolic risk factors. The report also predicts that if cases continue to rise at the current rate, the global number of liver cancer patients could double by 2050, from 870,000 to 1.52 million.
Through its Commissions programme, The Lancet Group regularly works with academic partners and leading experts to identify the most pressing issues in science, medicine and global health, with the aim of providing recommendations that change health policy or improve practice. This is the first time in The Lancet’s over 200 years of history that a major report addressing cancer has been led by Chinese scholars, in collaboration with liver cancer specialists from countries and regions including Japan, South Korea, the United States, Spain, France, and Italy -- in total 51 authors involved.
CU Medicine together with mainland scholars, led therecent Lancet Commission on liver cancer study, revealing that over 60% of liver cancer cases worldwide can be prevented by reducing associated risk factors. (From left) Professor Tony Mok Shu-kam, Li Shu Fan Medical Foundation Professor of Clinical Oncologyand Chairman of the Department of Clinical Oncology; Professor Stephen Chan Lam,first author of the Commission’s report and Ip’s Family Trust Professor in Clinical Oncology of theDepartment of Clinical Oncology; Professor Vincent Wong Wai-sun, Mok Hing Yiu Professor of Medicine and Head of the Division of Gastroenterology and Hepatology in the Department of Medicine and Therapeutics; Professor Philip Chiu Wai-yan, Shun Hing Education and Charity Fund Professor of Robotic Surgery and Dean of CU Medicine.
Liver cancer and lung cancer are among the most fatal malignancies
Both the incidence and mortality rate of liver cancer are on the rise globally. Alongside a doubling in the number of new cases over the next 25 years, the Commission’s report predicts that liver cancer-related deaths will follow a similar trajectory, increasing from 760,000 to 1.37 million.
Liver cancer is the sixth most common cancer globally, the fifth most common in Hong Kong and the third leading cause of cancer-related mortality for both. Although the number of liver cancer cases is only one-fifth that of lung cancer cases, both are considered silent killers. The lack of pain receptors inside the lung and liver, along with early symptoms that are often subtle, make it difficult to detect cancer in those regions, resulting in late-stage presentation in over 50% of patients. The five-year survival rate for both cancers is below 30%.
Professor Tony Mok Shu-kam, Li Shu Fan Medical Foundation Professor of Clinical Oncology and Chairman of the Department of Clinical Oncology at CU Medicine, said: “Both liver and lung cancer are among the most fatal malignancies, mostly because of the late stage at presentation. Early detection with national screening programmes for these two types of cancer is imminent and will be life-saving.”
60% of liver cancer cases worldwide are preventable
Hepatitis B and C virus infections, excessive alcohol use and metabolic dysfunction-associated steatotic liver disease (MASLD)[1] are the primary causes of liver cancer. The Commission report reveals there is a shift in the global distribution of liver cancer causes, with a rising proportion linked to excessive alcohol use and metabolic dysfunction-associated steatohepatitis (MASH), while those related to hepatitis have slightly declined. (See Table 1 for details.)
Table 1: Projected distribution of liver cancer by cause in 2022, 2035 and 2050
| 2022 | 2035 | 2050 |
|---|---|---|---|
Hepatitis B virus infection | 39.0% | 38.1% | 36.9% |
Hepatitis C virus infection | 29.1% | 27.6% | 25.9% |
Alcohol use | 18.8% | 19.9% | 21.1% |
MASH | 8.0% | 9.2% | 10.8% |
Other | 5.1% | 5.2% | 5.3% |
Professor Stephen Chan says clinical management strategies on liver cancer must be tailored to regional differences.
Professor Stephen Chan Lam,first author of the Commission’s report and Ip’s Family Trust Professor in Clinical Oncology of theDepartment of Clinical Oncology at CU Medicine, said: “Liver cancer can be deadly but our report finds that 60% of cases are preventable by targeting modifiable risk factors – such as increasing hepatitis vaccination coverage, reducing alcohol intake and managing obesity-related metabolic issues.”
“However, clinical management strategies must be tailored to regional differences. China accounts for 40% of global liver cancer cases, with 60% of those linked to hepatitis B virus infection. Therefore, enhancing hepatitis vaccination, antiviral treatment and screening of high-risk groups are the most effective prevention measures. In contrast, liver cancer in Western countries is primarily driven by metabolic-related fatty liver disease, making obesity control the top priority.”
Professor Vincent Wong says most liver cancer cases are associated with chronic liver disease. Lifestyle modifications such as reduction in alcohol intake, healthy diet and regular exercise can help prevent chronic liver disease.
Professor Vincent Wong Wai-sun, Mok Hing Yiu Professor of Medicine and Head of the Division of Gastroenterology and Hepatology in the Department of Medicine and Therapeutics at CU Medicine, said: “Most liver cancer cases are associated with chronic liver disease. Hepatitis vaccination helps prevent viral infections, while lifestyle modifications help prevent chronic liver disease, including a reduction in alcohol intake and weight control. Maintaining a balanced diet and regular exercise can also improve liver function.”
The Commission report estimates that if proactive liver cancer prevention measures were implemented globally, new cases could be reduced by 2% to 5% annually. By 2050, this could prevent up to 17 million new liver cancer cases and 15 million deaths.
CU Medicine has achieved numerous breakthroughs in liver cancer and disease research over the past two decades
Professor Chan, who jointly led the Commission report with mainland scholars, is a renowned expert in hepatobiliary pancreatic cancers. He has recently established a regimen featuring a combination of types of immunotherapy for liver cancer, which can considerably extend the length of time that patients survive while sparing them the complications of conventional treatment. To further improve outcomes among patients with hepatobiliary pancreatic cancers, he and his team have started working on the strategy of personalising cancer treatment with predictive biomarkers.
Professor Philip Chiu Wai-yan, Shun Hing Education and Charity Fund Professor of Robotic Surgery and Dean of CU Medicine, said: “The invitation from The Lancet, one of the world’s most prestigious medical journals, to lead its Liver Cancer Commission report represents powerful recognition of CU Medicine’s contribution to and leadership in global liver cancer and disease research. The fact that this is the first time Chinese scholars have led a Lancet Commission report on cancer underscores China’s pivotal role in shaping global strategies for liver cancer prevention and advancing the development of precision medicine.”
Over the past two decades, CU Medicine’s research in liver cancer and disease has achieved numerous breakthroughs, spanning immunotherapy, targeted drugs, radiotherapy, mechanisms and risk assessment of metabolic liver diseases, and more. Its teams have uncovered mechanisms of immune resistance in liver cancer and developed innovative combination therapies. They have also identified key oncogenic drivers such as HDAC8 and SQLE, paving the way for precision treatment. The early development of a risk calculation tool for hepatocellular carcinoma has significantly improved clinical management of hepatitis B patients. CU Medicine teams have also drawn up treatment guidelines for chronic hepatitis B management across the Asia-Pacific region. These achievements have earned widespread recognition in the medical community, reinforcing CU Medicine’s leadership in liver cancer and disease research.
This is the first time in The Lancet’s over 200 years of history that a major report addressing cancer has been led by Chinese scholars, in collaboration with liver cancer specialists from countries and regions including Japan, South Korea, the United States, Spain, France, and Italy -- in total 51 authors involved.
[1] Metabolic dysfunction-associated steatotic liver disease (MASLD) was once called nonalcoholic fatty liver disease (NAFLD). It refers to a condition where there is a buildup of fat in the liver in people with metabolic conditions such as diabetes and obesity, causing chronic inflammation and damage to the liver.
