Real-world 10-year retrospective study of the guidelines for diagnosis and treatment of primary liver cancer in China

Table 1 Baseline characteristics of patients with different China Liver Cancer staging levels, n (%)

Variables	CNLC staging
	Total	Ia	Ιb	IIa	IIb	IIIa	IIIb	IV
Sex
Male	2487 (82.3)	492 (79.3)	365 (81.7)	47 (78.3)	742 (83.7)	468 (84.7)	295 (81.4)	78 (82.9)
Female	535 (17.7)	128 (20.7)	82 (18.3)	13 (21.7)	145 (16.3)	84 (16.3)	67 (18.6)	16 (17.1)
Age
≤ 50	884 (29.2)	185 (29.8)	116 (25.9)	16 (26.7)	245 (27.7)	175 (31.7)	112 (30.9)	35 (37.3)
> 50	2138 (70.8)	435 (70.2)	331 (74.1)	44 (73.3)	642 (72.3)	377 (68.3)	250 (69.1)	59 (62.7)
Chronic hepatitis
HBV	2793 (90.6)	558 (90.0)	398 (89.0)	52 (86.6)	808 (91.0)	513 (92.9)	323 (89.2)	87 (92.5)
HCV	187 (6.1)	48 (7.7)	22 (4.9)	6 (10.0)	54 (6.0)	32 (5.7)	19 (5.2)	6 (6.3)
NAFLD	106 (3.5)	34 (32.0)	27 (25.4)	0 (0.0)	23 (21.6)	12 (11.3)	8 (7.5)	2 (1.8)
ALD	24 (0.7)	4 (16.6)	3 (12.5)	1 (4.1)	7 (29.1)	6 (25.0)	2 (8.3)	1 (4.1)
Complications
Hypertension	533 (17.6)	125 (20.1)	87 (19.4)	9 (15.0)	158 (17.8)	82 (14.8)	60 (16.5)	12 (12.7)
Diabetes	360 (11.9)	75 (12.0)	42 (9.3)	12 (20.0)	112 (12.6)	68 (12.3)	39 (10.7)	12 (12.7)
Coronary heart disease	95 (3.1)	22 (3.5)	15 (3.3)	1 (1.6)	30 (3.3)	13 (2.3)	12 (3.3)	2 (2.1)
Smoking history	1158 (38.32)	215 (34.96)	170 (39.63)	25 (35.71)	340 (38.16)	223 (39.89)	152 (41.76)	33 (35.11)
Drinking history	949 (31.40)	182 (29.59)	136 (31.70)	18 (25.71)	277 (31.09)	176 (31.48)	128 (35.16)	32 (34.04)
AFP (ng/mL)
≤ 20	1094 (36.2)	345 (55.7)	187 (41.8)	42 (70.0)	318 (35.9)	115 (20.8)	90 (24.8)	16 (17.0)
20–400	757 (25.1)	170 (27.4)	101 (22.6)	18 (30.0)	223 (26.2)	132 (23.9)	80 (22.1)	22 (23.5)
> 400	1171 (38.7)	105 (16.9)	159 (35.6)	0 (0.0)	336 (37.9)	305 (55.2)	192 (53.1)	56 (59.5)

HBV: Hepatitis B virus; HCV: Hepatitis C virus; CNLC: China Liver Cancer staging; AFP: Alpha-fetoprotein; NAFLD: Non-alcoholic fatty liver disease; ALD: Alcoholic liver disease.

Table 2 Diagnosis and treatment of patients with different China Liver Cancer staging levels, n (%)

	CNLC staging
	Total (n = 3022)	Ia (n = 620)	Ιb (n = 447)	IIa (n = 60)	IIb (n = 887)	IIIa (n = 552)	IIIb (n = 362)	IV (n = 94)
HCC diagnosis
Pathology	1390 (45.9)	436 (70.3)	270 (60.4)	38 (63.3)	290 (32.6)	228 (41.3)	111 (30.6)	17 (18.1)
Imaging	1632 (54.1)	184 (29.6)	117 (39.5)	22 (36.6)	597 (67.3)	324 (58.6)	251 (69.3)	77 (81.9)
Child–Pugh grade
A	2191 (72.5)	537 (86.6)	378 (84.5)	48 (80.0)	625 (70.4)	369 (66.8)	234 (64.6)	0 (0.0)
B	737 (24.3)	83 (13.4)	69 (15.4)	12 (20.0)	262 (29.5)	183 (33.1)	128 (35.4)	0 (0.0)
C	94 (3.1)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	94 (100.0)
Treatments
LR	803 (26.5)	324 (52.2)1	188 (42.0)1	28 (46.6)1	102 (11.4)1	126 (22.8)1	35 (9.6)	0 (0.0)
RFA	203 (6.7)	104 (16.7)1	27 (6.0)1	5 (8.3)	48 (5.5)	10 (1.8)	6 (1.6)	3 (3.1)
LT	92 (3.0)	10 (1.6)1	4 (0.8)1	0 (0.0)	38 (4.2)	25 (4.5)	6 (1.6)	9 (9.5)1
TACE	1052 (34.8)	93 (15.0)	145 (32.4)1	13 (21.6)1	422 (47.5)1	210 (38.0)1	141 (38.9)1	28 (29.7)
TACE + RFA	185 (6.1)	46 (7.4)	33 (7.3)1	7 (11.6)1	67 (7.5)	11 (1.9)	15 (4.1)1	6 (6.3)
LR + RFA	89 (2.9)	23 (3.7)1	19 (4.2)	4 (6.6)1	17 (1.8)1	19 (3.4)1	5 (1.3)	2 (2.1)
Systemic anti-tumor therapy	224 (7.4)	4 (0.6)	12 (2.6)	1 (1.6)	74 (8.3)1	58 (10.5)1	63 (17.4)1	13 (13.8)1
BSC	374 (12.3)	16 (2.5)	20 (4.4)	2 (3.3)	119 (13.4)	93 (16.8)	91 (25.1)	33 (35.1)1
Adherence1	2212 (73.2)	461 (74.3)	397 (88.8)	52 (86.6)	615 (69.3)	413 (74.8)	219 (60.4)	55 (58.5)

¹Treatment modalities recommended by the Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China.

HCC: Hepatocellular carcinoma; CNLC: China Liver Cancer staging; LR: Liver resection; RFA: Radiofrequency ablation; LT: Liver transplantation; TACE: Transcatheter arterial chemoembolization; BSC: Best supportive care.

Table 3 Compliance with and effect of hepatocellular carcinoma screening, n (%)

Variable	Total (n = 3022)	Whether to undergo screening		χ2	P value
		Yes, n = 304 (10.06%)	No, n = 2718 (89.94%)
Sex				0.254	0.614
Male	2487 (82.30)	247 (81.25)	2240 (82.41)
Female	535 (17.70)	57 (18.75)	478 (17.59)
Age				0.621	0.431
< 50	884 (29.25)	83 (27.30)	801 (29.47)
≥ 50	2138 (70.75)	221 (72.70)	1917 (70.53)
Chronic hepatitis				1.891	0.595
HBV	2694 (89.15)	266 (87.50)	2428 (89.33)
HCV	142 (4.70)	19 (6.25)	123 (4.53)
Mix	45 (1.49)	5 (1.64)	40 (1.47)
None	141 (4.66)	14 (4.61)	127 (4.67)
Smoking				0.652	0.419
Yes	1158 (38.32)	110 (36.18)	1048 (38.56)
No	1864 (61.68)	194 (63.82)	1670 (61.44)
Alcohol				1.217	0.270
Yes	949 (31.40)	87 (28.62)	862 (31.71)
No	2073 (68.60)	217 (71.38)	1856 (68.29)
Hypertension				2.714	0.099
Yes	533 (17.64)	64 (21.05)	469 (17.26)
No	2489 (82.36)	240 (78.95)	2249 (82.74)
Diabetes				0.002	0.968
Yes	360 (11.91)	36 (11.84)	324 (11.92)
No	2662 (88.09)	268 (88.16)	2394 (88.08)
Coronary heart disease				3.559	0.059
Yes	95 (3.14)	15 (4.93)	80 (2.94)
No	2927 (96.86)	289 (95.07)	2638 (97.06)
Family history of tumors				0.009	0.923
Yes	473 (15.65)	47 (15.46)	426 (15.67)
No	2549 (84.35)	257 (84.54)	2292 (84.33)
AFP (ng/mL)				41.808	0.000a
≤ 20	1094 (36.20)	145 (47.70)	949 (34.92)
20-400	757 (25.05)	93 (30.59)	664 (24.43)
> 400	1171 (38.75)	66 (21.71)	1105 (40.65)
Child-Pugh Grade				58.031	0.000a
A	2191 (72.50)	276 (90.79)	1915 (70.46)
B	737 (24.39)	28 (9.21)	709 (26.09)
C	94 (3.11)	0 (0.00)	94 (3.45)
CNLC				183.202	0.000a
Ia	620 (20.52)	141 (46.38)	479 (17.62)
Ιb	447 (14.79)	57 (18.75)	390 (14.35)
IIa	60 (1.99)	12 (3.95)	48 (1.77)
IIb	887 (29.35)	59 (19.41)	828 (30.46)
IIIa	552 (18.27)	27 (8.88)	525 (19.32)
IIIb	362 (11.98)	8 (2.63)	354 (13.02)
IV	94 (3.10)	0 (0.00)	94 (3.46)

^aP < 0.01.

HBV: Hepatitis B virus; HCV: Hepatitis C virus; Mix: HBV complicated with HCV; CNLC: China Liver Cancer staging; AFP: Alpha-fetoprotein.

Table 4 Analysis of treatment compliance among patients with hepatocellular carcinoma according to the Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China, n (%)

Variable	Total (n = 3022)	Compliance with guideline-recommended treatment		χ2	P value
		Yes, n = 2212 (73.20%)	No, n = 810 (26.80%)
Sex				3.191	0.074
Male	2487 (82.30)	1837 (83.05)	650 (80.25)
Female	535 (17.70)	375 (16.95)	160 (19.75)
Age				0.652	0.419
< 50	884 (29.25)	656 (29.66)	228 (28.15)
≥ 50	2138 (70.75)	1556 (70.34)	582 (71.85)
Chronic hepatitis				2.046	0.309
HBV	2694 (89.15)	1979 (89.47)	715 (88.27)
HCV	142 (4.70)	96 (4.34)	46 (5.68)
Mixed	45 (1.49)	36 (1.63)	9 (1.11)
None	141 (4.66)	101 (4.56)	40 (4.94)
AFP (ng/mL)				1.859	0.395
≤ 20	1094 (36.20)	786 (35.53)	308 (38.02)
20–400	757 (25.05)	555 (25.09)	202 (24.94)
> 400	1171 (38.75)	871 (39.38)	300 (37.04)
Child–Pugh grade				59.828	0.000a
A	2191 (72.50)	1687 (76.27)	504 (62.22)
B	737 (24.39)	470 (21.25)	267 (32.96)
C	94 (3.11)	55 (2.49)	39 (4.81)
CNLC				74.941	0.000a
Early stage (Ia, Ib, and IIa)	1127 (37.29)	910 (41.14)	217 (26.79)
Middle stage (IIb and IIIa)	1439 (47.62)	1028 (46.47)	411 (50.74)
Late stage (IIIb and IV)	456 (15.09)	274 (12.39)	182 (22.47)

^aP < 0.01.

HBV: Hepatitis B virus; HCV: Hepatitis C virus; Mix: HBV complicated with HCV; CNLC: China Liver Cancer staging; AFP: Alpha-fetoprotein.

Table 5 Basic characteristics of followed-up patients with hepatocellular carcinoma (n = 1128), n (%)

Variables	CNLC staging
	Total	Ia	Ιb	IIa	IIb	IIIa	IIIb	IV
Sex
Male	922 (81.74)	261 (80.56)	152 (79.58)	21 (75.00)	252 (84.00)	151 (84.36)	60 (78.95)	25 (83.33)
Female	206 (18.26)	63 (19.44)	39 (20.42)	7 (25.00)	48 (16.00)	28 (15.64)	16 (21.05)	5 (16.67)
Age
≤ 50	330 (29.26)	105 (32.41)	51 (26.70)	8 (28.57)	74 (24.67)	54 (30.17)	23 (30.26)	15 (50.00)
> 50	798 (70.74)	219 (67.59)	140 (73.30)	20 (71.43)	226 (75.33)	125 (69.83)	53 (69.74)	15 (50.00)
Chronic hepatitis
HBV	992 (87.94)	284 (87.65)	167 (87.43)	21 (75.00)	266 (88.67)	161 (89.94)	68 (89.47)	25 (83.33)
HCV	56 (4.96)	21 (6.48)	8 (4.19)	3 (10.71)	12 (4.00)	8 (4.47)	2 (2.63)	2 (6.67)
NAFLD	62 (5.50)	14 (4.32)	14 (7.33)	3 (10.71)	17 (5.67)	6 (3.35)	6 (7.89)	2 (6.67)
ALD	18 (1.60)	5 (1.54)	2 (1.05)	1 (3.57)	5 (1.67)	4 (2.23)	0 (0.00)	1 (3.33)
Complications
Hypertension	226 (20.04)	70 (21.60)	38 (19.90)	5 (17.86)	65 (21.67)	28 (15.64)	17 (22.37)	3 (10.00)
Diabetes	159 (14.10)	2 (12.96)	21 (10.99)	6 (21.43)	49 (16.33)	24 (13.41)	11 (14.47)	6 (20.00)
Coronary heart disease	33 (2.93)	7 (2.16)	8 (4.19)	1 (3.57)	10 (3.33)	2 (1.12)	4 (5.26)	1 (3.33)
Smoking	408 (36.17)	121 (37.35)	68 (35.60)	8 (28.57)	101 (33.67)	67 (37.43)	30 (39.47)	13 (43.33)
Drinking	337 (29.88)	98 (30.25)	53 (27.75)	7 (25.00)	88 (29.33)	50 (27.93)	29 (38.16)	12 (40.00)
AFP (ng/mL)
≤ 20	491 (43.53)	184 (56.79)	90 (47.12)	11 (39.29)	129 (43.00)	46 (25.70)	24 (31.58)	7 (23.33)
20–400	289 (25.62)	92 (28.40)	43 (22.51)	8 (28.57)	75 (25.00)	47 (26.26)	16 (21.05)	8 (26.67)
> 400	348 (30.85)	48 (14.81)	58 (30.37)	9 (32.14)	96 (32.00)	86 (48.04)	36 (47.37)	15 (50.00)
Child–Pugh grade
A	870 (77.13)	284 (87.65)	168 (87.96)	23 (82.14)	213 (71.00)	132 (73.74)	50 (65.79)	0 (0.00)
B	228 (20.21)	40 (12.35)	23 (12.04)	5 (17.86)	87 (29.00)	47 (26.26)	26 (34.21)	0 (0.00)
C	30 (2.66)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	30 (100.00)

CNLC: China Liver Cancer staging; HBV: Hepatitis B virus; HCV: Hepatitis C virus; NAFLD: Non-alcoholic fatty liver disease; ALD: Alcoholic liver disease; AFP: Alpha-fetoprotein.

Table 6 Analysis of overall survival in patients with hepatocellular carcinoma

Variables	Univariate analysis	Multivariate analysis
	P value	P value	Hazard ratio (95%CI)
Sex	0.5736	—
Age (> 50)	0.0074a	0.0087b	1.359 (1.081–1.709)
Screening	< 0.001b	0.0003b	2.181 (1.435–3.313)
HBV	0.0703	—
HCV	0.0354	—
Child-Pugh grade	< 0.001b
A			1 reference
B		< 0.001b	1.813 (1.480–2.252)
C		0.3798	1.274 (0.742–2.190)
CNLC staging	< 0.001b
Early			1 reference
Middle		< 0.001b	2.610 (2.056–3.312)
Late		< 0.001b	3.967 (2.827–5.591)
AFP (ng/mL)	< 0.001b
≤ 20			1 reference
20–400		0.615	1.070 (0.822–1.392)
> 400		< 0.001b	1.576 (1.256–1.977)

^aP < 0.05.

^bP < 0.01.

CI: Confidence interval; HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CNLC: China Liver Cancer staging, AFP: Alpha-fetoprotein.

Table 7 Analysis of factors influencing postoperative recurrence in patients with hepatocellular carcinoma

Variables	Univariate analysis	Multivariate analysis
	P value	P value	Hazard ratio (95%CI)
Sex	0.0455a	0.0164a	0.694 (0.515–0.935)
Age (> 50)	0.9711	—
Screening	0.0678	—
HBV	0.7773	—
HCV	0.3531	—
Child-Pugh grade	0.0012b	0.0016b	1.771 (1.243–2.524)
CNLC staging	< 0.001b
Early			1 reference
Middle		< 0.001b	2.556 (2.032–3.215)
Late		< 0.001b	3.312 (2.113-5.192)
AFP (ng/mL)	< 0.001b
≤ 20			1 reference
20–400		0.338	1.139 (0.873–1.487)
> 400		< 0.001b	1.612 (1.256–2.070)

^aP < 0.05.

^bP < 0.01.

CI: Confidence interval; HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CNLC: China Liver Cancer staging; AFP: Alpha-fetoprotein.