Liver cancer poses a significant public health challenge in China, with approximately 367,700 new cases in 2022, accounting for 42.5% of global incidence. However, the five-year survival rate is a mere 14.4%, markedly lower than the advanced levels seen in countries like Japan. One of the critical reasons is the inefficacy of the current "one-size-fits-all" screening strategy, which fails to address the diverse etiologies and limited sensitivity of liver cancer screening, resulting in inadequate early diagnosis and treatment.To address these unmet needs, the "Ruiganhu" project was launched by Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, in collaboration with enterprises and partner hospitals, with government support. This initiative aims to develop a digital platform-based precision screening and risk stratification management system to enhance early liver cancer detection rates and reduce disease burden. At the 2024 American Association for the Study of Liver Diseases (AASLD) Annual Meeting, Dr. Qing Xie's team presented the latest progress of this project in a poster session.
Project Overview and Methods
The study analyzed data from Ruijin Hospital and Lishui People’s Hospital, two participants in the “Ruiganhu” project. Between May 2023 and March 2024, a total of 3,907 patients were enrolled. Using a Liver Disease Precision Management Digital Platform (LDP), the study collected patient histories, laboratory results, and imaging findings. This information was used to generate customized risk assessments and follow-up management plans.
All enrolled patients first underwent liver cancer screening, including abdominal ultrasound and serum tests for AFP (alpha-fetoprotein) and PIVKA-II. Patients with abnormal results received further diagnostic evaluations, while those without evidence of liver cancer were classified into risk categories based on domestic guidelines, the hospital’s internal “Ruijin Decision Tree Model,” and published risk stratification models (aAMP, THRI, CAMD, mPAGE-B). Follow-up plans tailored to each risk level were then implemented for ongoing liver cancer monitoring.
Key Findings
Enhanced Screening Efficiency
Out of 2,775 patients who completed evaluations, 11 cases of liver cancer were confirmed, yielding an overall diagnosis rate of 0.4%. This represents a tenfold improvement over the national average diagnostic rate. Among these cases, 7 (63.6%) were diagnosed at an early stage, a significant increase compared to national averages. Early diagnosis is crucial for improving treatment outcomes and survival rates in liver cancer patients.
Improved Follow-Up Management
Ruijin Hospital achieved notable advancements in follow-up efficiency by integrating digital tools, standardized workflows, and quality control measures. Nurse-to-doctor support ratios improved from one nurse assisting one doctor in managing 3,000 patients to one nurse assisting 12 doctors, targeting the management of 20,000 patients.
Patient follow-up completion rates increased to 70.3%, substantially higher than baseline levels before project implementation. Moreover, follow-up monitoring revealed risk level reductions in 15 patients (5.8%), including 8 patients transitioning from high to medium risk and 7 from medium to low risk. These changes were primarily attributed to improvements in liver function and platelet levels.
Impact and Future Directions
The success of the “Ruiganhu” project demonstrates that integrating digital platforms with precise risk stratification and screening strategies can significantly improve liver cancer early diagnosis rates and streamline management processes. This innovative approach not only benefits high-risk populations but also contributes to enhancing the overall survival rates and quality of life for liver cancer patients in China.
As the project progresses, it is expected to benefit an even greater number of patients, setting a new standard for liver cancer screening and management in high-incidence regions.
