Liver cancer screening in China: practices and its extended questions

Abstract

Screening for liver cancer (hepatocellular carcinoma) in China started in early 1970s with the application of alphafetoprotein (AFP) in high-incidence regions. It has been extended to nationwide areas, emerging from the concepts of conducting screening in populations at-risk with positive hepatitis B surface antigen to the practice programs in rural and urban areas, and finally to the development of recommendations to guide medical practice for health care providers. The implementation of screening for liver cancer has resulted in earlier detection and hence the early curable treatment for patients who have gained short-or long-term survival, and even reduction in mortality rates, although these outcomes are more anecdotal than rigorously evidence-based. AFP or ultrasound examination has been considered as sensitive and specific methods for early detection but are with limitations. The combined use of these two modalities for screening populations at-risk every six months seems to have been reached consensus. The feasibility of screening for liver cancer is still debated because of differing opinions and even opposition to the choice of targeted sub-populations, the intrinsic necessity, and the contributions of the main risk factors among Western countries and China/Asian areas. Yet, the over 51% of global burden of liver cancer is in China, the solution to the early detection and treatment of liver cancer should fully consider the actual situation in China. The effectiveness of screening for liver cancer is worthy of anticipation.

Efficacy of Perioperative Continuous Intravenous Lidocaine Infusion for 72 Hours on Postoperative Pain and Recovery in Patients Undergoing Hepatectomy: Study Protocol for a Prospective Randomized Controlled Trial

“…The secondary outcomes are: (1) The incidence of moderate to severe pain at 24 hours after surgery at rest; (2) The incidence of moderate to severe pain at 48 and 72 hours after surgery at rest and during movement; (3) The cumulative morphine consumption at 24, 48 and 72 hours postoperatively (postoperative opioid use is reported as morphine milligram equivalents, calculated using the Practical Pain Management calculator); (4) Bowel function recovery (defined as the time to first defecation or time to first flatus); (5) The incidence of PONV during the first 72 hours after surgery (we considered it PONV if patients felt any nausea or had any vomiting); (6) The incidence of a composite of postoperative pulmonary complications during hospitalization, defined as positive if any component developed before discharge after surgery; These complications included respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, or aspiration pneumonitis (see Table S1 in Additional file 2 for definitions); 26 The diagnoses of pleural effusion, atelectasis, and pneumothorax were based on chest x-rays and were adjudicated by assessors blinded to study group allocation; (7) Length of hospital stay (determined by the number of days from admittance to discharge); ( 8) Patient satisfaction scores (satisfaction scores regarding pain control and the overall recovery process were obtained at 72 hours after surgery, using a 11-point Likert scale, with 0 indicating "very dissatisfied" and 10 indicating "very satisfied"); (9) Levels of inflammatory factors (IL-6, TNF-α) at 24 hours after surgery.…”

“…Liver cancer is the second leading cause of cancer-related death, which accounts for 8.2% of cancer worldwide. 1 , 2 Hepatic resection is widely accepted as the mainstay of curative therapy for liver cancer. Miserably, patients after hepatectomy always suffer from acute postoperative pain.…”

Association between hepatitis B and E virus infection and hepatocellular carcinoma risk

“…1 Liver cancer was also the second leading cause of years of life lost from cancer worldwide with a 4.6% yearly increase in absolute years of life lost. 2 China accounted for over 50% of world newly diagnosed liver cancer cases and liver cancer-related deaths 1,3 with a 5-year overall survival rate of about 12.1% during 2012 to 2015. 4 The overall burden of liver cancer is increasing over time both in China and worldwide, warranting research in etiology and preventive measures of liver cancer.…”

Liver Cancer Survival: A Real World Observation of 45 Years with 32,556 Cases

“…30 Liver cancer screening may be able to detect more early cases, lead to effective early treatment which will benefit the therapeutic effect of liver cancer and improve its survival rate. [31][32][33] Therefore, the differences in the survival rates of liver cancer among different countries or regions may reflect the discriminations in the effective treatment of liver cancer as well as the disparities in the early detection of liver cancer. In other words, the improvement in the survival rate of liver cancer in various countries or regions in recent years should be largely affected by the improvement of therapy and the ability of detecting early cases.…”

“…39 In Figure 6, the 1-year RS trend has showed a very interesting "pulse" increase, this could be explained by the alphafetoprotein (AFP) mass screening of over 1.8 M person times during the middle 1970's which resulted in a proportion of 35% early state cases with PLC. 33 The 5-year and 10-year RS trends may be the real reflection of the improved survival during the long-term period.…”