Socioeconomics and attributable etiology of primary liver cancer,1990-2019

BACKGROUND Primary liver cancer(PLC)is a major contributor to cancer-related deaths.Data on global and country-specific levels and trends of PLC are essential for understanding the effects of this disease and helping policymakers to allocate resources.AIM To investigate the association between the burden of PLC and socioeconomic development status.METHODS Cancer mortality and incidence rates were obtained from the Global Burden of Disease(GBD)2019,and the data were stratified by country and territory,sex,and the Socio-demographic Index(SDI)level.The association between the attributable etiology of PLC and socioeconomic development status,represented using the SDI,was described.The attributable etiology of PLC included hepatitis B,hepatitis C,alcohol use,and nonalcoholic steatohepatitis.The association between the attributable etiology of PLC and SDI was further stratified by sex and geographical location.A confidence analysis was also performed based on bootstrap draw.RESULTS The age-standardized incidence rate of PLC was 6.5[95%confidence intervals(CI):5.9-7.2]per 100000 person-years,which decreased by-27.5%(-37.0 to-16.6)from 1990 to 2019.Several countries located in East Asia,South Asia,West Africa,and North Africa shouldered the heaviest burden of PLC in 2019.In terms of incidence rates,the first leading underlying cause of PLC identified was hepatitis B,followed by hepatitis C,alcohol use,and nonalcoholic steatohepatitis.Regarding stratification using the SDI,the incidence rate of PLC was the highest for high and middle SDI locations.Further,the leading attributable etiologies of PLC were hepatitis B for the middle and high middle SDI locations while hepatitis C and nonalcoholic steatohepatitis for the high SDI locations.CONCLUSION The pronounced association between socioeconomic development status and PLC burden indicates socioeconomic development status affects attributable etiologies for PLC.GBD 2019 data are valuable for policymakers implementing PLC cost-effective interventions.

The Epidemiological, Clinical, Biological and Morphological Characteristics of Primitive Liver Cancers in Bangui

Objective: To describe the epidemiological, clinical, biological and morphological aspects of primary liver cancer (PLC). Patients and Methods: We conducted a 38-month cross-sectional study in the Department of hepatogas-troenterology and Internal Medicine “Amitié Sino-Centrafraine” University Hospital Center in Bangui. Included in the study were all patients with a diagnosis of PLC. The PLC’s diagnostic arguments were the large tumor liver associated or not with the elevation of alpha-fetoprotein, the heteronodular liver hypervascularized on abdominal ultrasound. Data analysis was done using Epi Info 3.5.1 software. Results: We collected 115 cases of CPF among 2410 hospitalized patients (4.7%). There were 86 men and 29 women (sex ratio: 2.9). The average age was 50 years old. The main risk factors were alcohol consumption (72.2%) and chronic hepatitis B infection (67.4%). Frequent clinical signs were pain in the right hypochondrium and/or epigastric (93.86%), large tumor liver under examination (91.3%), weight loss (74.78%). The serum alpha-fetoprotein concentration was ≥ 400 ng/ml in 73% of the cases. The abdominal ultrasound found a heteronodular liver in all patients. The nodules were multiple hyperechoic in 66.1% of the cases. According to the Child-Pugh classification, the patients were classified as B (49.5%) and C (33.9%). The Okuda Classification ranked patients at stage 1 in 16.5% cases, stage 2 in 52.1% cases and stage 3 in 31.3% cases. According to the BCLC classification, 5.2% of patients were in stage A, 12.2% in stage B, 52.2 in stage C and 30.4% in stage D. Death was recorded during hospitalization in 89 cases (77.4%). Conclusion: CPF is a frequent and serious pathology in Bangui. Its diagnosis is often late, preventing curative treatment. The main causes are alcohol consumption and the hepatitis B virus. The population should be educated to reduce the incidence of this disease.

原发性肝癌的流行病学及其危险因素研究进展

原发性肝癌是世界上常见的恶性肿瘤之一,具有较高的发病率和死亡率。本文详述了目前我国原发性肝癌的流行病学情况、人群归因分值及其相关危险因素。本文通过检索PubMed、Web of Science、中国知网等数据库发现,乙型肝炎病毒和丙型肝炎病毒仍是原发性肝癌发病的主要危险因素。随着乙型肝炎病毒疫苗接种以及抗病毒治疗,我国原发性肝癌的发病率略有下降,但代谢性因素如糖尿病、肥胖和非酒精性脂肪性肝病等引起的原发性肝癌的发病率正逐步上升;吸烟、饮酒等也是重要的危险因素。本文综述了原发性肝癌的流行病学特点及危险因素,可为制订原发性肝癌防控措施提供切实有力的循证医学证据。

基于SEER数据库的原发性肝癌患者预后危险因素研究

目的:探讨原发性肝癌患者预后的危险因素,为该病患者的临床诊疗和预后判断提供科学依据。方法:以2018年监测、流行病学和结果(Surveillance,Epidemiology,and End Results,SEER)数据库原发性肝癌患者作为研究对象,收集人口学资料、临床指标和预后随访信息,运用单因素和多因素logistic回归分析影响患者术后生存的危险因素。采用一致性指数评价模型的预测能力,构建受试者工作特征曲线分析预测模型的效能。采用绘制森林图的方法对不同分期下肝癌患者的治疗方式进行分析。结果:该研究共收集2018年原发性肝癌患者1750例。单因素logistic回归结果表明,肿瘤分期、淋巴结转移、远处转移、婚姻状况、放化疗及手术是影响原发性肝癌患者生存的危险因素(P<0.05);多因素logistic回归分析结果表明,肿瘤分期[T2/T3相对于T1,OR=5.142/3.390,95%CI=(3.654~7.236)(/2.327~4.939),P<0.001]、远处转移(OR=4.810,95%CI=3.384~6.839,P<0.001)、婚姻状况(OR=0.729,95%CI=0.575~0.925,P=0.009)、放疗(OR=0.361,95%CI=0.260~0.503,P<0.001)、化疗(OR=0.512,95%CI=0.381~0.687,P=0.001)以及手术(OR=0.245,95%CI=0.105~0.574,P=0.028)是影响肝癌患者生存的危险因素。将logistic回归中有意义的变量如肿瘤分期、远处转移、婚姻状况、放化疗和手术情况进行预测模型的构建,研究显示该模型一致性指数为0.786(95%CI=0.762~0.810),曲线下面积(area under the curve,AUC)为0.790(95%CI=0.764~0.812)。仅放疗这种干预方式在任何肿瘤分期的患者中都展现出了优势(P=0.003、P=0.013、P=0.003)。在未发生淋巴结转移的患者中无论哪种干预方式都会降低肝癌患者的病死率(P<0.001,P=0.001,P<0.001,P=0.004),但是在发生淋巴结转移的患者中,是否进行干预对肝癌患者的生存没有影响(P>0.05)。在未发生远处转移的患者中,仅进行放疗、化疗或化疗+放疗干预方式的患者与未进行干预的患者相比生存率更高(P<0.001,P=0.001,P<0.001,P=0.004),在发生远处转移的患者中,仅进行放疗的干预方式展现出优势(P=0.002)。结论:肿瘤分期、远处转移、婚姻状况、放化疗和手术情况是影响原发性肝癌预后的危险因素。

21世纪初广西肝癌的流行特征(英文)

Background and Objective:In Guangxi province,from 1970s to 1990s,the mortality of primary liver cancer(PLC) ranked the first among a variety of malignant tumors.Investigating the epidemiological characteristics of PLC is very important for developing reasonable and effective treatment strategy,allocating health resources rationally,and evaluating the quality of PLC prevention and control.This study was to analyze the mortality and epidemiological characteristics of PLC in Guangxi province between 2004 and 2005.Methods:Multi-stage stratified cluster random sampling method was used to select 9 counties(cities or urban areas) as sample points.The residents' death causes between 2004 and 2005 were analyzed,and the epidemiological characteristics of PLC were investigated.Results:In the period of 2004-2005,the crude mortality of PLC was 34.39/100 000 in Guangxi province population(55.30/100 000 in men and 13.21/100 000 in women).The national population-standardized mortality in 1964 was 22.17/100 000.The man-to-woman ratio of mortality was 4.19:1.PLC ranked as the first death cause among a variety of malignant tumors,and PLC-related death accounted for 30.70% of all tumor-related death cases.Age-specific mortality of PLC was increased with age,rising significantly from 30-year-old(from 25-year-old in men and from 40-year-old in women),and reached a peak at 75-year-old.Conclusions:The mortality of PLC shows a decreasing trend in Guangxi province in the early 21st century,and the starting age of PLC death peak postpones about 10 years than that in 1990s.It shows that the comprehensive prevention and control measures of PLC implemented in Guangxi province are fruitful.However,the PLC mortality in Guangxi province is still significantly higher than the national average level,and it still ranks as the first death cause in a variety of malignant tumors in Guangxi province.PLC mainly occurs in middle-aged and elderly people.The prevention and treatment research of PLC still has a long way to go.

原发性肝癌流行病学研究进展

目的 研究原发性肝癌流行病学特征。方法 采用文献复习的方法对原发性肝癌的地区分布及病因流行病学加以综述。结果 我国原发性肝癌主要分布在东南沿海一带 ,主要病因有乙肝病毒、黄曲霉毒素和饮水污染 ;相关的病因有某些微量元素缺乏、性激素、遗传等。结论 原发性肝癌的发生是多因素的。

原发性肝癌中医辨证标准的建议

采用严格的临床流行病学调查方案 ,通过对 2 0 60例原发性肝癌患者证候的临床调查 ,包括全面收集患者证候 ,统一辨证标准和资料处理方法 ,并比较以往有关辨证标准 ,提出肝癌肝郁气滞型、脾气虚型、肝血瘀阻型、肝胆湿热型、肝肾阴虚型等

肝癌中医症状、体征、病位、用药情况流行病学调查分析

目的:探讨肝癌症状、体征、中医病位与治则的规律。方法:采用回顾性抽样调查方法,随机抽取5家医院以中医药治疗为主的原发性肝癌病历834份,采用SPSS10．00统计软件对其症状、体征、中医病位与治疗用药情况进行分析。结果:症状、体征频次率在50％以上和聚为第1类的均为纳呆食少、神疲乏力、肝区疼痛、进行性肝肿大,同时出现两个症状、体征以上者占84．6％。病位频次率在50％以上和聚为第1类的均为肝脾。所用药物归类分析,频次大于150次和聚为第1类的为化瘀类、健脾类、理气类、清热解毒类。结论:肝癌的主要症状、体征是肝区疼痛、进行性肝肿大、神疲乏力、纳呆食少;中医病位在肝,与脾密切相关;中医常用治则为化瘀、健脾、理气、清热解毒。

原发性肝癌肝胆湿热证量化标准研究

为建立原发性肝癌肝胆湿热证量化标准(包括量化诊断标准和程度分级标准)。在流行病学调查的基础上,以肝胆湿热证辨证参考标准进行辨证,根据相关因素在肝胆湿热证组和非肝胆湿热证组中出现状况的差异对相关因素进行赋分,并以此为基础建立量化诊断标准,对量化诊断标准进行检验,建立程度分级标准。结果:原发性肝癌肝胆湿热证量化诊断标准为26分;量化诊断标准回顾性和前瞻性检验的敏感度、特异度、准确度均在90％以上,阳性似然比分别为12.68和11.78;程度分级标准:轻度26-35分,中度36-45分,重度≥46分。提示原发性肝癌肝胆湿热证量化标准同以往建立的各种形式的肝胆湿热证标准相比较更符合原发性肝癌的临床实际,统计更严谨,相关因素赋分更合理,验证更严谨,更具有临床实用价值。

福建省同安县原发性肝癌危险因素的流行病学研究概况

作者从１９９０年开始，对同安县肝癌高发现场的肝癌病因进行了流行病学研究。肝癌危险因素的病例─对照研究结果提示，同安肝癌高发与人均年收入、个人肝病史、家族肿瘤史、家庭生活、脂肪摄入量等因素有关。在此基础上的进一步研究认为，同安肝癌发病的主要原因，是ＨＢＶ感染、食品黄曲霉毒素污染和饮水污染等多因素综合作用的结果。

原发性肝癌脾气虚证量化标准的研究

目的建立原发性肝癌脾气虚证量化标准(包括量化诊断标准和程度分级标准)。方法选择457例患者,在流行病学调查的基础上,以脾气虚证辨证参考标准进行辨证,根据相关因素在脾气虚证组和非脾气虚证组中出现状况的差异对相关因素进行赋分,并以此为基础建立量化诊断标准;然后对量化诊断标准进行检验,最后建立程度分级标准。结果原发性肝癌脾气虚证量化诊断标准最低分为34分;量化诊断标准回顾性和前瞻性检验的敏感度、特异度、准确度均在85%以上,阳性似然比分别为9.6和11.33;程度分级标准:轻度34～48分,中度49～62分,重度≥63分。结论本原发性肝癌脾气虚证量化标准的特点是:①较符合原发性肝癌的特点;②统计学方法运用较为严谨;③验证较为严谨;④较符合中医临床实际。

原发性肝癌肝阴虚证量化标准方法学研究

目的:建立原发性肝癌肝阴虚证量化标准(包括量化诊断标准和程度分级标准).方法:在流行病学调查的基础上,以肝阴虚证辨证参考标准进行辨证,根据相关因素在肝阴虚证组和非肝阴虚证组中出现状况的差异对相关因素进行赋分,并以此为基础建立量化诊断标准;然后对量化诊断标准进行检验;最后建立程度分级标准.结果:原发性肝癌肝阴虚证量化诊断标准为24分;量化诊断标准回归性和前瞻性检验的敏感度、特异度、准确度均在90%以上,阳性似然比分别为23.18和26.75;程度分级标准为:轻度24～32分,中度33～44分,重度≥45分.结论:同肝阴虚证各种形式的标准相比较,原发性肝癌肝阴虚证量化标准有以下几个特点:①更符合原发性肝癌的临床实际;②统计更严谨;③相关因素赋分更合理;④检验更严谨;⑤更具有临床实用价值.

279例肝癌患者经络失衡状况调查

目的调查分析广西中医学院附属瑞康医院279例肝癌患者的经络失衡状况。方法通过对十二经原穴及八脉交会穴的皮肤穴位导电量测量来探讨279例肝癌患者的经络失衡状况。结果 279例肝癌患者十二正经原穴异常主要体现在肾经、肝经、脾经、胃经、胆经、心包经上,以肾经(占74.2%)、肝经(占69.5%)、脾经(占62.0%)不平衡率居高,与其他经络比较差异均有统计学意义(P<0.05)。奇经八脉经络异常主要体现在冲脉、阴维脉、阴跷脉、任脉、督脉上,以冲脉(占65.9%)、阴维(占60.9%)不平衡率居高,较之其他经脉,差异具有统计学意义(P<0.05)。结论十二经原穴及八脉交会穴的皮肤穴位导电量检测能够反映肝癌患者经络气血的失衡情况,该群体经络异常主要表现在与中医学肾、肝胆、脾胃、心胸体系相关的经脉上。

原发性肝癌患者抑郁症状的调查分析

目的了解原发性肝癌(PrimaryLiverCancer,PLC)患者的抑郁症状水平及特点。方法采用CES-D调查KPS≥60分的PLC患者及对照组(乙肝组和健康组)各100例。结果(1)49%的PLC患者可能或肯定有抑郁症状,其中肯定有抑郁症状的PLC患者占23%;(2)PLC组的CES-D总分(T20)高于乙肝组和健康组,乙肝组的T20高于健康组;(3)PLC患者的抑郁症状以躯体症状为首要表现,但T20≥20的PLC患者则以情绪低沉为首要表现。结论抑郁症状是PLC患者常见的负性情绪,医护人员不要因患者的躯体感受而忽视了对抑郁症状的评估,一旦发现患者情绪低沉,应采用简单有效的心理评定量表如CES-D对患者进行筛查,为可能有抑郁症状的患者提供进一步的检查和心理治疗,提高患者的生活质量。

福建省原发性肝癌遗传因素分析

为了探讨遗传因素与福建省原发性肝癌的关系,应用多种对照配对的病例对照研究方法,对100个原发性肝癌和200个对照家系进行了遗传流行病学分析。结果显示,原发性肝癌先证者一、二级亲属患病率明显高于对照组患病率,分离比为0.04146～0.08654,遗传度加权均值为63.52±4.22％。提示原发性肝癌系多基因遗传病,遗传易感性是原发性肝癌的危险因素之一,原发性肝癌的发生是遗传和环境多种因素共同作用的结果。

广西地区首发原发性肝癌患者体质状况调查

目的研究广西地区首发原发性肝癌(primary liver cancer,PLC)患者体质分布状况。方法采用中华中医药学会发布的《中医体质分类与判定》标准对147例广西地区首发PLC患者的体质类型进行辨识,对各种体质类型的频数分布进行统计学描述。结果患者的体质类型分布为:平和质55例(37.4%),气虚质9例(6.1%),阳虚质12例(8.2%),阴虚质2例(1.4%),痰湿质6例(4.1%),湿热质29例(19.7%),血瘀质18例(12.2%),气郁质7例(4.8%),特禀质9例(6.1%)。广西地区首发PLC患者的偏颇体质主要以湿热质、血瘀质和阳虚质3种体质为主,PLC患者的体质存在显著的性别差异(P<0.01)。男性以湿热质、血瘀质为主,而女性以阳虚质、血瘀质为主。结论广西地区PLC患者偏颇体质以湿热质为主,血瘀体质是PLC的高发体质。

原发性肝癌全球流行情况和危险因素的新进展

原发性肝癌是全球导致死亡的第2大癌症,同时也是危险因素比较明确的恶性肿瘤之一,本文主要通过国内外有关肝癌的流行病学文献,从近几十年来对其在全球流行情况和危险因素进行综述。

血清标志物在肝癌早期诊断中的研究进展

目前临床上诊断肝癌多以病理组织学及影像学为主要依据,但只有在瘤体长到一定体积时才能诊断,此时肿瘤已大多进入晚期,患者预后差。血清甲胎蛋白(AFP)作为肝癌筛查的主要血清学指标,由于敏感性不高导致其诊断的准确性差强人意,因此临床上迫切需要寻找新的肝癌血清标志物。本文将针对近年来肝细胞癌血清学诊断进展做一综述。

石河子地区2530例原发性肝癌流行病学及治疗现状分析

目的探讨石河子地区原发性肝癌的临床流行病学特征及近10年治疗现状。方法回顾性分析2009年1月至2019年6月十年间在石河子大学医学院第一附属医院、石河子市人民医院住院的2530例原发性肝癌患者的病历资料,随后以五年时间段分组,分为A组(2009~2014年)与B组(2014~2019年),分析A和B两组间性别、年龄、民族、职业、居住地、医疗付款方式、乙型肝炎病毒表面抗原(Hepatitis B virus surface antigen,HBsAg)、抗丙型肝炎病毒抗体(Antibody to hepatitis C virus,Anti-HCV)、BCLC分期、住院天数、住院费用和治疗方式的差异。结果在职业构成比中,工人、职员、农民和其他分别为69.3%、9.6%、12.6%和8.5%;城市、团场、农村居住者构成比为65.4%、20.8%和13.8%;HBsAg阳性者占54.2%,Anti-HCV阳性者占6.3%;BCLC分期中A、B、C、D期的构成比为33.6%、20.7%、37.4%、8.3%;A、B两组间原发性肝癌病例数分别为1478例和1052例;原发性肝癌积极治疗构成比分别为26.2%和39.4%,支持治疗构成比分别73.8%和60.6%;人均住院总天数分别为46±1.4 d和39±1.2 d;人均住院总费用分别为38447±1358.9元和45221±2069.4元,两组间治疗方式、人均住院总天数和总费用差异均具有统计学意义(均P<0.05)。结论石河子地区原发性肝癌主要集中在城市,以工人为主,原发性肝癌的肝炎感染患者比例低于全国。石河子地区近10年的原发性肝癌积极治疗比例增加,住院天数明显缩短,但治疗费用有所增加。

肝硬化并发原发性肝癌的流行病学特征、危险因素及相关预防干预对策研究

目的:探讨肝硬化并发原发性肝癌的流行病学特征、危险因素及相关预防干预对策。方法:将2015年1月到2018年12月收治的175例肝硬化患者依据有无并发原发性肝癌分成研究组77例、对照组98例。统计两组患者临床资料,经多因素Logistic回归分析法分析肝硬化并发原发性肝癌危险因素。结果:肝硬化并发原发性肝癌的男性、女性患病率分别是89.61%(69/77)、10.39%(8/77);≤20岁、21~40岁、41~60岁、>60岁患者的患病率分别为3.9%(3/77)、11.69%(9/77)、58.44%(45/77)、25.97%(20/77);单因素分析结果显示:肝硬化并发原发性肝癌和患者吸烟史、合并糖尿病、饮酒史、未接受抗病毒治疗、原发性肝癌遗传史、HBV DNA阳性、HBV DNA>104 copies/ml存在相关性,差异有统计学意义(P<0.05);多因素Logistic回归分析显示:长期吸烟、合并糖尿病、长期饮酒、未接受抗病毒治疗、原发性肝癌遗传史、HBV DNA阳性、HBV DNA>104 copies/ml为肝硬化并发原发性肝癌独立危险因素,差异有统计学意义(P<0.05)。结论:肝硬化并发原发性肝癌多见于中年男性,而其发生和患者长期吸烟、合并糖尿病、长期饮酒、未接受抗病毒治疗、原发性肝癌遗传史、HBV DNA阳性、HBV DNA>104 copies/ml有关,故针对上述高危人群,需告知患者戒烟、戒酒,养成良好生活习惯,积极控制血糖,强化日常监测和健康宣教,降低危险因素暴露,以减少肝硬化并发原发性肝癌的危险性。