AIM:Obesity is a well-established risk factor for type 2 diabetes mellitus (T2DM), with specific anthropometric indices offering even greater predictive value. This study aimed to systematically examine the associations between 17 anthropometric indices and T2DM risk, as well as the predictive value of these indices for T2DM. METHODS:Data from the Shanghai Men's and Women's Health Studies were used. Cox regression models estimated hazard ratios (HRs). Receiver operating characteristic (ROC) curves assessed the predictive performance, with subgroup and sensitivity analyses conducted to evaluate robustness. RESULTS:The study included 71 356 women and 56 288 men, with a mean follow-up of 17.42 and 12.35 years, respectively. Relative fat mass (RFM) had the highest HR in women (HR per SD = 2.42, 95% CI: 2.34-2.49) and men (HR per SD = 2.22, 95% CI: 2.13-2.31). Abdominal adiposity indices (e.g., WC, waist-to-height ratio [WHtR], body roundness index [BRI]) outperformed general adiposity indices (e.g., BMI) in predicting T2DM risk. CONCLUSIONS:Abdominal adiposity indices have significant value in predicting T2DM risk, with notable sex-specific differences. Among these, RFM were better predictors in both women and men. These findings suggest that abdominal obesity indices could be used to inform prevention strategies.

OBJECTIVES:Primary liver cancer (PLC) is a leading cause of global cancer-related mortality, with rising incidence and survival disparities. We aimed to analyze its long-term survival trends that likely help establish future prevention and treatment strategies for PLC. METHODS:Using the Surveillance, Epidemiology, and End Results (SEER) Program (1975-2019), we assessed long-term survival rates of PLC patients stratified by age groups, sex, race, and SEER tumor stage using period analysis. Model-based period analysis was employed to predict the 5-year relative survival rates (RSRs) during 2020-2024. Survival statistics included observed survival rates (OSRs), RSR, conditional RSR (CRSR), and age-standardized RSR (ARSR). RESULTS:From 2015 to 2019, female patients with PLC had a higher 5-year ARSR of 27.26% compared to male patients (24.81%). The 5-year CRSR improved to 72.17% in women and 70.05% in men. The 5-year RSR declined with age and from localized tumor stage (41.45%) to distant cancer (5.52%) in men. In addition, black male patients had the lowest 5-year ARSR (19.61% vs. 23.86% in white males and 31.22% in men of other races). Long-term trends during 1975-2019 showed rising survival rates, yet disparities persisted. Projections for 2020-2024 estimated an overall 5-year RSR of approximately 30%, with persistent gaps for patients aged ≥ 75 years and black males. CONCLUSIONS:Despite improved PLC survival over the 45 years, persistent disparities in age, sex, race, and tumor stage underscore the need for early detection and equitable care. The converging prognosis among long-term survivors highlights the value of survivorship programs.

Primary liver cancer (PLC) is a leading cause of global cancer-related mortality, with rising incidence and survival disparities. We aimed to analyze its long-term survival trends that likely help establish future prevention and treatment strategies for PLC. Using the Surveillance, Epidemiology, and End Results (SEER) Program (1975–2019), we assessed long-term survival rates of PLC patients stratified by age groups, sex, race, and SEER tumor stage using period analysis. Model-based period analysis was employed to predict the 5-year relative survival rates (RSRs) during 2020–2024. Survival statistics included observed survival rates (OSRs), RSR, conditional RSR (CRSR), and age-standardized RSR (ARSR). From 2015 to 2019, female patients with PLC had a higher 5-year ARSR of 27.26% compared to male patients (24.81%). The 5-year CRSR improved to 72.17% in women and 70.05% in men. The 5-year RSR declined with age and from localized tumor stage (41.45%) to distant cancer (5.52%) in men. In addition, black male patients had the lowest 5-year ARSR (19.61% vs. 23.86% in white males and 31.22% in men of other races). Long-term trends during 1975–2019 showed rising survival rates, yet disparities persisted. Projections for 2020–2024 estimated an overall 5-year RSR of approximately 30%, with persistent gaps for patients aged ≥ 75 years and black males. Despite improved PLC survival over the 45 years, persistent disparities in age, sex, race, and tumor stage underscore the need for early detection and equitable care. The converging prognosis among long-term survivors highlights the value of survivorship programs.

BACKGROUND & AIMS:Sex-specific associations between adiposity and death from primary liver cancer (PLC) remain poorly characterized, particularly those related to emerging anthropometric indices and populations with high abdominal adiposity. METHODS:In two prospective cohort studies, the sex-specific associations between 16 anthropometric indices (six traditional, 10 emerging) and PLC death were examined in 72,691 women and 59,892 men in China. Cox proportional hazards regression models with restricted cubic spline functions were applied to evaluate the associations between adiposity indices and PLC death. RESULTS:After a median follow-up time of 22.0 years for women and 16.1 years for men, 300 women and 485 men died from PLC. We observed distinct risk patterns: women demonstrated positive linear associations for 11 indices (five traditional, six emerging) with PLC death, with highest-quartile individuals showing a 46-82% elevated death risk compared with lowest-quartile counterparts, especially in premenopausal women. Conversely, men displayed U-shaped associations for 10 indices, indicating that death risk was minimized at moderate adiposity levels. Notably, the combined model of the Clínica Universitaria de Navarra Body Adiposity Estimator (CUN-BAE) and BMI best predicted PLC death in both sexes, highlighting the need for sex-specific adiposity management. CONCLUSIONS:Sex-specific differences exist in the association between adiposity and PLC death. The nonlinear pattern observed in men warrants mechanistic investigation for potential hormonal or metabolic mediators of the adiposity-PLC death relationship. IMPACT AND IMPLICATIONS:This study represents the first comprehensive investigation into the sex-specific associations between 16 anthropometric indices (traditional/emerging) and liver cancer death in two Chinese cohorts. Findings show distinct patterns: positive linear in women (especially premenopausal women) and U-shaped associations in men, with the lowest death risk observed at moderate adiposity levels. Models incorporating CUN-BAE and BMI improved prediction for liver cancer death in both sexes. These findings highlight adiposity as a crucial modifiable risk factor for PLC, urging policymakers to adopt sex-specific adiposity strategies, encouraging healthcare professionals and researchers to investigate the underlying mechanisms of the observed nonlinear associations in men, and utilizing the superior predictive power of combined models, such as CUN-BAE and BMI, to identify high-risk individuals.

MethodsA prospective study was conducted based on the Shanghai Women's Health Study. Night shift exposure was assessed via questionnaire, and incident cancer cases were identified through a combination of active and passive follow-up. The cohort was recruited from December 1996 to May 2000 in Changning District, Shanghai, comprising women aged 40-70 who met the inclusion and exclusion criteria. Associations between night shift exposure variables and cancer risk were evaluated using Cox proportional hazards regression models. Continuous night shift exposure variables were further incorporated into models as continuous form to test for linear trends, and restricted cubic splines were employed to explore the potential non-linear associations. This study was approved by the Renji Hospital Ethics Committee of Shanghai Jiao Tong University School of Medicine (KY2024-050-C) and acquired imformed consent.ResultsThis study included 69 244 women. With a mean follow-up of 15.8 years, 8 442 cancer cases were documented. The multivariate adjusted hazard ratios of night shift exposure variables-ever exposed to night shift work, age of starting night shift work, cumulative night shift work duration, and average monthly frequency of night shifts-in relation to cancer risk were not statistically significant. Furthermore, no significant linear or non-linear associations were detected for any of these continuous night shift variables in relation to cancer incidence (P>0.05).ConclusionThis study did not identify significant associations between night shift work, in any of the dimensions examined, and cancer risk in Chinese women. Further large-scale and rigorously designed prospective studies are warranted to provide reliable population-based evidence.Background and purposeNight shift work has been suggested to potentially increase the risk of cancer. However, prospective population-based evidence remains limited, particularly among Chinese populations. This study aimed to examine the associations between multiple dimensions of night shift work-including ever exposed to night shift work, age of starting night shift work, cumulative night shift work duration, and average monthly frequency of night shifts-and the risk of cancer incidence among Chinese women.

Although numerous epidemiological studies have reported significant associations between type 2 diabetes mellitus (T2DM) and breast cancer incidence, considerable heterogeneity exists across studies. Moreover, the breast cancer risk in relation to T2DM duration remains unclear. This study aimed to investigate the associations between T2DM, T2DM duration, and breast cancer risk in Chinese women. A total of 72,295 women aged 40–70 years from the Shanghai Women’s Health Study were included. T2DM was defined as diagnosis after age 30, and categorized as prevalent at enrollment or incident during follow-up. Incident T2DM was treated as a time-dependent exposure in Cox proportional hazards regression models. The risk trajectory of breast cancer following T2DM diagnosis was characterized using categorical modelling analysis. Over a median follow-up of 19.08 years, 1,759 incident cases of breast cancer were identified. Compared to individuals without diabetes, overall T2DM was associated with an increased risk of breast cancer (HR = 1.22, 95

BACKGROUND:The association between adiposity and increased liver cancer risk is well-recognized, yet underlying metabolic mechanisms require elucidation. This study aimed to identify metabolic mediators linking adiposity markers to liver cancer and assess their potential causality using two-sample Mendelian randomization (MR) analysis. METHODS AND FINDINGS:We conducted a 1:1 matched nested case-control study within a population-based and prospective cohort study-the Shanghai Men's Health Study (SMHS). The SMHS was initiated in 2002-2006, including 61,469 Chinese men aged 40-74 years, and has been followed up for over 20 years. Targeted metabolomic profiling was performed on baseline plasma samples. Associations between seven anthropometric measurements (body mass index [BMI], waist circumference, waist-to-hip ratio, waist-to-height ratio, a body shape index, hip circumference, and adult weight gain), 186 circulating metabolites, and liver cancer risk were assessed. Linear and conditional logistic regression model adjusted for multiple confounders (including smoking, alcohol drinking, physical activity, chronic hepatitis and cirrhosis, diabetes, etc.) were used. Pathway analysis and network analysis were conducted to explore the biological functions of these metabolites. Parallel mediation analysis was employed to quantify the mediating effects through metabolites. Subsequently, MR analysis was performed to investigate potential causal relationships. This study incorporated 322 incident liver cancer cases and 322 cancer-free controls. Participants diagnosed with liver cancer had higher proportions of seropositive hepatitis B surface antigen (63.7%) compared to their matched controls (6.2%). We identified 27 intermediate metabolites associated with both adiposity markers and liver cancer risk, which formed an interconnected functional network. Pyroglutamic acid demonstrated the most robust consistency, being significantly associated with seven anthropometric measurements (β per doubling with BMI = 0.17; 95% confidence interval [CI]: [0.09, 0.24]) and liver cancer (odds ratio per doubling = 1.56; 95% CI: [1.13, 2.15]). Pathway analysis highlighted significant alterations in energy, lipid, and amino acid metabolism. Specifically, Phenylalanine, tyrosine, and tryptophan biosynthesis showed the highest impact, suggesting a key role for aromatic amino acid metabolism. Parallel mediation analysis demonstrated significant indirect effects via intermediate metabolites for six of the seven anthropometric measurements, with the proportion mediated by the identified metabolite clusters reaching 0.16 (95% CI: [0.05, 0.29]) for BMI. MR analysis provided evidence supporting potential causality for 23 of 108 initially observed associations. The strongest association was observed between WC and oxoglutaric acid (βIVW per standard deviation = 0.31; 95% CI: [0.17, 0.43]). Notably, while the observational analysis suggested a broad metabolic mediation of the adiposity marker-liver cancer association, the MR findings pinpointed a more specific and limited set of causal metabolic mediators. The main limitation of this study was the population mismatch between the observational (Chinese men) and the MR (European ancestry) analyses, which may limit the generalizability of the findings to other populations. CONCLUSIONS:Integrating prospective observational and genetic evidence, we identified specific metabolic mediators linking adiposity to liver cancer, particularly involving amino acid, lipid and energy metabolism. These findings enhanced molecular understanding of adiposity-driven hepatocarcinogenesis and provided potential metabolic targets for future primary prevention strategies.

Background To better understand global status, temporal trends, and geographic disparities of prostate cancer survival, we systematically collected published survival studies on prostate cancer from cancer registries worldwide. Methods A comprehensive literature search was conducted in databases such as PubMed, Embase, Web of Science, SinoMed, CNKI and SEER for survival studies from cancer registries up to April 30, 2025. We synthesized data on observed, relative and net survival since the 1990s, along with age-standardized survival, and further stratified based on age at diagnosis and stage. Results The overall survival was favorable and exhibited a continuous improving trend. In most countries and regions, the 5-year relative survival rate exceeded 70%. However, substantial geographic disparities were observed. The prognosis was better in developed countries in Europe and America than that in less developed countries in Asia and Africa. Since 2000, the age-standardized 5-year relative survival was the highest in the United States at 98.5% (2007–2010), while it was the lowest in Punjab of India at 30.3% (2013–2016). The prognosis was poorest for patients aged ≥ 75, or for those diagnosed with distant or stage IV. Conclusions Although the survival has been improving over the past three decades, disparities between developed and less developed countries still persist. The extent of the popularization of prostate screening programs, the age or stage at diagnosis, and the sophistication of healthcare systems are likely to be significant contributing factors to these differences. Our results can provide fundamental statistics for formulating and refining relevant policies.

Background & Aims Sex-specific associations between adiposity and death of primary liver cancer (PLC) remain poorly characterized, particularly those related to emerging anthropometric indices and populations with high abdominal adiposity. Methods In two prospective cohort studies, the sex-specific associations between 16 anthropometric indices (six traditional, 10 emerging) and PLC death were examined in 72 691 women and 59 892 men in China. Cox proportional hazards regression models with restricted cubic spline functions were applied to evaluate the associations between adiposity indices and PLC death. Results After a median follow-up time of 22.0 years for women and 16.1 years for men, 300 women and 485 men died of PLC. we observed distinct risk patterns: women demonstrated positive linear associations for 11 indices (five traditional, six emerging) with PLC death, with highest-quartile individuals showing a 46%-82% elevated death risk compared to lowest-quartile counterparts, especially in premenopausal women. Conversely, men displayed U-shaped associations for 10 indices, indicating that death risk was minimized at moderate adiposity levels. Notably, the combined model of the Clínica Universitaria de Navarra Body Adiposity Estimator (CUN-BAE) and body mass index (BMI) best predicted PLC death in both sexes, highlighting the need for sex-specific adiposity management. Conclusions Sex-specific differences exist in the association between adiposity and PLC death. The non-linear pattern observed in men warrants mechanistic investigation for potential hormonal or metabolic mediators of the adiposity-PLC death relationship. Impact and implications This study represents the first comprehensive investigation into the sex-specific associations between 16 anthropometric indices (traditional/emerging) and liver cancer death in two Chinese cohorts. Findings show distinct patterns: positive linear in women (especially premenopausal) and U-shaped associations in men, with the lowest death risk observed at moderate adiposity levels. Models incorporating CUN-BAE and BMI improved prediction for liver cancer death in both sexes. These findings highlight adiposity as a critical modifiable risk factor for primary liver cancer, urging policymakers to adopt sex-specific adiposity strategies, encourage healthcare professionals and researchers to investigate the underlying mechanisms of the observed non-linear associations in men, and utilize the superior predictive power of combined models like CUN-BAE and BMI to identify high-risk individuals.

OBJECTIVE:Epidemiological evidence on the association between night shift work and cancer risk remains limited and inconsistent. This study aimed to systematically investigate this association among Chinese men. METHODS:This population-based prospective cohort study included 61 078 men from the Shanghai Men's Health Study. Detailed information on night shift work was collected at baseline using a structured questionnaire. Cox regression model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for total cancer and ten major site-specific cancers. Restricted cubic spline functions were used to characterize the dose-response associations for key metrics. Further analysis was conducted with lag periods of 5, 10, 15 and 20 years, and potential effect modification by lifestyle factors was tested. RESULTS:During a median follow-up period of 16.1 years, 8202 incident cancer cases were identified. Participants with 11-20 years of cumulative night shift work had a higher risk of pancreatic cancer compared with never-shift workers (HR 1.59, 95% CI 1.09-2.31). This association persisted across all lag periods tested, peaking at a 15-year lag (HR 1.82, 95% CI 1.25-2.64). No significant associations were found between night shift work metrics, including night shift work experience, starting age, cumulative duration, and frequency, and the risk of total and other major site-specific cancers. No evidence of effect modification by lifestyle factors was observed. CONCLUSIONS:Night shift work was not associated with the risk of overall or some common cancers among Chinese men. However, an increased risk of pancreatic cancer was associated with intermediate-to-long-term night shift work.

Aim: Globally, primary liver cancer ranks as the third most common cause of mortality among cancer patients. China reports the highest number of cases in the world, with chronic hepatitis B virus (HBV) infection being the most common cause. Recent studies have shown an increasing risk among adolescents and young adults aged 15-49 years, posing a significant public health challenge. Methods: This study uses the latest data from the Global Burden of Disease (GBD) 2021 to systematically evaluate the disease burden of liver cancer among individuals aged 15-49 years in China from 1990 to 2021. Results: The results show an increase in liver cancer cases and deaths in this age group, with a decreasing trend in incidence and mortality rates. The highest incidence and mortality rates were observed in the 45-49-year age group, with a significant increase in disease burden in men and a decrease in women. The annual net decreases in incidence and mortality rates are 1.65% and 2.31%, respectively. In the Chinese adolescent population aged 15-49 years, more than 80% of liver cancer cases are attributable to HBV. Other major risk factors include hepatitis C virus (HCV), alcohol consumption, non-alcoholic steatohepatitis (NASH), smoking, high body mass index (BMI), and high fasting plasma glucose. Conclusion: Our study underscores the potential of HBV vaccination and lifestyle interventions in controlling Chinese adolescents' liver cancer incidence, and provides valuable insights for other countries and regions facing similar stages of development and major health challenges related to liver cancer.

Background Primary liver cancer (PLC) remains a major public health concern, particularly in China where the incidence is high. Existing prediction models often focus on high-risk populations and depend heavily on laboratory data, which limits their utility in general population screening. Methods We developed and validated a 15-year PLC risk prediction model using data from two large prospective cohort studies in Shanghai (n = 132,360), including 618 incident PLC cases. Candidate variables encompassed sociodemographic characteristics, lifestyle behaviors, medical history, and dietary factors. Predictor selection was performed using LASSO regression and the Boruta algorithm. Five machine learning models and logistic regression were compared. Model performance was evaluated using AUC, calibration plots and net reclassification improvement (NRI). SHapley Additive exPlanations (SHAP) were used to interpret model predictions. Web-based tools, including a simplified risk calculator, were developed to facilitate practical application. Results LightGBM achieved the best discrimination (AUC = 0.766) and excellent calibration. Net reclassification analysis indicated an improved ability to correctly classify low-risk individuals. The model effectively stratified the population: the high-risk group had a 15-year PLC risk that was 39.56 times that of the low-risk group. SHAP analysis revealed biologically meaningful associations. A simplified logistic model with fewer variables also performed well (AUC = 0.762), supporting effective risk stratification. Conclusion We developed a questionnaire-based 15-year PLC risk prediction model applicable to the general Chinese population. Both the full and simplified models demonstrated strong performance and interpretability, making them valuable tools for large-scale screening and targeted prevention, especially in resource-limited settings.

Incidence and mortality rates of pancreatic cancer have either remained stable or increased slightly in many countries. The 5-year relative survival rate for pancreatic cancer is the lowest among 25 common cancers. This study focuses on the survival situation, variations, and trends of pancreatic cancer worldwide. This comprehensive overview searched 6 databases (PubMed, Web of Science, EMBASE, Surveillance, Epidemiology, and End Results [SEER], CNKI, and SinoMed) for all articles published before January 1, 2024. Survival estimates from the final included literature were extracted and compared. The 99 included studies showed that changes in pancreatic cancer survival over the past 30 years were less than ideal. We found no significant improvement in 5-year relative survival from pancreatic cancer in most countries over the past three decades. The age-standardized 1-year relative survival rates were mostly distributed between 10% and 20% from 1972 to 2020, and with the highest survival rate being 34.7% in the USA from 2009 to 2014. The age-standardized 5-year relative survival rates were below 10% in most regions in the same period. Younger pancreatic cancer patients also had higher survival rates. Over the past 30 years, the prognosis of patients with pancreatic cancer has not improved significantly worldwide, and more effective ways to prevent and control pancreatic cancer earlier are needed.

Supplementary Data from Menstrual Factors, Reproductive History and Liver Cancer Risk: Findings from a Prospective Cohort Study in Chinese Women

Present knowledge on metabolic perturbation prior to liver cancer is limited, with most studies unable to quantify the absolute concentrations of metabolites and lacking a focus on female-specific findings. We conducted a 1:1 matched nested case-control study (187 pairs of cases and controls) within the Shanghai Women's Health Study. A targeted metabolomics method was used to quantify 186 metabolites in plasma samples collected at recruitment. A multivariable conditional logistic regression model was utilized to estimate the odds ratio (OR) and 95% confidence interval (CI). Restricted cubic spline function was used to characterize the dose-response associations. A pathway analysis was conducted to identify the most relevant pathways. A metabolic score was calculated via a linear combination of metabolites with nonzero coefficients in the LASSO logistic regression model. After adjustment for potential confounders and correction for multiple testing, 27 metabolites were associated with liver cancer risk and a non-linear association was observed for glutamic acid. Primary bile acid biosynthesis and amino acid biosynthesis and metabolism were important pathways involved in the etiology. A metabolic score derived from 10 metabolites showed a positive linear association with liver cancer risk (ORper standard deviation: 8.44, 95% CI: 4.09-17.39). The metabolic score significantly improved the predictive performance of the model based on established risk factors alone, which included age, excess body weight, smoking, alcohol use, and medical history of hepatitis. Our findings reveal female-specific metabolic perturbations prior to liver cancer diagnosis and contribute to a better understanding of the etiology and prevention of liver cancer in women.

BACKGROUND AND AIMS:Although dietary factors have been extensively investigated as potential risk factors for liver cancer, the evidence is inconclusive. Our study systematically assessed the associations between ten dietary guidelines compliance scores and liver cancer risk among elder people, and found out the dietary patterns for liver cancer prevention. METHODS:Participants of 59,844 men and 72,680 women, aged 40-74 years and living in urban Shanghai, were included in two prospective cohort studies conducted between 2002-2006 and 1996-2000, respectively. Dietary intakes were assessed during baseline in-person interviews using validated food-frequency questionnaires, and dietary guideline compliance scores were calculated by adjusting for total energy intake and adapting existing dietary recommendations. Hazards ratios (HRs) with 95% confidence intervals (CIs) were evaluated by both tertile categories and per standard deviation (SD) increment using Cox proportional hazard regression models to assess the associations between ten dietary guideline compliance scores and liver cancer risk. RESULTS:In the two cohorts, 431 male and 256 female incident liver cancer cases were identified during a mean follow-up of 11.90 and 17.44 years, respectively. There were no statistically significant associations between these ten dietary guidelines and male liver cancer risk (P>0.05). In contrast, only the modified reversed Empirical Dietary Inflammation Pattern (rEDIP) tended to be associated with the low risk of female liver cancer (HR T3 vs. T1=0.67, 95% CI: 0.48-0.92, Ptrend=0.016, HR per SD=0.94, 95% CI: 0.85-1.03). The inverse associations appeared stronger between rEDIP and liver cancer risk at younger ages (<55 years) in women (HR per SD=0.91, 95% CI: 0.84-0.99) compared to the older women (≥55 years). There were suggestive but non-significant inverse associations between the modified Diabetes Risk Reduction Diet (mDRRD) (men: HR per SD=0.92, 95% CI: 0.84-1.02; women: HR per SD=0.97, 95% CI: 0.84-1.02) and the modified World Cancer Research Fund/American Institute for Cancer Research (mWCRF/AICR) (men: HR per SD=0.93, 95% CI: 0.84-1.02; women: HR per SD=0.91, 95% CI: 0.80-1.03) and liver cancer incidence. The associations of mDRRD (HR per SD=0.82, 95% CI: 0.75-0.98) and mWCRF/AICR (HR per SD=0.83, 95% CI: 0.74-0.99) on liver cancer risk were significant in men who ever smoked. CONCLUSIONS:Our findings confirm that greater adherence to some healthy dietary patterns (i.e. rEDIP, mDRRD and mWCRF/AICR) is inversely associated with liver cancer risk, especially in certain populations. Future studies are required to confirm these findings and elucidate potential mechanisms.

Background:Gallbladder cancer has historically been characterized with a poor prognosis. This study aims to describe the global patterns and temporal trends in gallbladder cancer survival using data from cancer registries. Methods:We conducted a systematic review by searching six databases-PubMed, Web of Science, EMBASE, SEER, CNKI, and Wanfang-for using of registry-based data published before January 1, 2024. Survival data were carefully extracted and analyzed from the final set of included studies. Results:Among the 55 studies included, more than 320,000 people, suggest that survival improvements for gallbladder cancer have stagnated over the past three decades. No significant improvements in 5-year relative survival rates were observed worldwide. After age standardization, the highest 5-year relative survival rate is 30.6 % (Changzhou, China, 2011-2013 and Korea, 2013-2019), while the lowest is 6.0 % (Austria, 1990). The 5-year relative survival rate for gallbladder cancer was generally higher in Asian populations than in other regions. Survival rates were more favorable in younger individuals, with no differences in survival observed between the sexes. Conclusions:Over the past 30 years, the prognosis of patients with gallbladder cancer has not improved significantly worldwide. There is an urgent need for new treatments for gallbladder cancer as well as simple and effective screening methods to improve the survival rate of gallbladder cancer.

BACKGROUND: The association between dietary protein intake and liver cancer risk has rarely been reported. The aim of this study was to explore whether the intake of dietary protein from various sources is differentially associated with liver cancer risk in the Chinese population. METHODS: This large-scale prospective cohort study collected diet information by validated food frequency questionnaires at baseline in two population-based cohorts in Shanghai, China. Dietary protein intake was calculated using the China Food Composition Table. Cox proportional hazards regression models were utilized to estimate the hazard ratio and 95% confidence interval. RESULTS: A total of 60,915 men and 72,655 women were included in the analysis. By the end of 2020, 594 men and 335 women had been identified as incident cases of liver cancer during median follow-up time of 15.28 years and 20.01 years, respectively. In both men and women, total protein intake and major dietary protein sources showed null associations with the risk of liver cancer in categorical analysis based on quartiles, continuous analysis with increments per standard deviation, and trend analysis. CONCLUSIONS: There was no evidence of a prospective association between total protein intake or any of the major dietary protein sources explored and the risk of liver cancer. Further validation through other large-scale cohort studies is needed in the future.