Epidemiological characteristics and precise prophylaxis and control of primary liver cancer in China

In China, the prevalence of primary liver cancer (PLC) is higher in the South than in the North, higher in the littoral than in the interior, and higher in the rural areas than in the urban areas. Male-to-female ratio of PLC is 3: 1. In the past 20 years, PLC has been the second leading cause of cancer-related death; the age-standardized mortality in middle-aged population (40-65 years) has been higher than that in the aged population (older than 65 years); and it has been the first leading cause of cancer-related death in males younger than 65 years old. In China, hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) account for 93% and 3% in PLC, respectively. Factors that persistently cause liver damage are the cause of PLC, which are key elements for the prophylaxis of the first grade. The major cause of HCC is persistent infection with hepatitis B virus (HBV), accounting for 84.4% of HCC in China. Approximately, 32% male and 9% female HBV chronic carriers are predicted to die of HCC by 75 years old. In addition, alpha-toxin exposure, infection with Clonorchis sinensis, heavy alcohol consumption, metabolic syndrome, and hepatitis C virus infection greatly increase the risk of PLC.HBV-related HCC (HBV-HCC) occurs 10 years earlier than HCC related to other causes and has poorer prognosis. Defining high-risk population of PLC is important for the prophylaxis of the second grade. Surgical resection is effective for the treatment of PLC at early stage; however, PLC is apt to recur postoperatively, with a five-year survival rate of approximately 30% after surgery. The 5-year survival rate after ICC surgery is less than 20%. Anti-HBV treatment not only decreases the occurrence of HCC in HBV-infected subjects significantly, but also greatly improves the postoperative prognosis. Surgery following the recurrence, radiation, anti-angiogenic treatment, immunotherapy, combined immunotherapy with targeted therapy, and aerobic exercise apparently improve the effect of phylaxis of Ⅰ-Ⅲ grade of PLC.