[Key epidemiological data and recommended prevention and control measures for primary liver cancer]

Primary liver cancer (PLC) accounted for 865,000 new cases worldwide in 2022, ranking sixth among all malignant tumors in terms of incidence, and 758,000 deaths, ranking third in mortality. The age-standardized 5-year survival rate for PLC in China has remained between 9.8% and 12.1%. Unlike other malignant tumors in China, the age-adjusted mortality rate of PLC in the middle-aged population (40-65 years) has consistently been higher than that in the elderly population aged 65 and above. Globally, hepatocellular carcinoma (HCC) accounted for 79.2% of PLC incidence and 78.8% of PLC mortality, with a male-to-female ratio of 3.3:1. The HCC incidence and mortality accounted for 45.2% and 44.6% of the world's totals, respectively, in China. There are three main categories of preventable risk factors for HCC: chronic persistent infections [hepatitis B virus (HBV), hepatitis C virus, and Clonorchis sinensis), metabolic factors (fatty liver disease, obesity, and type II diabetes), and behavioral/toxic factors (excessive alcohol consumption, smoking, and aflatoxin B1).The population attributable fraction (PAF) of these three categories of nine controllable risk factors for global HCC was 78.4%. Among them, HBV contributed the most to HCC etiology worldwide, with a PAF of 57.1%. HBV is the most important cause of all HCC in China, with HBV-positivity accounting for 84.4% and the PAF being 76.1%. Metabolic factors among the three major risk factors are growing steadily worldwide. Theoretically, functional cure of HBV, prevention and treatment of related chronic infections, reduction of metabolic diseases through aerobic exercise and dietary management, and control of tobacco, alcohol, and toxin exposure could prevent 78.4% of global HCC occurrence. Defining high-risk populations using indicators such as liver function and cirrhosis status, along with HCC screening and proactive prevention, offers a suitable input and output ratio for implementing primary prevention based on HBV replication and evolution. Models based on serum alpha-fetoprotein-3 and prothrombin can effectively enable secondary prevention through HCC screening, diagnosis, and treatment, improving patient survival rates at early stages. Targeted therapy and immunotherapy can downstage the disease, creating opportunities for surgical resection to achieve tertiary prevention for intermediate-to-advanced-stage HCC. Comprehensive management is required, with a focus on intervening and controlling the nine major risk factors to prevent PLC occurrence.