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. 2023 Mar 14:13:1109980.
doi: 10.3389/fonc.2023.1109980. eCollection 2023.

The 20 years transition of clinical characteristics and metabolic risk factors in primary liver cancer patients from China

Yezhou Ding  1 , Mingyang Feng  1 , Di Ma  2 , Gangde Zhao  1 , Xiaolin Wang  1 , Baoyan An  1 , Yumin Xu  1 , Shike Lou  1 , Lanyi Lin  1 , Qing Xie  1 , Kehui Liu  1 , Shisan Bao  1 , Hui Wang  1
Affiliations

The 20 years transition of clinical characteristics and metabolic risk factors in primary liver cancer patients from China

Yezhou Ding et al. Front Oncol. .

Abstract

Background: The clinical characteristics of primary liver cancer (PLC) patients are changing, maybe due to hepatitis viral vaccination and lifestyle changes, etc. The linkage between these changes and outcomes among these PLCs has not yet been fully elucidated.

Methods: It was identified total of 1691 PLC cases diagnosed between 2000 ~ 2020. Cox proportional hazards models were utilized to determine the connections between the clinical presentations and their close risk factor(s) from PLC patients.

Results: The average age of PLC patients increased gradually from 52.74 ± 0.5 years in 2000 ~ 2004 to 58.63 ± 0.44 years in 2017 ~ 2020, accompanied by an increased proportion of females from 11.11% to 22.46%, and non-viral hepatitis-related PLC was raised from 1.5% to 22.35%. 840 (49.67%) PLC patients with alpha-fetoprotein (AFP) < 20ng/mL (AFP-negative). The mortality was 285 (16.85%) or 532 (31.46%) PLC patients with alanine transaminase (ALT) between 40 ~ 60 IU/L or ALT > 60 IU/L. The PLC patients with pre-diabetes/diabetes or dyslipidemia also increased from 4.29% or 11.1% in 2000 ~ 2004 to 22.34% or 46.83% in 2017 ~ 2020. The survival period of the PLC patients with normoglycemia or normolipidemic was 2.18 or 3.14 folds longer than those patients with pre-diabetes/diabetes or hyperlipidemia (P<0.05).

Conclusions: It was gradually increased that age, the proportion of females, non-viral hepatitis-related causes, AFP-negative, and abnormal glucose/lipids among PLC patients. Proper control of glucose/lipids or ALT may improve the prognosis of PLCs.

Keywords: alanine transaminase; clinical traits; fetoprotein; glycolipid; liver cancer.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow chart demonstrated the selection criteria for PLC patients.
Figure 2
Figure 2
Changes in age, sex, and different AFP levels ratio among PLC patients. Changes in age of diagnosis of PLC patients (A). Changes in age composition ratio (B). Percentage of PLC patients’ age (C). Changes in sex ratio (D). Stratification of AFP levels (E). Changes in the proportion of different AFP stratifications (F).
Figure 3
Figure 3
Changes in clinical characteristics and metabolic risk factors of PLC patients. Changes in the proportion of combined vs without cirrhosis (A). Changes in the proportion of non-/viral hepatitis-related PLC patients (B). Changes in the proportion of different BCLC stages (C). Changes in the proportion of different treatment protocols (D). Changes in the proportion of pre-diabetes/diabetes vs normoglycemia (E). Changes in the proportion of hyperlipidemia vs normolipidemia (F).
Figure 4
Figure 4
Effect of metabolic risk factors on the prognosis of PLC patients. Prognostic differences between pre-diabetes/diabetes and normoglycemia (A). Prognostic differences between hyperlipidemia and normolipidemia (B). Prognostic differences between normal TC level and high TC level (C). Prognostic differences between normal TG level and high TG level (D). Prognostic differences between normal LDL-C levels and high LDL-C levels (E). Prognostic differences between normal ApoB level and high ApoB level (F).
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Grants and funding

This study was supported by grants from the Pilot Project of Clinical Cooperation between Chinese and Western Medicine for Major and Difficult Diseases (Hepatic Fibrosis) (ZY (2018–2020)-FXTW-2004), Shanghai Three-year Action Plan for Strengthening Public Health System Construction (GWV-3.1).

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