Burden landscape of hepatobiliary and pancreatic cancers in Chinese young adults:30 years’overview and forecasted trends

BACKGROUND Hepatobiliary and pancreatic(HBP)cancers impose a considerable burden on young populations(aged 15 to 49 years),resulting in a substantial number of new cases and fatalities each year.In young populations,the HBP cancers shows extensive variance worldwide and the updated data in China is lacking.AIM To investigate the current status,trends,projections,and underlying risk factors of HBP cancers among young populations in China.METHODS The Global Burden of Disease Study 2019 provided data on the annual incidence,mortality,disability-adjusted life years(DALYs),age-standardized incidence rate(ASIR),mortality rate(ASMR),and DALYs rate(ASDR)of HBP cancers in young Chinese adults between 1990 and 2019.Temporal trends were assessed using estimated annual percentage change and hierarchical clustering.Sex-specific mortality and DALYs caused by various risks were analyzed across China and other regions,with future trends until 2035 projected using the Bayesian age-period-cohort model.RESULTS From 1990 to 2019,incident cases,deaths,DALYs,ASIR,ASMR,and ASDR for liver cancer(LC)in young Chinese individuals decreased,classified into'significant decrease'group.Conversely,cases of gallbladder and biliary tract cancer and pancreatic cancer rose,categorized as either'significant increase'or'minor increase'groups.The contribution of risk factors to mortality and DALYs for HBP tumors increased to varying degrees.Healthy lifestyle behaviors,such as tobacco control,weight management,alcohol moderation,and drug avoidance,could lower HBP cancers incidence.Moreover,except for LC in females,which is likely to initially decline slightly and then rise,the forecasting model predicted that the ASIR and ASMR for all HPB cancers subtypes by gender will increase among young adults.CONCLUSION HBP cancers burden among young adults in China is expected to increase until 2035,necessitating lifestyle interventions and targeted treatment strategies to mitigate the public health impact of these cancers.

Post-transplant infection improves outcome of hepatocellular carcinoma patients after orthotopic liver transplantation

BACKGROUND Tumor recurrence after orthotopic liver transplantation(OLT)remains a serious threat for long-term survival of the recipients with hepatocellular carcinoma(HCC),since very few factors or measures have shown impact on overcoming HCC recurrence after OLT.Postoperative infection suppresses tumor recurrence and improves patient survival in lung cancer and malignant glioma probably via stimulating the immune system.Post-transplant infection(PTI),a common complication,is deemed to be harmful for the liver transplant recipients from a short-term perspective.Nevertheless,whether PTI inhibits HCC recurrence after OLT and prolongs the long-term survival of HCC patients needs to be clarified.AIM To investigate the potential influence of PTI on the survival and tumor recurrence of patients with HCC after OLT.METHODS A total of 238 patients with HCC who underwent OLT between August 2002 and July 2016 at our center were retrospectively included and accordingly subdivided into a PTI group(53 patients)and a non-PTI group(185 patients).Univariate analyses,including the differences of overall survival(OS),recurrence-free survival(RFS),and post-recurrence survival(PRS),between the PTI and non-PTI subgroups as well as survival curve analysis were performed by the Kaplan-Meier method,and the differences were compared using the log rank test.The variables with a P-value<0.1 in univariate analyses were included in the multivariate survival analysis by using a Cox proportional-hazards model.RESULTS The 1-,3-,and 5-year OS and RFS rates of the whole cohort were 86.6%,69.0%,and 63.6%,and 75.7%,60.0%,and 57.3%,respectively.The 1-,3-,and 5-year OS rates for the PTI patient group(96.0%,89.3%,and 74.0%)were significantly higher than those for the non-PTI group(84.0%,63.4%,and 60.2%)(P=0.033).The absence of PTI was an independent risk factor for dismal OS(relative risk[RR]=2.584,95%CI:1.226-5.449)and unfavorable RFS(RR=2.683,95%CI:1.335-5.390).Subgroup analyses revealed that PTI remarkably improved OS(P=0.003)and RFS(P=0.003)rates of HCC patients with vascular invasion(IV),but did not impact on OS(P=0.404)and RFS(P=0.304)of patients without VI.Among the patients who suffered post-transplant tumor recurrence,patients with PTI showed significantly better OS(P=0.026)and PRS(P=0.042)rates than those without PTI.CONCLUSION PTI improves OS and RFS of the transplant HCC patients at a high risk for posttransplant death and tumor recurrence,which is attributed to suppressive effect of PTI on HCC recurrence.

Combined analysis of imaging tumor capsule with imaging tumor size guides the width of resection margin for solitary hepatocellular carcinoma

Background:The optimal width of resection margin(RM)for hepatocellular carcinoma(HCC)remains controversial.This study aimed to investigate the value of imaging tumor capsule(ITC)and imaging tu-mor size(ITS)in guiding RM width for patients with HCC.Methods:Patients who underwent hepatectomy for HCC in our center were retrospectively reviewed.ITC(complete/incomplete)and ITS(≤3 cm/>3 cm)were assessed by preoperative magnetic resonance imaging(MRI).Using subgroup analyses based on ITC and ITS,the impact of RM width[narrow RM(<5 mm)/wide RM(≥5 mm)]on recurrence-free survival(RFS),overall survival(OS),and RM recurrence was analyzed.Results:A total of 247 patients with solitary HCC were included.ITC and ITS were independent predictors for RFS and OS in the entire cohort.In patients with ITS≤3 cm,neither ITC nor RM width showed a significant impact on prognosis,and the incidence of RM recurrence was comparable between the narrow RM and wide RM groups(15.6%vs.4.3%,P=0.337).In patients with ITS>3 cm and complete ITC,the narrow RM group exhibited comparable RFS,OS,and incidence of RM recurrence with the wide RM group(P=0.606,0.916,and 0.649,respectively).However,in patients with ITS>3 cm and incomplete ITC,the wide RM group showed better RFS and OS and a lower incidence of RM recurrence compared with the narrow RM group(P=0.037,0.018,and 0.046,respectively).Conclusions:As MRI-based preoperative markers,conjoint analysis of ITC with ITS aids in determining RM width for solitary HCC patients.Narrow RM is applicable in patients with ITS≤3 cm regardless of ITC status and in those with ITS>3 cm and complete ITC.Wide RM is preferred in those with ITS>3 cm and incomplete ITC.