Hepatoblastoma regional trends: dynamic SDI & joinpoint regression analysis.

BACKGROUND

Hepatoblastoma (HB), the most common pediatric primary liver cancer, accounts for 80% of childhood liver malignancies but only 1% of all pediatric cancers. Approximately 90% of cases occur in children under five years old, with 20-40% of patients presenting with distant metastases at diagnosis. Surgical resection is critical, but only 50-60% of tumors are completely resectable initially; unresectable or highly invasive cases require liver transplantation, highlighting the disease's severe clinical and economic burden. Despite regional disparities in incidence and mortality, the global burden of HB remains underquantified, with limited understanding of its correlation with socioeconomic factors., This study aims to comprehensively assess the disease burden of HB and its correlation with socioeconomic factors, identify high-burden regions, and provide evidence to optimize resource allocation and reduce disease burden.

METHODS

Using data from the global burden of disease (GBD) 2021 Study, we analyzed HB incidence, mortality, prevalence, and disability-adjusted life years (DALYs) across 204 countries/regions from 1990 to 2021. Linear regression was employed to calculate the estimated annual percentage change (EAPC) to assess time trends, while joinpoint regression calculate the annual percentage change (APC) and average annual percentage change (AAPC) to identified inflection points in trends. Subgroup analyses were conducted by time-varying socio-demographic index (SDI), geographic region, and age.

RESULTS

From 1990 to 2021, global HB incidence rate decreased by 60.11%, with mortality and DALYs rates showing parallel decreases. (EAPC=-0.53 for both). However, high-SDI region exhibited increasing incidence (EAPC = 0.21), driven by Australasia (EAPC = 0.81) and high-income North America (EAPC = 0.73), In 2021, Low-SDI regions, particularly West Sub-Saharan Africa, ranked first globally in all assessed HB burden indicators. China had the highest case count, and India had the most deaths. Mali had the highest incidence and mortality rates, whereas Estonia had the lowest. Joinpoint regression analysis revealed a post-2004 slowing of the global decline in age-standardized HB incidence and prevalence, and post-2006 slowing of the global decline in mortality rates. Concurrently, high-SDI regions exhibited persistent upward trends (AAPC = 0.75), particularly in high-income North America (AAPC = 2.23), Australasia (AAPC = 2.02), and Western Europe (AAPC = 0.73), where incidence rates have risen consistently since the early 2000s. These trends contrast with sustained declines in regions like Central Sub-Saharan Africa.

CONCLUSIONS

HB remains a significant global health issue. Over the past 32 years, the global burden of HB has generally declined, but the rate of decline has slowed, with stark disparities between socioeconomic regions. Global cooperation is essential in addressing the challenges posed by HB. The rise in high-SDI areas highlights the need to distinguish diagnostic improvements from true incidence increases. The burden is particularly heavy in low-middle-SDI regions and certain geographical areas. Priorities include enhancing access to pediatric oncology care in low-resource settings, optimizing prenatal/postnatal screening, and addressing socioeconomic drivers of inequity to reduce HB's burden globally.