Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
World J Gastroenterol. 2019 Aug 28;25(32):4749-4763. doi: 10.3748/wjg.v25.i32.4749.
Liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide. Socioeconomic development, indicated by the Human Development Index (HDI), is closely interconnected with public health. But the manner in which social development and medical advances influenced liver cancer patients in the past decade is still unknown.
To investigate the influence of HDI on clinical outcomes for patients with existing liver cancer from 2008 to 2018.
The HDI values were obtained from the United Nations Development Programme, the age-standardized incidence and mortality rates of liver cancer were obtained from the GLOBOCAN database to calculate the mortality-to-incidence ratio, and the estimated 5-year net survival of patients with liver cancer was provided by the CONCORD-3 program. We then explored the association of mortality-to-incidence ratio and survival with HDI, with a focus on geographic variability across countries as well as temporal heterogeneity over the past decade.
From 2008 to 2018, the epidemiology of liver cancer had changed across countries. Liver cancer mortality-to-incidence ratios were negatively correlated and showed good fit with a modified "dose-to-inhibition response" pattern with HDI ( = -0.548, < 0.0001 for 2018; = -0.617, < 0.0001 for 2008). Cancer survival was positively associated with HDI ( = 0.408, < 0.01) and negatively associated with mortality-to-incidence ratio ( = -0.346, < 0.05), solidly confirming the interrelation among liver cancer outcome indicators and socioeconomic factors. Notably, in the past decade, the HDI values in most countries have increased alongside a decreasing tendency of liver cancer mortality-to-incidence ratios ( < 0.0001), and survival outcomes have simultaneously improved ( < 0.001), with significant disparities across countries.
Socioeconomic factors have a significant influence on cancer outcomes. HDI values have increased along with improved cancer outcomes, with significant disparities among countries.
肝癌是全球第六大常见癌症，也是第四大癌症死亡原因。以人类发展指数（HDI）为代表的社会经济发展与公共卫生密切相关。但是，过去十年中社会发展和医疗进步对肝癌患者的影响方式尚不清楚。
研究人类发展指数（HDI）对 2008 年至 2018 年间现有肝癌患者临床结局的影响。
HDI 值来自联合国开发计划署，肝癌的年龄标准化发病率和死亡率来自 GLOBOCAN 数据库，以计算死亡率与发病率的比值，肝癌患者的估计 5 年净生存率来自 CONCORD-3 项目。然后，我们探讨了死亡率与发病率比值和生存率与 HDI 的关系，重点关注各国之间的地域差异以及过去十年的时间异质性。
2008 年至 2018 年，各国肝癌的流行病学发生了变化。肝癌死亡率与发病率比值与 HDI 呈负相关，并与修正后的“剂量抑制反应”模式具有良好的拟合度（2018 年： = -0.548，<0.0001；2008 年： = -0.617，<0.0001）。癌症生存率与 HDI 呈正相关（ = 0.408，<0.01），与死亡率与发病率比值呈负相关（ = -0.346，<0.05），这充分证实了肝癌结局指标与社会经济因素之间的相互关系。值得注意的是，在过去十年中，大多数国家的人类发展指数（HDI）值有所增加，肝癌死亡率与发病率比值呈下降趋势（<0.0001），同时生存结果也得到了改善（<0.001），各国之间存在显著差异。
社会经济因素对癌症结局有重大影响。HDI 值随着癌症结局的改善而增加，各国之间存在显著差异。
