Epidemiological And Clinical Characteristics Of Primary Liver Cancer From 2003 To 2020 And Prognosis Of Hepatocellular Carcinoma Was Predicted By Preoperative Parameters

Background and ObjectivePrimary liver cancer(PLC)is one of the most common malignant tumors in China and even around the world.It is the third leading cause of cancer death in the world and the second leading cause of cancer death in China.Hepatocellular carcinoma(HCC)is the most primary category of HCC,accounting for 75% to 85% worldwide and up to 90% in China.Hepatitis B virus(HBV)is one of the main causes of liver cancer in China,and 30% to 50% of PLC worldwide can be attributed to HBV.At present,the most effective treatment for HCC is surgical resection and liver transplantation.However,the overall prognosis of HCC patients is poor.Therefore,it is urgent to explore the prognostic factors of HCC patients,establish a highly accurate prognostic model of HCC,and supplement the clinical staging of HCC.It is of great significance for the selection of preoperative treatment methods and the selection of postoperative follow-up treatment methods and timing,and provides data basis for the formulation and implementation of more effective postoperative management measures.MethodsThis study was based on four research institutions located in Shanghai,Beijing,Guangxi,Gansu,from January 1,2003 to June 30,2020,a total of 15801 patients with PLC clinical information was collected to explore the epidemiological characteristics of PLC.Among them,7257 HCC follow-up cohort were randomly divided into training cohort and validation cohort at 7:3.Chisquare test was used for the comparison of counting data,non-parametric test was used for the comparison of measurement data,multivariate Cox regression was used to explore independent factors,and preoperative parameters were used to establish a Nomogram,and then evaluated by consistency index(C-index)and receiver operator characteristic curve(ROC).ResultsIn this study,HCC accounted for 93.0% of PLC patients,and the positive proportion of HBV was80.1%,both of which showed an increasing trend.In HCC,the positive proportion of HBV was84.4%.The characteristics of HBV-associated HCC and HCV-associated HCC are significantly different,and the prognosis of HBV-associated HCC is significantly worse than that of HCVassociated HCC.Multivariate Cox regression analysis showed that HBV was positive [Hazard Ratio(HR)1.29,95% Confidence interval(CI)1.10-1.21],and incomplete tumor capsule(HR[95%CI] : 1.58[1.41-1.77]),tumor thrombus(HR[95%CI]:2.12[1.90-2.36]),tumor diameter(≥3cm)(HR[95%CI]: 1.65[1.29-2.12]),higher grade of BCLC stage(HR[95%CI]: 2.11[1.85-2.41]),high AFP(≥20ng/ m L)(HR[95%CI]: 1.69[1.50-1.91]),direct bilirubin(>8μmol/L)(HR[95%CI]: 1.27[1.11-1.45])was an independent risk factor for postoperative survival of HCC.Postoperative RFA(HR[95%CI]: 0.65 [0.53-0.79])and second radical resection of HCC(HR[95%CI]: 0.43[0.34-0.55])were independent protective factors for postoperative survival of HCC.In the training cohort,prognostic models and Nomogram established using six preoperative variables including age,sex,AFP,HBV,tumor number,tumor diameter,tumor envelope,and tumor thrombus showed good predictive power,with a C-index of 0.723(95%CI: 0.717-0.729),better than Barcelona staging system(0.654,95%CI: 0.649-0.659,P<0.001),the area under ROC curve(AUC)of 1-year,3-year and 5-year survival rates were 0.790(95%CI: 0.762-0.819),0.766(95%CI: 0.736-0.795)and 0.736(95%CI: 0.697-0.775)respectively,the predicted and actual survival rates showed good agreement in the calibration curves of 1,3 and 5 years survival rates.Conclusion1.The characteristics of HBV-induced HCC and HCV-induced HCC are significantly different,and the prognosis of HBV-related HCC is significantly worse than that of HCV-related HCC.2.Positive HBV,incomplete tumor capsule,tumor embolism,larger tumor diameter,higher grade of BCLC stage,AFP and direct bilirubin were independent risk factors for postoperative survival of HCC,while postoperative RFA and second radical hepatocellular carcinoma resection were independent protective factors for postoperative survival of HCC.3.The postoperative survival rate of HCC can be accurately predicted by using the Nomogram constructed by age,gender,AFP,HBV,tumor number,tumor diameter,tumor envelope and tumor thrombus.