Analysis of risk factors for primary liver cancer in rural China and high risk population identification: a cohort study in Qidong, China_Chinese Journal of Evidence-Based Medicine

Authors：

FAN Chunsun ^1,2 , ZHU Jian ¹ , WANG Yuting ² , JI Shenjie ³ , YAN Yongfeng ¹ , LU Jianquan ¹ ,  CHEN Taoyang ¹ ,  QU Chunfeng ²

1. Department of Etiology, Qidong People’s Hospital/Qidong Liver Cancer Institute, Qidong, 226200, P.R.China;
2. National Key Laboratory of Molecular Oncology/Department of Immunology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, P.R.China;
3. Department of Clinical Laboratory, Qidong People’s Hospital/Qidong Liver Cancer Institute, Qidong, 226200, P.R.China;

Corresponding author：

CHEN Taoyang, Email: ty110@263.net; QU Chunfeng, Email: quchf@cicams.ac.cn

Keywords：

Primary liver cancer; High risk population; Cohort study; Risk factor

DOI：

10.7507/1672-2531.201802031

Video：

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ObjectivesTo classify the high risk population for primary liver cancer (PLC) in rural China.MethodsBetween June 2011 and June 2013, hepatitis B surface antigen (HBsAg) carriers were identified in clinical laboratory of Qidong People’s Hospital and surveyed by questionnaires. Cox proportional hazard regression model was introduced to demonstrate independent risk factors associated with PLC occurrence. Moreover, receiver characteristic operating (ROC) curve was utilized to evaluate discrimination power of risk factor panel for PLC risk classification.ResultsA total of 1 296 HBsAg carriers were enrolled, among which 686 participants were male with an average age of 45.73±11.58 years, and 610 participants were female with an average age of 45.67±12.33 years. After a mean follow up period of 5.5 years, 43 incident PLC cases were confirmed, which generated a PLC incidence of 60.5 millions person years. Multi-univariate Cox model showed that increase of age (HR=1.055, 95%CI 1.029 to 1.083, P<0.000 1), male (HR=3.263, 95%CI 1.567 to 6.796,P=0.001 6), having family history of PLC (HR=2.315, 95%CI 1.260 to 4.252, P=0.006 8), HBeAg positivity (HR=2.367, 95%CI 1.267 to 4.419, P=0.006 9) and GGT abnormality (HR=2.721, 95%CI 1.457 to 5.083, P=0.001 7) were the independent risk factors of PLC.ConclusionRoutine host, viral and liver biochemical parameters which are readily accessible in daily clinical practice can be utilized in identification of the targeted population for prevention of PLC in rural China.

Citation： FAN Chunsun, ZHU Jian, WANG Yuting, JI Shenjie, YAN Yongfeng, LU Jianquan, CHEN Taoyang, QU Chunfeng. Analysis of risk factors for primary liver cancer in rural China and high risk population identification: a cohort study in Qidong, China. Chinese Journal of Evidence-Based Medicine, 2018, 18(5): 428-433. doi: 10.7507/1672-2531.201802031 Copy

1.	Islami F, Chen W, Yu XQ, et al. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013. Ann Oncol, 2017, 28(10): 2567-2574.
2.	Wang M, Wang Y, Feng X, et al. Contribution of hepatitis B virus and hepatitis C virus to liver cancer in China north areas: experience of the Chinese national cancer center. Int J Infect Dis, 2017, 65: 15-21.
3.	朱健, 陈建国, 张永辉, 等. 启东肝癌早诊早治示范项目的管理与质量控制. 中国肿瘤, 2011, 20(5): 331-335.
4.	Sherman M. Surveillance for hepatocellular carcinoma. Best Pract Res Clin Gastroenterol, 2014, 28(5): 783-793.
5.	冉建朝, 王乐, 张玥, 等. 中国人群肝癌所致 DALYs 疾病负担: 1990～2016 年长期分析及预测. 中国循证医学杂志, 2018, 18(5): 401-409.
6.	Chan SL, Wong VW, Qin S, et al. Infection and cancer: the case of hepatitis B. J Clin Oncol, 2016, 34(1): 83-90.
7.	Yang HI, Sherman M, Su J, et al. Nomograms for risk of hepatocellular carcinoma in patients with chronic hepatitis B virus infection. J Clin Oncol, 2010, 28(14): 2437-2444.
8.	Lin YJ, Lee MH, Yang HI, et al. Predictability of liver-related seromarkers for the risk of hepatocellular carcinoma in chronic hepatitis B patients. PLoS One, 2013, 8(4): e61448.
9.	Yang HI, Yuen MF, Chan HL, et al. Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): development and validation of a predictive score. Lancet Oncol, 2011, 12(6): 568-574.
10.	Lee HW, Ahn SH. Prediction models of hepatocellular carcinoma development in chronic hepatitis B patients. World J Gastroenterol, 2016, 22(37): 8314-8321.
11.	Hann HW, Wan S, Myers RE, et al. Comprehensive analysis of common serum liver enzymes as prospective predictors of hepatocellular carcinoma in HBV patients. PLoS One, 2012; 7(10): e47687.
12.	Papatheodoridis GV, Dalekos GN, Yurdaydin C, et al. Incidence and predictors of hepatocellular carcinoma in Caucasian chronic hepatitis B patients receiving entecavir or tenofovir. J Hepatol, 2015, 62(2): 363-370.
13.	Su TH, Hu TH, Chen CY, et al. Four-year entecavir therapy reduces hepatocellular carcinoma, cirrhotic events and mortality in chronic hepatitis B patients. Liver Int, 2016, 36(12): 1755-1764.
14.	朱立国, 田华, 姜洁, 等. 江苏省 2012-2014 年慢性 HBV 感染者 HBeAg 血清学转换后再逆转的特征分析. 中华流行病学杂志, 2017, 38(1): 43-48.
15.	胡晓云, 孙剑. 我国乙型肝炎长期随访队列建设的现状与展望. 临床肝胆病杂志, 2017, 33(8): 1454-1457.
16.	启东肝癌早诊早治示范基地项目工作进展. 中国肿瘤, 2009, 18(9): 731-734.
17.	严永峰, 王宇婷, 朱陈, 等. 肝癌筛查技术准确性的 Meta 分析. 中国循证医学杂志, 2018, 18(5): 418-427.
18.	石菊芳, 赵琨, 曲春枫, 等. 肝癌筛查相关卫生技术评估. 中国循证医学杂志, 2018, 18(5): 397-400.
19.	van Meer S, de Man RA, Siersema PD, et al. Surveillance for hepatocellular carcinoma in chronic liver disease: evidence and controversies. World J Gastroenterol, 2013, 19(40): 6744-6756.
20.	Cucchetti A, Cescon M, Erroi V, et al. Cost-effectiveness of liver cancer screening. Best Pract Res Clin Gastroenterol, 2013, 27(6): 961-972.

1. Islami F, Chen W, Yu XQ, et al. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013. Ann Oncol, 2017, 28(10): 2567-2574.
2. Wang M, Wang Y, Feng X, et al. Contribution of hepatitis B virus and hepatitis C virus to liver cancer in China north areas: experience of the Chinese national cancer center. Int J Infect Dis, 2017, 65: 15-21.
3. 朱健, 陈建国, 张永辉, 等. 启东肝癌早诊早治示范项目的管理与质量控制. 中国肿瘤, 2011, 20(5): 331-335.
4. Sherman M. Surveillance for hepatocellular carcinoma. Best Pract Res Clin Gastroenterol, 2014, 28(5): 783-793.
5. 冉建朝, 王乐, 张玥, 等. 中国人群肝癌所致 DALYs 疾病负担: 1990～2016 年长期分析及预测. 中国循证医学杂志, 2018, 18(5): 401-409.
6. Chan SL, Wong VW, Qin S, et al. Infection and cancer: the case of hepatitis B. J Clin Oncol, 2016, 34(1): 83-90.
7. Yang HI, Sherman M, Su J, et al. Nomograms for risk of hepatocellular carcinoma in patients with chronic hepatitis B virus infection. J Clin Oncol, 2010, 28(14): 2437-2444.
8. Lin YJ, Lee MH, Yang HI, et al. Predictability of liver-related seromarkers for the risk of hepatocellular carcinoma in chronic hepatitis B patients. PLoS One, 2013, 8(4): e61448.
9. Yang HI, Yuen MF, Chan HL, et al. Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): development and validation of a predictive score. Lancet Oncol, 2011, 12(6): 568-574.
10. Lee HW, Ahn SH. Prediction models of hepatocellular carcinoma development in chronic hepatitis B patients. World J Gastroenterol, 2016, 22(37): 8314-8321.
11. Hann HW, Wan S, Myers RE, et al. Comprehensive analysis of common serum liver enzymes as prospective predictors of hepatocellular carcinoma in HBV patients. PLoS One, 2012; 7(10): e47687.
12. Papatheodoridis GV, Dalekos GN, Yurdaydin C, et al. Incidence and predictors of hepatocellular carcinoma in Caucasian chronic hepatitis B patients receiving entecavir or tenofovir. J Hepatol, 2015, 62(2): 363-370.
13. Su TH, Hu TH, Chen CY, et al. Four-year entecavir therapy reduces hepatocellular carcinoma, cirrhotic events and mortality in chronic hepatitis B patients. Liver Int, 2016, 36(12): 1755-1764.
14. 朱立国, 田华, 姜洁, 等. 江苏省 2012-2014 年慢性 HBV 感染者 HBeAg 血清学转换后再逆转的特征分析. 中华流行病学杂志, 2017, 38(1): 43-48.
15. 胡晓云, 孙剑. 我国乙型肝炎长期随访队列建设的现状与展望. 临床肝胆病杂志, 2017, 33(8): 1454-1457.
16. 启东肝癌早诊早治示范基地项目工作进展. 中国肿瘤, 2009, 18(9): 731-734.
17. 严永峰, 王宇婷, 朱陈, 等. 肝癌筛查技术准确性的 Meta 分析. 中国循证医学杂志, 2018, 18(5): 418-427.
18. 石菊芳, 赵琨, 曲春枫, 等. 肝癌筛查相关卫生技术评估. 中国循证医学杂志, 2018, 18(5): 397-400.
19. van Meer S, de Man RA, Siersema PD, et al. Surveillance for hepatocellular carcinoma in chronic liver disease: evidence and controversies. World J Gastroenterol, 2013, 19(40): 6744-6756.
20. Cucchetti A, Cescon M, Erroi V, et al. Cost-effectiveness of liver cancer screening. Best Pract Res Clin Gastroenterol, 2013, 27(6): 961-972.

Chinese Journal of Evidence-Based Medicine

Analysis of risk factors for primary liver cancer in rural China and high risk population identification: a cohort study in Qidong, China

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