Published: 2020-10-28

The changing patterns of liver cancer in Saudi Arabia over a 22-year period

Bandar M. Alshehri


Background: Liver cancer is a major public health problem in the developing world. It is the sixth most common cancer in the developed world and the second leading cause of death among cancer patients, globally. This study evaluated the trends and geographical distributions of liver cancer in the Saudi Arabian population.

Methods: A secondary data analysis was performed on liver cancer cases registered in the Saudi Cancer registry for the period 1994 to 2015. In all, 8,785 liver cancer cases were included in the analysis, all of them Saudi nationals.

Results: There were significant decreases in the mean age-standardised rates of liver cancer over the study period. The incidence of liver cancer varied by region. A strong positive correlation was observed between liver cancer incidence and age. Hepatocellular carcinoma-NOS is the most common histopathology subtype among the Saudi population.

Conclusions: The overall trend of the liver cancer age-standardised rate for males and females decreased among the Saudi population. This rate varies by region. Studying this variation in more detail will help improve public health policy, optimise distribution of resources and allocation of funding for research on prevention and diagnosis and direct awareness programs to the regions that are most in need.



Cancer epidemiology, Liver neoplasm, Hepatocellular carcinoma, Saudi cancer registry

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Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Canc. 2015;136(5):E359-86.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.

Atiyeh M, Ali MA. Primary Hepatocellular Carcinoma in Saudi Arabia. Americ J Gastroenterol. 1980;74(1).

Fashir B, Sivasubramaniam V, Al-Momen S, Assaf H. Hepatic tumors in a Saudi patients population. Sau J Gastroenterol. 1996;2(2):87-90.

Ayoola EA, Gadour MO. Hepatocellular carcinoma in Saudi Arabia: role of hepatitis B and C infection. J Gastroenterol Hepatol. 2004;19(6):665-9.

Alshehri B. Descriptive Epidemiological Analysis of Thyroid Cancer in the Saudi Population (2001-2013). Asian Pac J Cancer Prev. 2017;18(5):1445-51.

WorldBank. Saudi Arabia total Population. Available at: /SP.POP.TOTL?locations=SA. Accessed on 10 May 2020.

Cancer Research Uk. Liver cancer incidence statistics in europ. Available at: https://www.cance incidence#heading-Two. Accessed on 21 September 2020.

Rasul KI, Al-Azawi SH, Chandra P, Abou-Alfa GK, Knuth A. Status of hepatocellular carcinoma in Gulf region. Chine Clinic Oncol. 2013;2(4).

Al-Faleh FZ, Ayobanji Ayoola E, Al-Jeffry M, Arif M, Al-Rashed RS, Ramia S. Integration of hepatitis B vaccine into the expanded program on immunization. Saudi Arabian experience. Ann Sau Medic. 1993;13(3):231-6.

Cancer IAfRo. Hepatitis viruses. IARC monographs on the evaluation of carcinogenic risks to humans. 1994;59.

Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. 2006;45(4):529-38.

Bosch FX, Ribes J, Díaz M, Cléries R. Primary liver cancer: worldwide incidence and trends. Gastroenterol. 2004;127(5):S5-16.

McGlynn KA, Petrick JL, London WT. Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability. Clini Liv Disea. 2015;19(2):223-38.

Naugler WE, Sakurai T, Kim S, Maeda S, Kim K, Elsharkawy AM, et al. Gender disparity in liver cancer due to sex differences in MyD88-dependent IL-6 production. Sci. 2007;317(5834):121-4.

Aunan JR, Cho WC, Soreide K. The Biology of Aging and Cancer: A Brief Overview of Shared and Divergent Molecular Hallmarks. Aging Dis. 2017;8(5):628-42.

Chuang S-C, La Vecchia C, Boffetta P. Liver cancer: descriptive epidemiology and risk factors other than HBV and HCV infection. Canc lett. 2009;286(1):9-14.