研究目的

一、全面分析中国肝癌疾病负担现状及流行趋势，为肝癌防控提供数据依据。

二、评估中晚期肝癌患者的生存质量，并分析其影响因素，为提高患者的生存质量提供依据。

研究方法

1. 中国肝癌疾病负担分析：本研究基于《中国肿瘤登记年报》《中国卫生健康统计年鉴》《中国死因监测数据集》、GLOBOCAN以及GBD等5个国内外权威数据库，从中筛选出中国肝癌发病、死亡以及DALY等疾病负担指标的全国总体数据以及分时期、分地区、分性别、分年龄段的细化数据进行整理分析，生成多数据源肝癌疾病负担数据集，并运用Joinpoint回归模型计算APC和AAPC，分析中国肝癌疾病负担的变化情况，全面评估中国肝癌的疾病负担现状及流行趋势。

2. 中晚期肝癌患者生存质量调查研究：本研究是一项以医院为基础的全国多中心横断面研究，纳入全国7家三甲医院在2022年1月至2022年8月期间收治的807例原发性中晚期肝癌患者为研究对象。采用自行设计的问卷收集研究对象的社会人口学特征及临床特征资料，同时采用EORTC开发的EORTC QLQ-C30以及EORTC QLQ-HCC18量表调查中晚期肝癌患者的生存质量。通过单因素分析方法比较不同特征患者生存质量的得分差异，并运用多因素线性回归模型分析中晚期肝癌患者生存质量的影响因素。

研究结果

1. 中国肝癌疾病负担分析：中国肝癌疾病负担存在性别、地区及年龄差异，基于多个数据库的数据分析结果均显示我国呈现出男性疾病负担高于女性，农村高于城市，随着年龄的增长逐渐升高的特点。基于《中国肿瘤登记年报》以及GBD数据分析结果显示在2004—2018年间中国肝癌的粗发病率均呈现出缓慢上升趋势，AAPC分别为0.4%和0.9%（P＜0.05）。基于《中国肿瘤登记年报》数据进行Joinpoint回归分析结果显示，在2004—2018年间中国肝癌的世标发病率呈现出下降趋势，基于GBD数据分析结果同时显示在1990—2019年间肝癌世标率也呈现出下降趋势，AAPC分别为-0.7%和-3.2%（P＜0.05）。此外，基于《中国肿瘤登记年报》《中国死因监测数据集》以及GBD数据分析结果均显示中国肝癌世标死亡率呈现下降趋势，AAPC分别为-1.4%、-2.7%、-3.5%（P＜0.05）。基于GBD数据分析结果显示DALY在1990—2019年间呈现出下降趋势。由此可见，中国的肝癌防控取得了显著成果，但由于中国现存慢性肝炎患者基数大，且社会已迈入深度老龄化，肝癌的疾病负担仍然严重，防控形势依然严峻。

2. 中晚期肝癌患者生存质量调查研究：中晚期肝癌患者总健康状况得分较差，在社会功能、角色功能及情绪功能等领域得分相对其他功能领域得分较低，功能状况较差，在经济困难、失眠、疲乏及腹胀等领域得分相对其他症状领域得分较高，症状较为严重。单因素分析结果显示，患者的社会人口学特征及临床特征均对中晚期肝癌患者生存质量的不同维度得分有显著影响（P＜0.05），而不同性别（t=3.762，P＜0.001）、年龄（t=6.209，P＜0.001）、就业状况（F=39.336，P＜0.001）、家庭年收入（t=-4.645，P＜0.001）、是否接受过介入治疗（t=-2.443，P=0.015）及是否患有其他慢性病（t=-4.152，P＜0.001）的中晚期肝癌患者，其C30生存质量量表总得分的差异具有统计学意义。多元线性回归分析结果显示，性别（t=-3.685，P＜0.001）、年龄（t=-2.991，P=0.003）、就业状况（t=-7.964，P＜0.001）、家庭年收入（t=3.302，P=0.001）及患其他慢性病情况（t=-2.524，P=0.012）是影响患者生存质量的主要因素。

研究结论

中国肝癌疾病负担具有男性高于女性、农村高于城市，随年龄增长不断升高的特点，中国肝癌世标发病、死亡及DALY呈现出下降趋势，但肝癌疾病负担仍然较重，应进一步加强肝癌的综合防控。中国肝癌发病隐匿，影响其生存质量的因素较多，应关注患者多方面的需求，采取综合措施，如开展健康教育、提供社会支持、完善相关医疗保障政策及加强个体化治疗等，全面提高患者的生存质量。

Objectives

1. To analyze the current disease burden and epidemiological trends of liver cancer in China, and provide a data basis for liver cancer prevention and control.

2. To assess the quality of life in patients with middle-advanced stage liver cancer and analyze its influencing factors, thereby providing evidence for improving the quality of life of patients.

Materials and methods

1. Analysis of the burden of disease of liver cancer in China: This study draws upon five authoritative domestic and international databases, including China Cancer Registry Annual Report, China Health Statistical Yearbook, China Death Cause Surveillance Dataset, GLOBOCAN and GBD. From these sources, we extracted nationwide data on the incidence, mortality, and DALY of liver cancer in China, along with stratified data by period, region, sex, and age group. A comprehensive, multi-source dataset on the disease burden of liver cancer was constructed. To assess temporal trends, we employed Joinpoint regression model to calculate the APC and AAPC in the burden of liver cancer in China. This approach enabled a comprehensive evaluation of the current disease burden and epidemiological trends of liver cancer.

2. Investigation of quality of life in patients with middle-advanced stage liver cancer: This study is a hospital-based, nationwide, multicenter cross-sectional study. A total of 807 patients with primary middle-advanced stage liver cancer were enrolled from seven tertiary hospitals across China between January, 2022, and August, 2022. The participating hospitals included Henan Cancer Hospital, Sichuan Cancer Hospital, Chongqing University Cancer Hospital, Beijing Friendship Hospital, Capital Medical University, Gansu Provincial Cancer Hospital, Affiliated Cancer Hospital of Xinjiang Medical University, and Liaoning Cancer Hospital. A self-designed questionnaire was used to collect general demographic information and clinical characteristics of participants, and EORTC QLQ-C30 and EORTC QLQ-HCC18 were used to measure the quality of life in patients with middle-advanced stage liver cancer. Differences in quality of life in patients with different sociodemographic characteristics were analyzed using t-test and analysis of variance, and multiple linear regression model was used to identify factors influencing the quality of life in patients with middle-advanced stage liver cancer.

Results

1. Analysis of the burden of disease of liver cancer in China: The disease burden of liver cancer in China demonstrates significant disparities by sex, region, and age. Analyses from multiple authoritative databases consistently show a higher burden among males than females, in rural areas compared to urban areas, and a progressive increase with advancing age. Joinpoint regression analysis reveals an upward trend in the crude incidence rate of liver cancer in recent years, whereas age-standardized incidence and mortality rates have shown a declining trend. Moreover, the DALY exhibited a decreasing trend from 1990 to 2019. These findings indicate that substantial progress has been made in liver cancer prevention and control in China. Nevertheless, given the large population of individuals with chronic hepatitis and the country's transition into a rapidly aging society, the overall disease burden of liver cancer remains high, posing persistent challenges for prevention and control.

2. Investigation of quality of life in patients with middle-advanced stage liver cancer: A total of 807 participants were included in the final analysis. Patients with middle-advanced stage liver cancer had low scores in the functional domains of social functioning, role functioning, and emotional functioning, indicating poor functional status in these areas. They had high scores in the symptom domains of financial difficulties, fatigue, insomnia, and abdominal distention, indicating poor functional status in these areas. Univariate analysis showed that all sociodemographic and clinical characteristics significantly affected various dimensions of quality of life among patients with middle-advanced stage liver cancer (P < 0.05). It also showed that gender (t=3.762, P<0.001), age (t=6.209, P<0.001), employment status (F=39.336, P<0.001), annual household income (t=-4.645, P<0.001), whether they had undergone interventional therapy (t=-2.443, P=0.015) and whether they had other chronic diseases (t=-4.152, P<0.001) had significant impact on overall EORTC QLQ-C30 scores of patients with middle-advanced stage liver cancer. Multivariate analysis showed that gender (t=-3.685, P<0.001), age (t=-2.991, P=0.003), employment status (t=-7.964, P<0.001), annual household income (t=3.302, P=0.001) and suffering from other chronic diseases (t=-2.524, P=0.012) were the main factors affecting the quality of life of patients.

Conclusion

The disease burden of liver cancer in China is characterized by higher rates among males compared to females, greater burden in rural areas than in urban areas, and a progressive increase with advancing age. Although the age-standardized incidence, mortality and DALY of liver cancer in China have shown a declining trend, the disease burden remains substantial, highlighting the need for strengthened comprehensive prevention and control strategies. The onset of liver cancer is insidious, and the proportion of patients with advanced liver cancer is relatively high, and there are many factors affecting their quality of life. we should pay attention to the needs of patients in various aspects. Comprehensive measures, such as health education, social support, and enhanced individualized treatment, should be taken to improve the quality of life of patients comprehensively.