Morgan A, Zhu A, Hannah N, Haridy J, Raj A, Bhala N. Letter to the Editor: Hepatocellular carcinoma in patients without cirrhosis - urgent need to include Australasian populations. World J Gastroenterol 2026; 32(28): 117785 [DOI: 10.3748/wjg.117785]
Corresponding Author of This Article
Neeraj Bhala, PhD, Professor, Department of Gastroenterology and Hepatology, Royal Melbourne Hospital & The University of Melbourne, 300 Grattan St, Parkville, Melbourne 3050, Victoria, Australia. neeraj.bhala@mh.org.au
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
letter
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Morgan A, Zhu A, Hannah N, Haridy J, Raj A, Bhala N. Letter to the Editor: Hepatocellular carcinoma in patients without cirrhosis - urgent need to include Australasian populations. World J Gastroenterol 2026; 32(28): 117785 [DOI: 10.3748/wjg.117785]
World J Gastroenterol. Jul 28, 2026; 32(28): 117785 Published online Jul 28, 2026. doi: 10.3748/wjg.117785
Letter to the Editor: Hepatocellular carcinoma in patients without cirrhosis - urgent need to include Australasian populations
Aparna Morgan, Angela Zhu, Nicholas Hannah, James Haridy, Ashok Raj, Neeraj Bhala
Aparna Morgan, Angela Zhu, Nicholas Hannah, James Haridy, Ashok Raj, Neeraj Bhala, Department of Gastroenterology and Hepatology, Royal Melbourne Hospital & The University of Melbourne, Melbourne 3050, Victoria, Australia
Author contributions: Morgan A, Zhu A, Hannah N, Haridy J, Raj A, and Bhala N were involved in the research work and contributed to the writing, reviewing and editing of this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Neeraj Bhala, PhD, Professor, Department of Gastroenterology and Hepatology, Royal Melbourne Hospital & The University of Melbourne, 300 Grattan St, Parkville, Melbourne 3050, Victoria, Australia. neeraj.bhala@mh.org.au
Received: December 17, 2025 Revised: January 20, 2026 Accepted: January 29, 2026 Published online: July 28, 2026 Processing time: 204 Days and 14.9 Hours
Abstract
We read with interest the recent review article by Sato-Espinoza et al[1] published in World Journal of Gastroenterology. Non-cirrhotic hepatocellular carcinoma (HCC) is an increasingly recognised entity that constitutes over 20% of all HCC cases worldwide. However, contemporary reviews of non-cirrhotic HCC epidemiology have omitted data from Australasia, limiting representation of regions with distinct demographics and risk factor profiles. The diverse migrant and Indigenous populations of Australia and New Zealand include the Aboriginal and Torres Strait Islander peoples, Māori, and Pasifika. The high prevalence of chronic hepatitis B and rising burden of metabolic dysfunction-associated steatotic liver disease among this cohort highlight an urgent need for unbiased epidemiological overviews to inform equitable guideline development.
Core Tip: Global reviews of hepatocellular carcinoma (HCC) that exclude Australasian data risk overlooking important epidemiological patterns. In Australia and New Zealand, non-cirrhotic HCC accounts for a substantial proportion of cases, driven predominantly by chronic hepatitis B and an increasing burden of metabolic dysfunction-associated steatotic liver disease, particularly among Indigenous and migrant populations. Inclusion of Australasian data is essential for a truly comprehensive understanding of non-cirrhotic HCC risk and surveillance worldwide.
