Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2023; 15(5): 859-877
Published online May 15, 2023. doi: 10.4251/wjgo.v15.i5.859
Real-world 10-year retrospective study of the guidelines for diagnosis and treatment of primary liver cancer in China
Yun-Wei Yan, Xin-Kui Liu, Shun-Xiang Zhang, Qing-Feng Tian
Yun-Wei Yan, Qing-Feng Tian, Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan Province, China
Xin-Kui Liu, Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, Henan Province, China
Shun-Xiang Zhang, Department of Epidemiology and Health Statistics and Henan Key Laboratory for Tumour Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan Province, China
Author contributions: Yan YW, Zhang SX and Tian QF designed the study; Yan YW and Liu XK performed the data collection and conducted the data analysis; Yan YW wrote the manuscript; Zhang SX and Tian QF revised the manuscript; all authors approved the final version of the manuscript.
Supported by The Major Project of Science and Technology in Henan Province, No. 161100311400.
Institutional review board statement: The study was approved by the Institutional review board of Zhengzhou University, No. ZZUIRB2022-151.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: Qing-Feng Tian, PhD, Professor, Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, No. 100 Kexue Avenue, Zhengzhou 450001, Henan Province, China. tianqf@zzu.edu.cn
Received: December 5, 2022
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
Processing time: 157 Days and 22.3 Hours
Abstract
BACKGROUND

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.

AIM

To analyze the current situation and problems associated with the Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: China liver cancer; Compliance; Guideline; Hepatocellular carcinoma; Real-world study

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.