Management and outcomes of patients with liver cancer in China and the United States

BACKGROUND: The management and outcomes of liver cancer in China have not been well studied. This study aimed to evaluate the management and prognosis of patients with liver cancer in China through a comprehensive multicenter analysis and to compare these findings with data from the United States (US). METHODS: We conducted a retrospective cohort study using data from 13 hospitals across 10 provinces in China, covering patients diagnosed with primary liver cancer between January 2016 and December 2017. We collected data on sociodemographic characteristics, lifestyle factors, stage at diagnosis, and first-line treatment. Patients' survival outcomes were tracked using active and passive follow-up methods until December 2023. Multivariable Cox regression was used to identify prognostic factors. We further compared treatment patterns and prognoses of liver cancer patients between 13 hospitals in China and the Surveillance, Epidemiology, and End Results (SEER) cohort in the US. RESULTS: A total of 4951 patients with liver cancer from China and 18,365 from the Surveillance, Epidemiology, and End Results cohort were analyzed. In the Chinese cohort, commonly used treatments, ranked from highest to lowest, were surgery (37.3%, 1821/4879), interventional therapy (32.1%, 1570/4898), chemotherapy (17.4%, 850/4877), radiofrequency ablation (6.9%, 337/4872), radiotherapy (3.7%, 182/4890), and targeted therapy (2.6%, 127/4875). Surgery rates for patients with liver cancer in stages I to IV were 59.2% (309/522), 58.8% (443/753), 39.0% (328/841), and 18.6% (141/760), respectively. According to the stage at diagnosis, 5-year survival rates for patients in stages I to IV were 48.1% (95% confidence interval [CI]: 44.0-52.6%), 37.8% (95% CI: 34.5-41.4%), 24.0% (95% CI: 21.3-27.0%), and 8.0% (95% CI: 6.2-10.1%), respectively. Compared with the US, China had higher surgery rates and stage-specific survival for patients with liver cancer across all stages. Data from both countries indicated a poor prognosis for liver cancer, with the stage at diagnosis and surgical intervention being key prognostic factors in both China and the US. CONCLUSION: The present findings underscore the urgent need for early diagnosis and curative treatment interventions such as surgery to enhance survival outcomes for patients with liver cancer.