Global Prevalence, Clinical Characteristics, Surveillance, Treatment Allocation, and Outcomes of Alcohol-Associated Hepatocellular Carcinoma
Abstract
Background Although the burden of alcohol-associated hepatocellular carcinoma (HCC) is increasing with rising alcohol consumption, clinical presentation and outcomes of alcohol-associated HCC have not been systematically assessed. We aimed to determine the prevalence, clinical characteristics, surveillance rates, treatment allocation, and outcomes of alcohol-associated HCC.Methods Medline and Embase were searched from inception to January 2023. Proportional data were analyzed using a generalized linear mixed model. The odds ratio (OR) or mean difference comparing alcohol-associated HCC and other causes was obtained with pairwise meta-analysis. Survival outcomes were evaluated using a pooled analysis of hazard ratios.Results Of 4824 records identified, 55 articles (86,345 patients) were included. Overall, 30.4% (95% confidence interval [CI], 24.0%-37.7%) of HCC was alcohol associated, with the highest proportion in Europe and the lowest in the Americas. People with alcohol-associated HCC were more likely male but were similar in age and comorbidities compared with other causes. A total of 20.8% (95% CI, 11.4%-34.9%) of people with alcohol-associated HCC underwent surveillance compared with 35.0%, 31.6%, and 21.4% in hepatitis B virus, hepatitis C virus, and metabolic dysfunction-associated HCC, respectively (all P < .05). Alcohol-associated HCC had a lower likelihood of Barcelona Clínic Liver Cancer C stage (0/A) (OR, 0.7; 95% CI, 0.6-0.9; P = .018) and curative therapy (24.5% vs 33.9%; OR, 0.7; 95% CI, 0.5-0.9; P = .003), and higher mortality (HR, 1.3; 95% CI, 1.1-1.5; P = .012) when compared with other causes.Conclusions Alcohol-associated HCC is associated with lower surveillance rates, more advanced BCLC stage, lower likelihood of receiving curative therapy, and poorer survival. These data call for measures to reduce heavy alcohol consumption and improve strategies for effective HCC surveillance in high-risk individuals.
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Improved screening and diagnostic techniques allow for earlier and more accurate detection, while changes in disease registry systems may enhance the ability to capture current epidemiological trends, potentially leading to higher reported prevalence rates.
“Improved screening and diagnostic techniques allow for earlier and more accurate detection, while changes in disease registry systems may enhance the ability to capture current epidemiological trends, potentially leading to higher reported prevalence rates [27,28].”
From Global epidemiology of alcohol-related liver disease, liver cancer, and alcohol use disorder, 2000–2021 (2025) · cites this paper as [28]
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Dugum, M. F., Hanouneh, I. A., López, R., Aucejo, F., Eghtesad, B., & Zein, N. N. (2015) · Transplantation Proceedings · doi:10.1016/j.transproceed.2015.02.021 · Cited by 11 · see citing works
Siriwardana, R. C., Niriella, M. A., Dassanayake, A. S., Liyanage, C., Gunathilaka, B., Jayathunge, S., & de Silva, H. J. (2015) · Hepatobiliary & pancreatic diseases international · doi:10.1016/s1499-3872(15)60343-5 · Cited by 11 · see citing works
Yoon, C. H., Jin, Y., & Lee, J. W. (2018) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000001174 · Cited by 10 · see citing works
deLemos, A. S., Patel, M., Gawrieh, S., Burney, H. N., Dakhoul, L., Miller, E., Scanga, A. E., Kettler, C. D., Liu, H., Roche, P., et al. (2020) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000139 · Cited by 10 · see citing works
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Burgmans, M. C., Too, C. W., Fiocco, M. F., Kerbert, A. J. C., Lo, R. H. G., Schaapman, J. J., van Erkel, A. R., Coenraad, M. J., & Tan, B. S. (2016) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-016-1462-7 · Cited by 4 · see citing works
Flagged first, then by citations
2 of the 95 references couldn’t be matched to a known paper.
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Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment
Hwang, S. Y., Danpanichkul, P., Agopian, V. G., Mehta, N., Parikh, N. D., Abou‐Alfa, G. K., Singal, A. G., & Yang, J. D. (2024) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2024.0824 · Cited by 348 · see citing works
Self-citationDanpanichkul, P., Díaz, L. A., Suparan, K., Tothanarungroj, P., Sirimangklanurak, S., Auttapracha, T., Blaney, H. L., Sukphutanan, B., Pang, Y., Kongarin, S., et al. (2025) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2024.0835 · Cited by 85 · see citing works
Self-citationChanges in the epidemiological trends of primary liver cancer in the Asia–Pacific region
Danpanichkul, P., Suparan, K., Sukphutanan, B., Kaeosri, C., Tothanarungroj, P., Sirimangklanurak, S., Kalligeros, M., Polpichai, N., Pang, Y., Wijarnpreecha, K., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-70526-z · Cited by 42 · see citing works
Self-citationDanpanichkul, P., Duangsonk, K., Chen, V. L., Saokhieo, P., Dejvajara, D., Sukphutanan, B., Aboona, M. B., Lopimpisuth, C., Pang, Y., Ibrahim, A., et al. (2025) · Hepatology · doi:10.1097/hep.0000000000001260 · Cited by 38 · see citing works
Self-citationPublic health strategies for hepatocellular carcinoma: from risk factors to prevention and control
Lee, M.-H. (2025) · Journal of Liver Cancer · doi:10.17998/jlc.2025.07.25 · Cited by 31 · see citing works
The burden of alcohol and substance use disorders in adolescents and young adults
Danpanichkul, P., Duangsonk, K., Díaz, L. A., Chen, V. L., Rangan, P., Sukphutanan, B., Dutta, P., Wanichthanaolan, O., Ramadoss, V., Sim, B., et al. (2024) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2024.112495 · Cited by 30 · see citing works
Self-citationDifferences between hepatocellular carcinoma caused by alcohol and other aetiologies
Ganne‐Carrié, N., & Nahon, P. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.12.030 · Cited by 34 · see citing works
Kuo, C., Li, C., Chuang, M., Huang, P., Kuo, H., & Lai, C. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70007 · Cited by 25 · see citing works
Recompensation in decompensated cirrhosis
Premkumar, M., Kamath, P. S., Reiberger, T., & Reddy, K. R. (2025) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(25)00095-0 · Cited by 25 · see citing works
Burden of Alcohol‐Related Liver Disease and Alcohol Use Disorder in Asia
Danpanichkul, P., Pang, Y., Suparan, K., Saokhieo, P., Jatupornpakdee, P., Polpichai, N., Attachaipanich, T., Suenghataiphorn, T., Ibrahim, A., Vichitkunakorn, P., et al. (2025) · United European Gastroenterology Journal · doi:10.1002/ueg2.70077 · Cited by 17 · see citing works
Self-citationMeta‐Analysis: Utilisation of Hepatocellular Carcinoma Surveillance
Tang, N. S. Y., Gunalan, S. Z., Ong, C. E. Y., Koh, B., Tham, E. K. J., Lim, R. Y., Tan, D. J. H., Syn, N. L. X., Ng, C. H., Muthiah, M. D., et al. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70403 · Cited by 17 · see citing works
Self-citationDanpanichkul, P., Duangsonk, K., Tham, E. K. J., Tothanarungroj, P., Auttapracha, T., Prasitsumrit, V., Sim, B., Tung, D., Barba, R., Wong, R. J., et al. (2024) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.15516 · Cited by 15 · see citing works
Self-citationDanpanichkul, P., Suparan, K., Auttapracha, T., Tothanarungroj, P., Kongarin, S., Rakwong, K., Tan, D. J. H., Sukphutanan, B., Muthiah, M. D., Tung, D., et al. (2025) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2024.10.021 · Cited by 15 · see citing works
Self-citationGeographic diversity of human liver cancers mirrors global social inequalities
Cano, L., Foucher, F., & Musso, O. C. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1565692 · Cited by 15 · see citing works
Danpanichkul, P., Duangsonk, K., Kalligeros, M., Fallon, M. B., Vuthithammee, C., Pan, C., Saokhieo, P., Derrick, W. P., Pang, Y., Chen, V. L., et al. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18473 · Cited by 14 · see citing works
Self-citationPrevention of liver cancer in the era of next-generation antivirals and obesity epidemic
Suzuki, H., Fujiwara, N., Singal, A. G., Baumert, T. F., Chung, R. T., Kawaguchi, T., & Hoshida, Y. (2025) · Hepatology · doi:10.1097/hep.0000000000001227 · Cited by 11 · see citing works
Self-citationYoung Adults and Alcohol-Associated Liver Cancer: Incidence and Death from 2000 to 2021
Danpanichkul, P., Pang, Y., Díaz, L. A., Arab, J. P., Hwang, S. Y., Dejvajara, D., Suresh, V. V., Suenghataiphorn, T., Wannaphut, C., Suparan, K., et al. (2025) · Cancers · doi:10.3390/cancers17040609 · Cited by 11 · see citing works
Self-citationLi, D., Li, X., Liu, R., Yao, Z., Zheng, C., Jin, S. Z., Guo, X., Zhang, Z., Tan, S., & Zhu, X. (2025) · Journal of Translational Medicine · doi:10.1186/s12967-025-06314-8 · Cited by 11 · see citing works
Alcohol‐Attributable Cancer: Update From the Global Burden of Disease 2021 Study
Danpanichkul, P., Pang, Y., Díaz, L. A., White, T. M., Sirimangklanurak, S., Auttapracha, T., Suparan, K., Syn, N. L. X., Jatupornpakdee, P., Saowapa, S., et al. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70163 · Cited by 11 · see citing works
Self-citationLongitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis
Kim, D. H., Ko, D., Danpanichkul, P., Ho, G. J. K., Tan, F. X. N., Sasikumar, N. A., Tham, E. K. J., Huang, D. Q., Syn, N. L. X., Zheng, M., et al. (2025) · The American Journal of Medicine · doi:10.1016/j.amjmed.2025.04.027 · Cited by 8 · see citing works
Self-citationTamaki, N., Kimura, T., Wakabayashi, S., Yamazaki, T., Iwadare, T., Tanaka, N., & Kurosaki, M. (2026) · Japanese Journal of Radiology · doi:10.1007/s11604-025-01930-2 · Cited by 8 · see citing works
Self-citationThe global epidemiology of alcohol-associated liver disease
Danpanichkul, P., Idalsoaga, F. J., Murray, F., Arab, J. P., & Díaz, L. A. (2026) · Hepatology Communications · doi:10.1097/hc9.0000000000000947 · Cited by 6 · see citing works
Self-citationChen, J. K., Li, L., SuFang, F., & Zhou, H. (2026) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s607656 · Cited by 3 · see citing works
Chen, Z., Fan, D., Hang, T., & Yue, X. (2025) · Discover Oncology · doi:10.1007/s12672-025-01853-4 · Cited by 3 · see citing works
Wang, Y., Oza, N., Leo, J., Choudhury, A. K., & Huang, D. Q. (2025) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2025.0133 · Cited by 3 · see citing works
Self-citationJarrah, M., Deodhar, S., Quirk, L., Al-Hasan, M., Sharma, A., Bhamra, G. S., Terrell, J., Kanwal, F., Hoshida, Y., Rich, N. E., et al. (2025) · Cancers · doi:10.3390/cancers17233835 · Cited by 2 · see citing works
Xia, S., Qin, X., Pan, C., Fan, D., & Dh, Y. (2026) · IET Systems Biology · doi:10.1049/syb2.70051 · Cited by 2 · see citing works
Danpanichkul, P., Suparan, K., Chaiyakunapruk, N., Auttapracha, T., Kongarin, S., Wattanachayakul, P., Ramadoss, V., Suenghataiphorn, T., Sukphutanan, B., Pang, Y., et al. (2024) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002882 · Cited by 2 · see citing works
Self-citationLifestyle factors in hepatocellular carcinoma: From pathogenesis to prognosis
Zhao, H., Zhang, X., & Li, X. F. (2025) · World Journal of Clinical Oncology · doi:10.5306/wjco.v16.i7.107723 · Cited by 1 · see citing works
Metabolic and alcohol-related steatotic liver disease and gastrointestinal cancer risk in diabetes
Im, S.-G., Shin, C. M., Han, K., Jung, J., Choi, J., Jo, H., Lee, H.-K., Jin, E. H., Kang, S. J., Lim, J. H., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-21005-6 · Cited by 1 · see citing works
Etiology of cirrhosis is associated with risk of hepatic decompensation and hepatocellular carcinoma
Ng, M., Bardhi, O., Lai, K., Koo, E., Yekkaluri, S., Bass, K., Bhamra, G. S., Danpanichkul, P., Quirk, L., Yang, J. D., et al. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-04538-y · Cited by 1 · see citing works
Self-citationEpidemiological trends and age–period–cohort analysis of alcoholic liver cancer from 1990 to 2021
Chen, J., Li, R., Li, X., Shi, K., Zeng, R., Hu, K., & Wang, Q. (2025) · Hepatology International · doi:10.1007/s12072-025-10966-5 · Cited by 1 · see citing works
Self-citationYan, X., Dong, X., Yao, L., Guo, M., & Wang, N. (2026) · Pathology - Research and Practice · doi:10.1016/j.prp.2026.156425 · Cited by 1 · see citing works
Contemporary global epidemiology of cirrhosis
Saokhieo, P., Auttapracha, T., Danpanichkul, P., Pang, Y., Yang, L., Singal, A. G., Kim, D., & Wijarnpreecha, K. (2026) · Hepatology Communications · doi:10.1097/hc9.0000000000000989 · Cited by 1 · see citing works
Self-citationYi, J.-H., Guo, H., Jiang, C., Duan, J., Xue, J., Zhao, Y., He, W.-Z., & Xia, L.-P. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1462591 · Cited by 1 · see citing works
Danpanichkul, P., Kim, D., Pan, C., Singal, A. G., Yang, J. D., & Wijarnpreecha, K. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18511 · Cited by 1 · see citing works
Self-citationBoudagh, G., Alnasart, A., Chaer, K. A., Naylor, P. H., & Mutchnick, M. G. (2025) · Onco · doi:10.3390/onco5030030
Hepatocellular carcinoma of non-viral etiology: From theory to real practice
Петкау, В. В., Krasilnikova, N. E., Николаевна, Б. Е., & Тарханов, А. А. (2025) · Meditsinskiy sovet = Medical Council · doi:10.21518/ms2025-260
Stepanov, Y. M., Zavhorodnia, N. Y., & Vlasova, O. M. (2025) · GASTROENTEROLOGY · doi:10.22141/2308-2097.59.3.2025.694
Pinto, E., Zanetto, A., Gambato, M., Ferrarese, A., Germani, G., Senzolo, M., Russo, F. P., & Burra, P. (2025) · European Journal of Transplantation · doi:10.57603/ejt-1749
Huang, H., Chen, H., Xu, X., Pan, S., Cheng, Y., Tang, J., Wang, Q., Tao, J., Huang, L., 陈仁彪, et al. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1882068
Environmental factors related to pathogenesis of hepatocellular carcinoma
Jing, L.-B., & Li, Y. (2026) · Hepatobiliary & pancreatic diseases international · doi:10.1016/j.hbpd.2026.08.010
Alcohol Consumption Increases Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B
Chen, Y., Rui, F., Zhang, S., Wu, X., Li, S., Cui, J., Mao, Y., Lin, Z., 秦向欣, Song, Y., et al. (2026) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2026.09.010
Global Burden of Liver Disease: 2026 Update
Devarbhavi, H. C., Asrani, S. K., Arab, J. P., Pose, E., Nartey, Y. A., & Kamath, P. S. (2026) · Gastroenterology · doi:10.1053/j.gastro.2026.09.014
Mignot, V., Baron, A., Decaens, T., & Costentin, C. E. (2026) · Liver International · doi:10.1111/liv.70923
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Mechanisms of Alcohol-Associated Cancers: Liver Cancer
Juergens, B., Seth, D., & Liu, K. (2026) · Springer eBooks · doi:10.1007/978-3-031-35658-2_125-1
- Authors
- Zeng, R. W., Ong, C. E. Y., Ong, E. Y. H., Chung, C. H., Lim, W. H., Xiao, J., Danpanichkul, P., Law, J. H., Syn, N., Chee, D., Kow, A. W. C., Lee, S. W., Takahashi, H., Kawaguchi, T., Tamaki, N., Dan, Y. Y., Nakajima, A., Wijarnpreecha, K., Muthiah, M. D., Noureddin, M., Loomba, R., Ioannou, G. N., Tan, D. J. H., Ng, C. H., & Huang, D. Q.
- Affiliations
- National University of Singapore (SG)
- Chiang Mai University (TH)
- National University Hospital (SG)
- National University Cancer Institute, Singapore (SG)
- Catholic University of Korea (KR)
- Kurume University (JP)
- Musashino Red Cross Hospital (JP)
- Yokohama City University (JP)
- Banner Health (US)
- University of California San Diego (US)
- University of Washington (US)
- Corresponding author
- Huang, Daniel Q.
- ORCID
- Zeng, Rebecca Wenling
- Ong, Christen En Ya
- Chung, Charlotte Hui
- Lim, Wen Hui
- Xiao, Jieling
- Danpanichkul, Pojsakorn
- Law, Jia Hao
- Syn, Nicholas
- Chee, Douglas
- Kow, Alfred Wei Chieh
- Lee, Sung Won
- Kawaguchi, Takumi
- Tamaki, Nobuharu
- Dan, Yock Young
- Nakajima, Atsushi
- Wijarnpreecha, Karn
- Muthiah, Mark D.
- Noureddin, Mazen
- Loomba, Rohit
- Ioannou, George N.
- Tan, Darren Jun Hao
- Ng, Cheng Han
- Huang, Daniel Q.
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2024-12
- Volume
- 22
- Issue
- 12
- Pages
- 2394-2402.e15
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W4400429106
- Cited by
- 47
- References
- 95
- Citations by year
- 2026: 13 · 2025: 27 · 2024: 7
- FWCI
- 3.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR001442)
- National Institute on Alcohol Abuse and Alcoholism (U01AA029019)
- National Heart, Lung, and Blood Institute (P01HL147835)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124318, R01DK121378, R01DK106419, P30DK120515, U01DK061734, U01DK130190)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
- Keywords
- alcohol consumption, cancer surveillance, treatment allocation, curative treatment, Barcelona Clinic Liver Cancer staging, survival outcomes, mortality, hepatitis B virus, hepatitis C virus, non-alcoholic fatty liver disease, global burden
- MeSH terms
- Female, Carcinoma, Hepatocellular, Humans, Liver Neoplasms, Male, Global Health, Prevalence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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