Primary liver cancer (PLC) is the sixth most common cancer and the fourth most common cause of cancer death worldwide[
Certainly, incidence, mortality, and prevalence are commonly applied to describe the burden of disease. However, it is also crucial to comprehend and employ survival rate, which is another important descriptive indicator of disease burden and widely used in the evaluation of cancer prognosis. Survival data are available from three sources: clinical studies, hospital-based follow-up data, and population-based follow-up data[
Cancer registries are the premise and foundation of cancer prevention and control. They help obtain comprehensive, accurate, and timely information on the incidence, mortality, survival, and other factors related to cancer in the population[
A literature search of related studies from 1 January 2000 to 30 April January 2020 was conducted using the databases of CNKI, Wanfang Data, PubMed, Web of Science, EMBASE and SEER, with the following keywords: “liver cancer”, “hepatocellular carcinoma”, “HCC”, “population-based survival studies”, “relative survival”, “observed survival” “cancer registry”. Two researchers collected the data independently according to the search criteria, and 129 articles were retrieved by titles and abstracts. After screening with the following criteria: (1) provided RSR or observed survival rate (OSR) of patients with primary liver cancer; and (2) data were population-based or from cancer registries, and excluding duplicate, incomplete or unavailable articles. The final analysis included 53 studies, 9 of which were in Chinese and the remaining 44 were in English
Study selection process. OSR: observed survival rate; RSR: relative survival rate
Estimates of one to five-year RSRs from the published studies were extracted. We used overall and age-standardized 5-year RSR mainly to describe and compare different countries or regions, age groups, and gender. Most of the included publications provided the age-standardized relative survival rates which were extracted. SPSS 22.0 and Excel 2016 were used for data management and analysis.
Population-based sex-specific overall 5-year relative survival rates of primary liver cancer in selected countries
Region | Year | 5-year RSR (%) | ||
---|---|---|---|---|
Male | Female | |||
Korea[ |
1993-1995 | 9.9 | 13.6 | |
1996-2000 | 12.9 | 14.2 | ||
2001-2005 | 20.1 | 20.3 | ||
2007-2011 | 28.5 | 28.7 | ||
2005-2009 | 25.1 | 25.1 | ||
2008-2012 | 30.4 | 29.3 | ||
2010-2014 | 33.1 | 31.9 | ||
2012-2016 | 35.2 | 32.7 | ||
2006-2010 | 26.6 | 26.7 | ||
Japan[ |
1993-1996 | 21.0 | 21.8 | |
1997-1999 | 23.7 | 21.8 | ||
USA[ |
1983-1985 | 2.7 | 6.2 | |
1986-1988 | 3.5 | 8.5 | ||
1989-1991 | 3.4 | 7.0 | ||
1992-1994 | 4.7 | 5.3 | ||
1996-1998 | 8.3 | 9.1 | ||
1999-2001 | 10.9 | 12.1 | ||
2002-2004 | 14.9 | 14.7 | ||
2005-2009 | 17.7 | 17.3 | ||
2010-2016 | 20.8 | 20.9 | ||
Europe[ |
1983-1985 | 2.8 | 5.3 | |
1986-1988 | 3.7 | 5.2 | ||
1989-1991 | 5.3 | 6.0 | ||
1990-1994 | 7.0 | 7.0 | ||
1992-1994 | 7.2 | 7.0 | ||
1995-1999 | 8.9 | 8.4 | ||
Scotland[ |
1985-1989 | 0.4 | 0.5 | |
1990-1994 | 2.2 | 5.4 | ||
1995-1999 | 5.5 | 7.1 | ||
2000-2004 | 8.7 | 8.7 | ||
2005-2007 | 4.4 | 10.6 | ||
France | Total[ |
1989-1997 | 7.0 | 9.0 |
Côte-d’Or, Burgundy[ |
1976-1985 | 1.1 | 2.0 | |
1986-1995 | 4.6 | 2.6 | ||
1996-2005 | 10.3 | 10.3 | ||
Spain[ |
2000-2007 | 13.8 | 10.6 | |
Switzerland[ |
Vaud | 1974-1978 | - | 22.0 |
1984-1988 | 3.0 | - | ||
1989-1993 | 8.0 | 7.0 |
-: No report or non-available in the original articles; RSR: relative survival rate
Population-based sex-specific age-standardised 5-year relative survival rates of primary liver cancer in selected countries
Region | Year | Age-standardised 5-year RSR (%) | |
---|---|---|---|
Male | Female | ||
Singapore[ |
1968-1972 | 5.0 | 3.0 |
1973-1977 | 1.0 | 6.0 | |
1978-1982 | 3.0 | 8.0 | |
1983-1987 | 2.0 | 3.0 | |
1988-1992 | 3.0 | 2.0 | |
Europe[ |
1990-1994 | 6.2 | 6.7 |
Austria[ |
1990-1994 | 7.0 | - |
Czech Republic[ |
1990-1994 | 1.1 | 3.4 |
Denmark[ |
1989-1993 | 3.0 | 3.0 |
1990-1994 | - | 2.3 | |
1994-1998 | 4.0 | 4.0 | |
1999-2003 | 3.0 | 5.0 | |
England[ |
1990-1994 | 6.1 | 7.2 |
Estonia[ |
1990-1994 | 5.5 | - |
Finland[ |
1989-1993 | 4.0 | 5.0 |
1990-1994 | 3.9 | 4.4 | |
1994-1998 | 7.0 | 7.0 | |
1999-2003 | 8.0 | 8.0 | |
Iceland[ |
1989-1993 | 14.0 | - |
1994-1998 | 7.0 | - | |
1999-2003 | 7.0 | - | |
France[ |
1989-1997 | 8.0 | 9.0 |
1990-1994 | 6.9 | - | |
Germany[ |
1990-1994 | - | 3.8 |
Italy[ |
1990-1994 | 6.2 | 8.6 |
The Netherlands[ |
1990-1994 | 6.2 | 5.8 |
Norway[ |
1989-1993 | 6.0 | 8.0 |
1990-1994 | 2.1 | 3.2 | |
1994-1998 | 5.0 | 11.0 | |
1999-2003 | 5.0 | 11.0 | |
Poland[ |
1990-1994 | - | 1.3 |
Scotland[ |
1990-1994 | - | 4.8 |
Slovakia[ |
1990-1994 | - | 1.8 |
Slovenia[ |
1990-1994 | - | 4.9 |
Spain[ |
1990-1994 | 10.4 | 11.6 |
Sweden[ |
1989-1993 | 5.0 | 3.0 |
1990-1994 | 2.9 | 3.1 | |
1994-1998 | 6.0 | 7.0 | |
1999-2003 | 7.0 | 8.0 | |
Switzerland[ |
1990-1994 | 5.9 | - |
Wales[ |
1990-1994 | 5.1 | 6.3 |
-: No reports or non-available in the original articles; RSR: relative survival rate
Age-standardised and overall 5-year relative survival rates of primary liver cancer in some selected countries during 1974-2016. A: Age-standardised 5-year relative survival rates (a: Europe*[
Time changes in survival rates for liver cancer were also reviewed in our study.
The age-standardised 5-year relative survival rates of primary liver cancer in different areas of Europe*, 1999-2007[
Age-specific 5-year relative survival rates of primary liver cancer in different years in some selected countries and regions[
Population-based overall and age-standardised 5-year relative survival rates of PLC in some areas of China
Area | Year | 5-year RSR (%) | Age-standardised 5-year RSR (%) | ||||||
---|---|---|---|---|---|---|---|---|---|
Total | Male | Female | Total | Male | Female | ||||
China[ |
2003-2005 | - | - | - | 10.1 | 10.2 | 10.3 | ||
2006-2008 | - | - | - | 10.1 | 10.0 | 11.0 | |||
2009-2011 | - | - | - | 9.8 | 9.8 | 10.7 | |||
2012-2015 | - | - | - | 12.1 | 12.2 | 13.1 | |||
East China | Shanghai[ |
2002-2006 | 15.5 | 16.0 | 14.8 | - | - | - | |
Zhejiang | Total[ |
2005-2010 | 19.1 | 19.5 | 18.0 | - | - | - | |
Haining and Jiashan[ |
2003-2006 | 10.3 | 9.8 | 11.4 | 10.2 | - | - | ||
2007-2010 | 8.9 | 9.5 | 7.9 | 9.0 | - | - | |||
2011-2014 | 10.6 | 11.3 | 8.9 | 10.2 | - | - | |||
Jiangsu | Huaian[ |
2010 | 8.4 | 8.9 | 6.9 | - | - | - | |
Jintan District of Changzhou[ |
2012-2013 | 11.6 | - | - | - | - | - | ||
Qidong[ |
1972-2011 | 4.7 | 4.5 | 5.4 | - | - | - | ||
1973-1977 | 2.8 | - | - | - | - | - | |||
1978-1982 | 1.4 | - | - | - | - | - | |||
1983-1987 | 2.6 | - | - | - | - | - | |||
1988-1992 | 4.7 | - | - | - | - | - | |||
1993-1997 | 4.7 | - | - | - | - | - | |||
1998-2002 | 5.1 | - | - | - | - | - | |||
2001-2007 | 10.0 | 9.8 | 10.6 | - | - | - | |||
2003-2007 | 7.1 | - | - | - | - | - | |||
Taiwan[ |
2004-2008 | 28.9 | 28.1 | 31.7 | 27.6 | 27.0 | 31.5 | ||
North China | Beijing[ |
1982-1983 | - | 2.2 | 2.4 | - | - | - | |
1987-1988 | - | 3.4 | 5.3 | - | - | - | |||
Hebei[ |
Cixian | 2000-2002 | 4.2 | - | - | - | - | - | |
2003-2013 | 7.6 | 7.1 | 8.7 | - | - | - | |||
South China | Hong Kong[ |
1996-2001 | - | - | - | 22.4 | - | - | |
Northeast China | Liaoning[ |
2000-2002 | - | - | - | 10.7 | 8.8 | 15.2 |
-: No reports or non-available in the original articles; RSR: relative survival rate
As shown in
Survival data based on clinical trials, hospital-based follow-up studies, and population-based cancer registration are disparate in their aims, methods of survival estimation, and application. This study collected overall or age-standardized RSRs of liver cancer worldwide so that we can describe the prognosis of liver cancer in the general population, and make comparisons between different countries and regions. All publications in the study were from the cancer registries or population-based survival analysis, which aimed to provide valuable information for epidemiologists, basic scientists, oncologists, and clinical physicians in liver cancer research.
The aim of clinical trials and hospital-based follow-up studies are quite different from that of population-based survival studies. The survival obtained from clinical trials or studies comes from the evaluation of certain therapeutics, and generally adopts overall survival (defined as the date from randomization to death from any cause) and progression-free survival (defined as the date from randomization until progression or death from any cause) as endpoints. For instance, a randomized, phase 3 clinical trial published in the New England Journal of Medicine evaluated cabozantinib as compared with placebo in previously treated patients with advanced hepatocellular carcinoma, and demonstrated that cabozantinib treatment significantly prolonged survival in patients with longer overall survival and progression-free survival (median overall survival and median progression-free survival were 10.2 months and 5.2 months, respectively) compared to placebo (8.0 months and 1.9 months, respectively)[
A common reason to study population-based cancer survival is to estimate the net survival, a measure of patient survival following primary cancer in the absence of other causes of death[
It is apparent from our review then that the prognosis of PLC has shown continuous improvement overtime, whether in China or around the world. Over the past decades, numerous changes in clinical practice, public health, and social economy may affect the survival of PLC. For instance, advances in imaging diagnosis, clinical treatment such as chemoembolization, ablation, and surgical resection techniques, increased surveillance and screening for early-stage disease and anti-cancer health education, the improvement of socio-economic status (SES) and the transformation of peoples’ health consciousness and lifestyles[
The data we have summarized from the literature implied that there are gender and age disparities in liver cancer survival. For example, in the majority of countries and regions, the prognosis of liver cancer in women was better than men, although the situation was not systematic. Therefore, it is inappropriate to draw the conclusion that the prognosis of women with PLC is better than men. Gender-specific distinctions in the survival rate of PLC require more population-based follow-up studies. In terms of the age at diagnosis, survival was highest among patients in the 35-44 age group, followed by the 45-54 age group, and lowest for the 75 or older age group. This might have been due to the presence of comorbidities and various chronic diseases in the aged patients that reduced their tolerance of cancer treatments or affected physicians’ decisions for treatment options, as compared to younger patients[
When comparing survival rates in different countries, times, or populations,
In conclusion, we summarized one to five-years RSRs of liver cancer, which were markedly distinct between different regions or periods in the same region. This implied that the region, period, and age might affect the survival rate of PLC; however, whether gender is a relevant factor remains to be studied. Therefore, more attention should be drawn to PLC prevention and screening, in particular, must be developed and implemented. Epidemiological, basic, and clinical studies of PLC have a long way to go still.
Conducted the study and collected publications and abstract data and wrote the first draft: Jiang YF
Double check the collected publications and abstract data: Li ZY
Reviewed and approved the final version of the paper: Jiang YF, Li ZY, Ji XW, Shen QM, Tuo JY, Yuan HY, Xiang YB
Primary responsibility for final content, designed the research study and obtained funding: Xiang YB
Not applicable.
This work was supported by the National Key Project of Research and Development Program of China (No. 2016YFC1302503); the National Key Basic Research Program of China “973 Program” (No. 2015CB554000); the State Key Project Specialized for Infectious Diseases of China (No. 2008ZX10002-015 and No. 2012ZX10002008-002).
All authors declared that there are no conflicts of interest.
Not applicable.
Not applicable.
© The Author(s) 2020.