Secular trend in universal hepatocellular carcinoma prevention: Taiwan, Poland, and Belgium experience

doi:10.4251/wjgo.v17.i11.110840

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Oncol. Nov 15, 2025; 17(11): 110840
Published online Nov 15, 2025. doi: 10.4251/wjgo.v17.i11.110840

Secular trend in universal hepatocellular carcinoma prevention: Taiwan, Poland, and Belgium experience

Zong-Ze Huang, Karol Żmudka, Valerio Ruggiano, Wan-Lun Hsu, Jessica Liu, Chun-Ju Chiang, Yong-Chen Chen, Vinchi Wang

Zong-Ze Huang, Yong-Chen Chen, Vinchi Wang, Department of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan

Karol Żmudka, Department of Infectious Diseases and Hepatology, Medical University of Silesia in Katowice, Katowice 41-500, Poland

Valerio Ruggiano, Department of Medicine, Università Degli Studi Della Campania “Luigi Vanvitelli”, Napoli 81100, Italy

Wan-Lun Hsu, Yong-Chen Chen, Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan

Wan-Lun Hsu, Master’s Program of Big Data in Medical Healthcare Industry, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan

Jessica Liu, Department of Pediatrics, Stanford University, Palo Alto, CA 94305, United States

Chun-Ju Chiang, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 106319, Taiwan

Yong-Chen Chen, Post-Baccalaureate Program in Nursing, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan

Vinchi Wang, Department of Neurology, Cardinal Tien Hospital, New Taipei City 23148, Taiwan

Co-first authors: Zong-Ze Huang and Karol Żmudka.

Author contributions: Huang ZZ, Żmudka K, and Ruggiano V were responsible for formal analysis, investigation, resources, data curation, and writing-original draft; Hsu WL, Chen YC, and Wang V were responsible for supervision; Hsu WL and Chen YC were responsible for conceptualization, methodology, software, and project administration; Liu J and Chiang CJ participated in writing-review and editing. Huang ZZ and Żmudka K contributed equally as co-first authors.

Institutional review board statement: This research protocol was approved by the Institutional Review Board of Fu Jen Catholic University (No. C110216). The study was performed in accordance with the Declaration of Helsinki.

Informed consent statement: Patient consent was waived due to this study using an open database with encrypted personal identities, and the Institutional Review Board exempted the study from review. Patients or the public were not involved in this study.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.

Data sharing statement: Data types were deidentified participant data. Data were available from the Taiwan cancer registry from 2000 to 2019 in Taiwan: https://twcr.tw/?page_id = 1843&lang = en; Polish national cancer registry from 2000 to 2019 in Poland: https://onkologia.org.pl/pl/publikacje; Belgian cancer registry from 2000 to 2019 in Flanders: https://kankerregister.org/default.aspx?lang = EN.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Yong-Chen Chen, PhD, Assistant Professor, Post-Baccalaureate Program in Nursing, College of Medicine, Fu Jen Catholic University, No. 510 Zhongzheng Road, Xinzhuang District, New Taipei City 242062, Taiwan. 137159@mail.fju.edu.tw

Received: June 18, 2025
Revised: July 23, 2025
Accepted: September 24, 2025
Published online: November 15, 2025
Processing time: 149 Days and 21.8 Hours

Abstract

BACKGROUND

Liver cancer poses a significant public health threat. The difference between disease patterns and national policies is crucial to elucidating factors influencing hepatocellular carcinoma (HCC) incidence.

AIM

To investigate the secular trend and disease pattern of liver cancer in Taiwan, Poland, and Belgium.

METHODS

This population-based cohort study presents the incidence, period, and cohort effects in HCC incidence between 2000 and 2019 in Taiwan, Poland, and Flanders, Belgium. Data on HCC were obtained from cancer registry data from Taiwan, Poland, and regional data from Belgium. Age-standardized incidence rates (ASIRs), annual percentage changes, and age-period-cohort analyses were conducted by sex and period.

RESULTS

Taiwan’s ASIR decreased from 2000 to 2019 (males: 55.17 to 43.42, females: 21.91 to 16.20, per 100000). In Poland, ASIR declined from 2000 to 2019 (males: 3.21 to 2.77, females: 1.95 to 1.32, per 100000). However, Flanders experienced an increase in ASIR from 2000 to 2019 (males: 2.66 to 5.63, females: 1.40 to 2.20, per 100000). In Taiwan, the cohort effect rate ratio increased from 1915 to 1935 (males: 1.02 to 1.36, females: 1.04 to 1.54) and decreased from 1935 to 1989 (males: 1.36 to 0.22, females: 1.54 to 0.20). In Poland, rate ratios consistently decreased (males: 1.75 to 0.25, females: 3.46 to 0.26). Flanders exhibited an increase in both males (0.14 to 2.52, 1915 to 1975) and females (0.53 to 3.66, 1915 to 1989).

CONCLUSION

Taiwan and Poland’s declining ASIR may be due to effective hepatitis B virus immunization and viral hepatitis therapy. Flanders’ persistent increase may be tied to higher HCC risk in high hepatitis C virus risk populations.

Keywords: Hepatocellular carcinoma; Hepatitis B virus; Hepatitis C virus; Metabolic syndrome; Cancer incidence

Core Tip: Due to differences in etiological factors and nationwide policies, limited evidence exists regarding the prevention outcomes of hepatocellular carcinoma (HCC) in different countries. This retrospective cohort study presented the incidence, period, and cohort effects in HCC incidence between 2000 and 2019 in Taiwan, Poland, and Flanders, Belgium. Decreasing cohort effect in Taiwan and Poland resulted from effective hepatitis B virus immunization and viral hepatitis therapy. The increasing cohort effect in Flanders, Belgium suggests that further measures are needed to prevent the increasing risk of the hepatitis C virus.