Hepatocellular carcinoma (HCC) represents ∼90% of the primary liver cancer cases, and 90% of HCC cases occur in patients with chronic liver disease.1 It also represents the sixth most common cancer (4.7%) and the third leading cause of cancer-related death globally (8.3%).2 More troubling, the global incidence and mortality rates have been increasing since 1990.3 In the United States, the highest average annual percentage change (known as AAPC) reported between 2000 and 2012 involved individuals between 55 and 59 years of age (AAPC: 8.9%; 95% confidence interval: 7.1–10.7%).4
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