Published online May 15, 2023. doi: 10.4251/wjgo.v15.i5.859
Peer-review started: December 5, 2022
First decision: February 21, 2023
Revised: March 6, 2023
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: May 15, 2023
Hepatocellular carcinoma (HCC) is a common malignant tumor worldwide. Many regions across the world have issued various HCC diagnosis and treatment protocols to improve the diagnosis and targeted treatment of patients with HCC. However, real-world studies analysing the practice, application value, and existing problems of the China Liver Cancer (CNLC) staging system are scarce.
To analyze the current situation and problems associated with the Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China.
We collected the medical records of all patients with HCC admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2011 to December 31, 2019, and recorded the hospitalization information of those patients until December 31, 2020. All information on the diagnosis and treatment of the target patients was recorded, and their demographic and sociological characteristics, CNLC stages, screening situations, and treatment methods and effects were analyzed. The survival status of the patients was obtained from follow-up data.
This study included the medical records of 3022 patients with HCC. Among these cases, 304 patients were screened before HCC diagnosis; their early-stage diagnosis rate was 69.08%, which was significantly higher than that of patients with HCC who were diagnosed without screening and early detection (33.74%). Herein, patients with no clinical outcome at discharge were followed up, and the survival information of 1128 patients was obtained. A Cox model was used to analyse independent risk factors affecting overall survival, which were revealed as age > 50 years, no screening, alpha-fetoprotein > 400 ng/mL, Child–Pugh grade B, and middle and late CNLC stages. Based on the Cox model survival analysis, in our study, patients with HCC identified via screening had significant advantages in overall and tumor-free survival after hepatectomy.
Early diagnosis and treatment can be achieved by screening groups at high risk for HCC based on the guidelines; however, real-world compliance is poor.
Core Tip: This retrospective study evaluated the current situation and problems associated with the Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China. The findings revealed that 70% of hepatocellular carcinoma (HCC) treatments at the First Affiliated Hospital of Zhengzhou University were performed according to the guidelines. Patients who underwent liver resection in accordance with the guidelines had a significant survival advantage. Furthermore, screening for HCC high-risk groups according to the guidelines can achieve early diagnosis and treatment; however, real-world compliance is poor.