Asia bears the heaviest burden of liver disease globally. Liver cancer is the fifth most common cancer and the second leading cause of cancer death in Asia. Therefore, a detailed analysis of its disease burden, changes in trends, and predictions of future trends are crucial for reducing the global burden of liver cancer.

We evaluated the temporal and spatial trends of LC from 2005-2023 and forecasted to 2035. We calculated average annual percent change (AAPC) of age-standardized incidence (ASIR), prevalence (ASPR), death (ASDR), and disability-adjusted life years (DALYs) rates (ASDALYR). Das Gupta's standardization and decomposition method was used to decompose the regional difference in LC burden during 2005-2023 by age structure, population growth, and epidemiological changes to explain the differences.

From 2005 to 2023, the East Asia always carried the highest incidence, prevalence, deaths and DALYs. High-income Asia Pacific (HIAP) always had the highest ASIR, ASPR, ASDR of LC, with the fastest decrease (AAPC-ASIR=-3.03, 95%CI: -3.28 to -2.78; AAPC-ASDR=-3.28, 95%CI: -3.30 to -3.26; AAPC-ASPR=-2.31, 95%CI: -2.59 to -2.03). ASIR decreased in all Asian areas during 2005-2023, except for South Asia, where ASIR increased (AAPC-ASIR=0.88, 95%CI: 0.82 to 0.95). ASDR, ASPR, ASDALYR decreased in High-income Asia Pacific, Central and East Asia, whereas they increased in South and Southeast Asia. In addition, ASIR, ASPR, ASDR, ASDALYR is projected to increase in South and Southeast Asia in 2035. Areas with the highest ASDALYR had changed from High-income Asia Pacific in 2005 to Southeast Asia in 2023, while it kept the lowest ASDALYR in South Asia. ASDALYR decreased the fastest in High-income Asia Pacific (AAPC=-3.91, 95%CI: -4.01 to -3.81). Among HIAP, Republic of Korea always carried the highest ASRs of LC. Among Central Asia, Mongolia always had the highest ASRs. Among Southeast Asia, Thailand always had the highest ASRs. Among East Asia, ASRs in Democratic People's Republic of Korea in 2023 had surpassed that in China in 2005. Among South Asia, ASRs in Bangladesh in 2023 had surpassed that in Bhutan in 2005. As for ASPR in East Asia, China always carried the highest ASPR of LC. In East Asia and HIAP, the epidemiologic changes mainly contributed to the decrease of the burden of LC, and age structure mainly affected the increase.

East Asia always carried the highest disease burden of LC. HIAP always had the highest ASRs of LC, with the fastest decrease. China always carried the highest ASPR of LC. Our study highlights the need for targeted public health strategies in special countries.