Analysis and projections of liver cancer trends in Yunnan Province, 1990–2021_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Baohui ¹ , SONG Aijing ¹ , TANG Xian ² , YU Qiuli ² , PU Xueya ² ,  CHEN Yang ^1,2,3

1. School of Public Health, Kunming Medical University, Kunming 650500, P. R. China;
2. Institute for the Prevention and Control of Chronic Noncommunicable Diseases, Yunnan Provincial Center for Disease Control and Prevention, Kunming 650500, P. R. China;
3. Yunnan Provincial International Joint Laboratory for Public Health and Disease Control, Kunming 650500, P. R. China;

Corresponding?author：

CHEN Yang, Email: yncdccy@126.com

Keywords：

liver cancer; disease burden; Bayesian age–period–cohort model; Yunnan Province

DOI：

10.7507/1007-9424.202606057

Video：

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Objective To analyze and forecast trends in the burden of liver cancer in Yunnan Province, thereby providing a basis for the formulation of liver cancer prevention and control strategies. Methods Data on incidence, mortality, and disability-adjusted life year (DALY) for liver cancer from the Global Burden of Diseases 2021 study in Yunnan Province were extracted. The Joinpoint regression model was used to analyze trends in incidence rate and age-standardized incidence rate (ASIR), mortality rate and age-standardized mortality rate (ASMR), DALY rate and age-standardized DALY rate. A Bayesian age-period-cohort model was used to project the trends in ASIR and ASMR from 2022–2030. Results From 1990 to 2021, the incidence, mortality, and DALY rates for liver cancer in Yunnan Province increased from 5.07/100 000, 5.00/100 000, and 181.52/100 000 to 11.59/100 000, 10.39/100 000, and 316.94/100 000, respectively, with average annual percentage changes of 2.73% [95%CI (2.68%, 2.77%), P<0.001], 2.45% [95%CI (2.34%, 2.56%), P<0.001], and 1.86% [95%CI (1.77%, 1.96%), P<0.001]. ASIR, ASMR, and age-standardized DALY rate also increased from 7.20/100 000, 7.37/100 000, and 234.34/100 000 to 8.84/100 000, 8.06/100 000, and 239.26/100 000. Average annual percentage changes were 0.68% [95%CI (0.65%, 0.71%), P<0.001], 0.30% [95%CI (0.19%, 0.40%), P<0.001], and 0.11% [95%CI (0.00%, 0.22%), P=0.046]. In 2021, the incidence, mortality, and DALY burden of liver cancer among male in Yunnan Province were all higher than those among female. Incidence and mortality rates increased steadily with age, peaking in the ≥85 age group, while the number of new cases, deaths, and DALYs followed a pattern of initially rising and then declining. It was projected that by 2030, the annual number of new cases and deaths from liver cancer in Yunnan Province will rise to 6 100 and 5 100, respectively, while ASIR and ASMR will decrease to 8.72/100 000 [95%CI (5.46/100 000, 11.97/100 000)] and 6.82/100 000 [95%CI (1.74/100 000, 11.91/100 000)], respectively. Conclusions The burden of liver cancer in Yunnan Province continued to increase from 1990 to 2021, with men bearing a heavier burden. In its future efforts to prevent and control liver cancer, Yunnan Province should consolidate primary prevention measures while precisely targeting middle-aged and elderly populations for liver cancer screening, and examine the synergistic carcinogenic effects of emerging risk factors such as metabolic liver disease.

Citation： CHEN Baohui, SONG Aijing, TANG Xian, YU Qiuli, PU Xueya, CHEN Yang. Analysis and projections of liver cancer trends in Yunnan Province, 1990–2021. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(8): 1018-1027. doi: 10.7507/1007-9424.202606057 Copy

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10.	Chen J, Li C, Bu CLN, et al. Global burden of non-communicable diseases attributable to kidney dysfunction with projection into 2040 [J]. Chin Med J (Engl), 2025, 138(11): 1334-1344.
11.	Zhao P, Guan C, Lu J, et al. Global, regional, and national trends and burden of multiple sclerosis in adolescents and young adults: a data analysis from 1990 to 2021 and projections to 2040 [J]. Front Immunol, 2025, 16: 1685316. doi: 10.3389/fimmu.2025.1685316.
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15.	Feng C, Liu J, Ran H, et al. Spatial and temporal analysis of liver cancer mortality in Yunnan province, China, 2015-2019 [J/OL]. Front Public Health, 2022, 10: 1010752. doi: 10.3389/fpubh.2022.1010752.
16.	Zhao Z, Chu M, Guo Y, et al. Feasibility of hepatitis c elimination in China: from epidemiology, natural history, and intervention perspectives [J/OL]. Front Microbiol, 2022, 13: 884598. doi: 10.3389/fmicb.2022.884598.
17.	Wang Y, Lu M, Su X, et al. Trend analysis of liver cancer mortality in Chinese residents from 2002 to 2021 [J/OL]. BMC Cancer, 2026, 26(1): 337. doi: 10.1186/s12885-026-15660-9.
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19.	Dai J, Zhao J, Du Y, et al. Adherence to hepatocellular carcinoma surveillance and perceived barriers among high-risk chronic liver disease patients in Yunnan, China [J]. Cancer Manag Res, 2020, 12: 6209-6220.
20.	蔡雷琦, 姜帆, 邊學峰, 等. 2014—2019年山東省濟南市肝癌流行趨勢及生存分析 [J]. 中國腫瘤, 2022, 34(12): 938-945.
21.	周海茸, 王巍巍, 周金意, 等. 2007—2021年江蘇省南京市肝癌死亡趨勢分析及其對期望壽命的影響 [J]. 中國腫瘤, 2022, 33(5): 398-404.
22.	秦家勝, 陳蓉, 方楊, 等. 2021年浙江省腫瘤登記地區肝癌發病與死亡特征及2000—2021年變化趨勢分析 [J]. 中國腫瘤, 2021, 34(11): 838-846.
23.	Zhang Y, Wang Y, Jiao S, et al. Nonlinear relationship between age and the risk of hepatocellular carcinoma in patients with hepatitis B virus-related cirrhosis [J/OL]. BMC Infect Dis, 2025, 25(1): 1635. doi: 10.1186/s12879-025-12016-9.
24.	Macias RIR, Monte MJ, Serrano MA, et al. Impact of aging on primary liver cancer: epidemiology, pathogenesis and therapeutics [J]. Aging (Albany NY), 2021, 13(19): 23416-23434.
25.	Song L, Sun L, Ren Y, et al. Sex disparities in hepatocellular carcinoma immunotherapy: hormonal and genetic influences on treatment efficacy [J/OL]. Front Immunol, 2025, 16: 1607374. doi: 10.3389/fimmu.2025.1607374.
26.	Tang Z, Deng Y, He Y, et al. Trend of liver cancer attributable to alcohol use in China from 1992 to 2021: an age-period-cohort analysis study [J/OL]. PLoS One, 2026, 21(3): e0343137. doi: 10.1371/journal.pone.0343137.
27.	Ma X, Jiang L, Han B, et al. Trends in liver cancer burden in China and G20: a comparative analysis using GBD 2021 [J/OL]. Front Oncol, 2025, 15: 1642502. doi: 10.3389/fonc.2025.1642502.
28.	Petrick JL, Campbell PT, Koshiol J, et al. Tobacco, alcohol use and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: the Liver Cancer Pooling Project [J]. Br J Cancer, 2018, 118(7): 1005-1012.
29.	Nevola R, Tortorella G, Rosato V, et al. Gender differences in the pathogenesis and risk factors of hepatocellular carcinoma [J/OL]. Biology (Basel), 2023, 12(7): 984. doi: 10.3390/biology12070984.
30.	Pi S, Liu A, Zhu B, et al. Body composition and risk of liver cancer: a population-based prospective cohort study on gender difference [J/OL]. Front Nutr, 2023, 10: 1102722. doi: 10.3389/fnut.2023.1102722.
31.	Cheung OK, Cheng AS. Gender differences in adipocyte metabolism and liver cancer progression [J/OL]. Front Genet, 2016, 7: 168. doi: 10.3389/fgene.2016.00168.
32.	Loomba R, Yang HI, Su J, et al. Synergism between obesity and alcohol in increasing the risk of hepatocellular carcinoma: a prospective cohort study [J/OL]. Am J Epidemiol, 2013, 177(4): 333-342.
33.	Xia Y, Zhu W, Pang L, et al. Prevalence and clustering trends association of modifiable cardiovascular disease risk factors and ASCVD risk change in ethnic areas of the Southwest China plateau: progressively increasing sex disparity [J/OL]. BMC Cardiovasc Disord, 2025, 25(1): 763. doi: 10.1186/s12872-025-05241-2.
34.	Shi Y, Zhang X, Wong T, et al. Sex differences in risk of adverse liver events in patients with cirrhosis [J/OL]. JAMA Netw Open, 2025, 8(7): e2523674. doi: 10.1001/jamanetworkopen.2025.23674.
35.	Chai Y, Xu T, Chen B, et al. Burden of digestive system neoplasms in middle-aged and elderly adults: temporal trends and geographic disparities (1990-2021) [J/OL]. PLoS One, 2025, 20(8): e0330259. doi: 10.1371/journal.pone.0330259.
36.	Berben L, Floris G, Wildiers H, et al. Cancer and aging: two tightly interconnected biological processes [J/OL]. Cancers (Basel), 2021, 13(6): 1400. doi: 10.3390/cancers13061400.
37.	Qin Y, Tang C, Li J, et al. Liver cancer in China: the analysis of mortality and burden of disease trends from 2008 to 2021 [J/OL]. BMC Cancer, 2024, 24(1): 594. doi: 10.1186/s12885-024-12334-2.
38.	Wen J, Xia M, Luo H, et al. Global, regional, and national burden of liver cancer in adolescents and young adults from 1990 to 2021: an analysis of the global burden of disease study 2021 and forecast to 2040 [J/OL]. Front Public Health, 2025, 13: 1547106. doi: 10.3389/fpubh.2025.1547106.
39.	李敬東, 肖雨竹. 中國《原發性肝癌診療指南 (2026年版)》更新解讀及與歐美指南對比 [J]. 中國普外基礎與臨床雜志, 2023, 33(7): 865-874.
40.	Li M, He H, Zhao X, et al. Burden of liver cancer and underlying etiologies in China from 1990 to 2021: a systematic analysis from the Global Burden of Disease Study 2021 [J/OL]. Chin Med J (Engl), 2026, 139(3): 415-423.

1. 郝運, 李川, 文天夫, 等. 全球及中國的肝癌流行病學特征: 基于《2022全球癌癥統計報告》解讀 [J]. 中國普外基礎與臨床雜志, 2017, 31(7): 781-789.
2. Cao G, Liu J, Liu M. Trends in mortality of liver disease due to hepatitis B in China from 1990 to 2019: findings from the Global Burden of Disease Study [J]. Chin Med J (Engl), 2022, 135(17): 2049-2055.
3. 范蕓苑, 唐嫻, 文洪梅, 等. 云南省2020年腫瘤登記地區肝癌的發病和死亡情況及2012—2020年趨勢分析 [J]. 實用腫瘤學雜志, 2024, 38(6): 377-382.
4. GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021 [J]. Lancet, 2024, 403(10440): 2162-2203.
5. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021 [J]. Lancet, 2024, 403(10440): 2100-2132.
6. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021 [J]. Lancet, 2024, 403(10440): 2133-2161.
7. 鄭文敏, 田元元. 1994–2023年中國肝癌發病和死亡的年齡-時期-隊列分析及病因歸因分析 [J]. 中國普外基礎與臨床雜志, 2024, 33(6): 769-776.
8. Ma Y, Liu Y, Liu Y, et al. Global, regional, and national burden of early-onset prostate cancer, 1990-2021: a systematic analysis for the global burden of disease study 2021 [J/OL]. World J Surg Oncol, 2026, 24(1): 145. doi: 10.1186/s12957-026-04261-2.
9. Li S, Chen H, Man J, et al. Changing trends in the disease burden of esophageal cancer in China from 1990 to 2017 and its predicted level in 25 years [J]. Cancer Med, 2021, 10(5): 1889-1899.
10. Chen J, Li C, Bu CLN, et al. Global burden of non-communicable diseases attributable to kidney dysfunction with projection into 2040 [J]. Chin Med J (Engl), 2025, 138(11): 1334-1344.
11. Zhao P, Guan C, Lu J, et al. Global, regional, and national trends and burden of multiple sclerosis in adolescents and young adults: a data analysis from 1990 to 2021 and projections to 2040 [J]. Front Immunol, 2025, 16: 1685316. doi: 10.3389/fimmu.2025.1685316.
12. 吳一璇, 肖亮滿, 劉鑫, 等. 1990—2021年中國與全球帕金森病的疾病負擔分析與未來趨勢預測 [J]. 中國全科醫學, 2025, 29(20): 2895-2902.
13. 許傲倫, 丁昊, 翟鐵民, 等. 1990—2021年我國肝癌疾病負擔變化趨勢分析 [J]. 中國衛生經濟, 2026, 44(9): 67-72.
14. Cao M, Ding C, Xia C, et al. Attributable deaths of liver cancer in China [J]. Chin J Cancer Res, 2021, 33(4): 480-489.
15. Feng C, Liu J, Ran H, et al. Spatial and temporal analysis of liver cancer mortality in Yunnan province, China, 2015-2019 [J/OL]. Front Public Health, 2022, 10: 1010752. doi: 10.3389/fpubh.2022.1010752.
16. Zhao Z, Chu M, Guo Y, et al. Feasibility of hepatitis c elimination in China: from epidemiology, natural history, and intervention perspectives [J/OL]. Front Microbiol, 2022, 13: 884598. doi: 10.3389/fmicb.2022.884598.
17. Wang Y, Lu M, Su X, et al. Trend analysis of liver cancer mortality in Chinese residents from 2002 to 2021 [J/OL]. BMC Cancer, 2026, 26(1): 337. doi: 10.1186/s12885-026-15660-9.
18. Xia C, Basu P, Kramer BS, et al. Cancer screening in China: a steep road from evidence to implementation [J/OL]. Lancet Public Health, 2023, 8(12): e996-e1005. doi: 10.1016/S2468-2667(23)00186-X.
19. Dai J, Zhao J, Du Y, et al. Adherence to hepatocellular carcinoma surveillance and perceived barriers among high-risk chronic liver disease patients in Yunnan, China [J]. Cancer Manag Res, 2020, 12: 6209-6220.
20. 蔡雷琦, 姜帆, 邊學峰, 等. 2014—2019年山東省濟南市肝癌流行趨勢及生存分析 [J]. 中國腫瘤, 2022, 34(12): 938-945.
21. 周海茸, 王巍巍, 周金意, 等. 2007—2021年江蘇省南京市肝癌死亡趨勢分析及其對期望壽命的影響 [J]. 中國腫瘤, 2022, 33(5): 398-404.
22. 秦家勝, 陳蓉, 方楊, 等. 2021年浙江省腫瘤登記地區肝癌發病與死亡特征及2000—2021年變化趨勢分析 [J]. 中國腫瘤, 2021, 34(11): 838-846.
23. Zhang Y, Wang Y, Jiao S, et al. Nonlinear relationship between age and the risk of hepatocellular carcinoma in patients with hepatitis B virus-related cirrhosis [J/OL]. BMC Infect Dis, 2025, 25(1): 1635. doi: 10.1186/s12879-025-12016-9.
24. Macias RIR, Monte MJ, Serrano MA, et al. Impact of aging on primary liver cancer: epidemiology, pathogenesis and therapeutics [J]. Aging (Albany NY), 2021, 13(19): 23416-23434.
25. Song L, Sun L, Ren Y, et al. Sex disparities in hepatocellular carcinoma immunotherapy: hormonal and genetic influences on treatment efficacy [J/OL]. Front Immunol, 2025, 16: 1607374. doi: 10.3389/fimmu.2025.1607374.
26. Tang Z, Deng Y, He Y, et al. Trend of liver cancer attributable to alcohol use in China from 1992 to 2021: an age-period-cohort analysis study [J/OL]. PLoS One, 2026, 21(3): e0343137. doi: 10.1371/journal.pone.0343137.
27. Ma X, Jiang L, Han B, et al. Trends in liver cancer burden in China and G20: a comparative analysis using GBD 2021 [J/OL]. Front Oncol, 2025, 15: 1642502. doi: 10.3389/fonc.2025.1642502.
28. Petrick JL, Campbell PT, Koshiol J, et al. Tobacco, alcohol use and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: the Liver Cancer Pooling Project [J]. Br J Cancer, 2018, 118(7): 1005-1012.
29. Nevola R, Tortorella G, Rosato V, et al. Gender differences in the pathogenesis and risk factors of hepatocellular carcinoma [J/OL]. Biology (Basel), 2023, 12(7): 984. doi: 10.3390/biology12070984.
30. Pi S, Liu A, Zhu B, et al. Body composition and risk of liver cancer: a population-based prospective cohort study on gender difference [J/OL]. Front Nutr, 2023, 10: 1102722. doi: 10.3389/fnut.2023.1102722.
31. Cheung OK, Cheng AS. Gender differences in adipocyte metabolism and liver cancer progression [J/OL]. Front Genet, 2016, 7: 168. doi: 10.3389/fgene.2016.00168.
32. Loomba R, Yang HI, Su J, et al. Synergism between obesity and alcohol in increasing the risk of hepatocellular carcinoma: a prospective cohort study [J/OL]. Am J Epidemiol, 2013, 177(4): 333-342.
33. Xia Y, Zhu W, Pang L, et al. Prevalence and clustering trends association of modifiable cardiovascular disease risk factors and ASCVD risk change in ethnic areas of the Southwest China plateau: progressively increasing sex disparity [J/OL]. BMC Cardiovasc Disord, 2025, 25(1): 763. doi: 10.1186/s12872-025-05241-2.
34. Shi Y, Zhang X, Wong T, et al. Sex differences in risk of adverse liver events in patients with cirrhosis [J/OL]. JAMA Netw Open, 2025, 8(7): e2523674. doi: 10.1001/jamanetworkopen.2025.23674.
35. Chai Y, Xu T, Chen B, et al. Burden of digestive system neoplasms in middle-aged and elderly adults: temporal trends and geographic disparities (1990-2021) [J/OL]. PLoS One, 2025, 20(8): e0330259. doi: 10.1371/journal.pone.0330259.
36. Berben L, Floris G, Wildiers H, et al. Cancer and aging: two tightly interconnected biological processes [J/OL]. Cancers (Basel), 2021, 13(6): 1400. doi: 10.3390/cancers13061400.
37. Qin Y, Tang C, Li J, et al. Liver cancer in China: the analysis of mortality and burden of disease trends from 2008 to 2021 [J/OL]. BMC Cancer, 2024, 24(1): 594. doi: 10.1186/s12885-024-12334-2.
38. Wen J, Xia M, Luo H, et al. Global, regional, and national burden of liver cancer in adolescents and young adults from 1990 to 2021: an analysis of the global burden of disease study 2021 and forecast to 2040 [J/OL]. Front Public Health, 2025, 13: 1547106. doi: 10.3389/fpubh.2025.1547106.
39. 李敬東, 肖雨竹. 中國《原發性肝癌診療指南 (2026年版)》更新解讀及與歐美指南對比 [J]. 中國普外基礎與臨床雜志, 2023, 33(7): 865-874.
40. Li M, He H, Zhao X, et al. Burden of liver cancer and underlying etiologies in China from 1990 to 2021: a systematic analysis from the Global Burden of Disease Study 2021 [J/OL]. Chin Med J (Engl), 2026, 139(3): 415-423.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis and projections of liver cancer trends in Yunnan Province, 1990–2021

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