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:
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.
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
Research background

Hepatocellular carcinoma (HCC) is a common malignant tumor worldwide; however, no staging scheme that would apply across populations is currently described in the extant literature. Although a China Liver Cancer (CNLC) staging system was proposed for the Chinese population, there is no study regarding the practice of CNLC staging in real clinical settings in China, which the current study addresses.

Research motivation

Although HCC patients detected through screening in the current study had a significant survival advantage compared with those who were not screened, the screening compliance in patients remained was poor. Therefore, improving patients’ screening compliance would be the key to achieving early HCC diagnosis and treatment, which we have identified as the direction of future research.

Research objectives

Most importantly, the study highlighted that although no benefit was demonstrated in HCC patients for receiving the treatment recommended by the guidelines, the patients who underwent liver resection in accordance with the guidelines had a significant survival advantage.

Research methods

The results of the current study demonstrated that patients who were treated according to the CNLC guidelines had a survival advantage over those who were not treated per the guidelines. However, this advantage was limited i.e., 54 vs 51 mo, and no statistical difference was observed. This result also corroborated with a study, which demonstrated survival advantage for Barcelona Clinic Liver Cancer stages B and C with the choice of treatment over the guidelines. Prospective studies are required to further understand the survival of patients.

Research results

The hospitalisation information of patients with HCC admitted to the First Affiliated Hospital of Zhengzhou University was obtained, which included demographic characteristics, imaging and serological reports, treatment, and patients’ prognosis. Thereafter, the CNLC staging was done according to the guidelines. Each stage was characterised by the performance status, tumor number and diameter, liver function status using Child-Pugh A/B, and infringements such as vascular tumor thrombus and extrahepatic metastasis on imaging.

Research conclusions

The study aimed to investigate the present situation and problems of HCC diagnosis and treatment guidelines in China, since real-world studies for the existing problems of CNLC staging in China’s clinical practice are lacking.

Research perspectives

The method of CNLC staging includes CNLC stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV, and it is based on the liver function status, tumor size, number, and invasion, and the general conditions of patients with HCC. However, given that the first method of CNLC staging was published as recently as 2017, only a few studies have addressed specific treatment methods in different CNLC staging. Since this study highlights significant difference in the tumor-free survival time between patients undergoing hepatectomy according to the guideline and those undergoing hepatectomy without the guideline, these findings will aid in future research to improve clinical decision making for HCC treatment.