Decreased Incidence of Hepatocellular Carcinoma in Hepatitis B Vaccinees: A 20-Year Follow-up Study

Chang, Mei–Hwei; You, San–Lin; Chen, Chien-Jen; Liu, Chun‐Jen; Lee, Chuan–Mo; Lin, Shi‐Ming; Chu, Heng-Cheng; Wu, Tzee–Chung; Yang, Sheng‐Shun; Kuo, Hsu Sung; Chen, Ding‐Shinn

doi:10.1093/jnci/djp288

Cited by 526 publications

(321 citation statements)

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“…This was demonstrated in Taiwan, where a hepatitis B virus (HBV) immunization program started in 1984 was followed by a significant decline in HCC incidence among Taiwanese children 20. A subsequent follow‐up report of the same cohort 12 years later showed that the significant lowering of the HCC incidence rate had extended beyond childhood into adolescence 21. A separate explanation to account for the decline of CHB‐related HCC is the positive impact of HBV treatment.…”

Section: Discussionmentioning

confidence: 99%

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Goh

Chang

et al. 2017

Hepatology Communications

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Hepatocellular carcinoma (HCC) is one of the most common and lethal cancers globally. With advances in therapy for chronic viral hepatitis, changing social circumstances, and increasing practice of HCC surveillance, the epidemiology of HCC is expected to change over time. We explored the temporal trends in HCC in Singapore, a multiethnic Asian country, over the last 3 decades. Patients with HCC were prospectively enrolled and stratified into two cohorts (C1, 1988‐2002; C2, 2003‐2016). Patient and tumor characteristics, management, and survival were compared between the two cohorts, and a survival census was performed on October 31, 2015. There were 1,401 patients, and the mean age at diagnosis of HCC for C1 and C2 was 60.1 and 63.5 years, respectively. Male patient preponderance decreased significantly, with the male to female ratio falling from 5.2:1 to 3.9:1 between C1 and C2. Hepatitis B, although still the predominant risk factor for HCC, showed a significant decline from C1 to C2 (76.5% to 68.2%), while the nonviral etiology increased significantly over the same period (14.4% versus 25.0%, respectively). Significantly more patients in C2 than C1 were diagnosed through surveillance (39.2% versus 11.3%, respectively) and had better physical performance (Eastern Cooperative Oncology Group 0, 62.1% versus 20.4%, respectively). While Child‐Pugh status was comparable, significantly more patients in C2 than C1 had early stage disease (Barcelona Clinic Liver Cancer 0‐A, 39.5% versus 7.4%, respectively), which translated into significantly higher median survival (18.6 months versus 3.8 months, respectively). Conclusion: Over the past 3 decades, hepatitis B‐related HCC has been decreasing while HCC due to nonviral etiology has been increasing significantly. Surveillance to diagnose early stage HCC is important in improving the outcome of HCC. (Hepatology Communications 2017;1:564–571)

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Section: Discussionmentioning

confidence: 99%

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Goh

Chang

et al. 2017

Hepatology Communications

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“…Infant HBV immunization programs have been widely implemented in these 2 countries over the past few decades. Although these programs have led to reductions in HCC incidence among children and adolescents (27)(28)(29), they are likely too new to have affected adult liver cancer incidence trends. It is more probable that the observed reduction in the overall liver cancer incidence rates in China could be related to improved sanitary conditions and reduction in consumption of foods contaminated with aflatoxin B1 in over the past decades (7).…”

Section: Discussionmentioning

confidence: 99%

International Trends in Liver Cancer Incidence Rates

Center

Jemal

2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Several previous studies have documented region or country-specific liver cancer incidence trends around the world. However, no study has systematically examined the international pattern using the most recently updated incidence data from the International Agency for Research on Cancer.Methods: We examined recent trends in liver cancer incidence rates from 1993 to 2002 by joinpoint analysis for 32 cancer registries worldwide, using Cancer Incidence in Five Continents. We also examined the male to female rate ratios for these and four additional registries, based on the 1998-2002 incidence data.Results: Liver cancer incidence rates for both men and women statistically significantly increased from 1993 to 2002 for 8 of 32 cancer registries considered in the analysis. Increases were largely confined to economically developed countries of Western Europe, North America, and Oceania. In contrast, rates decreased in both men and women in 5 registries including 3 in Asia. Despite this, the incidence rates in Asian countries are twice as high as those in Africa and more than four times as high as rates in North America. Male to female rate ratios varied from 0.9 in sub-Saharan African and South American registries to 5.0 in France and Egypt.Conclusions: Liver cancer incidence rates continue to increase in some low-risk parts of the world whereas they are decreasing in some of the highest risk countries in Asia. Etiologic studies are required to further elucidate factors contributing to the divergent liver cancer incidence trends worldwide.Impact: Our description of international liver cancer incidence trends may stimulate further etiologic studies. Cancer Epidemiol Biomarkers Prev; 20(11); 2362-8. Ó2011 AACR.

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“…As of 2015, HCC still ranked second among the leading causes of cancer‐related death in men in Taiwan,10 and researchers have estimated that 80% of HCC cases in Taiwan are related to chronic viral hepatitis 5, 6, 7, 8, 9. In 1984, Taiwan became the first country in the world to establish a universal HBV vaccination program for newborns/infants 11, 12. HBV vaccination has successfully reduced the incidence of HCC in children and adolescents 11, 12.…”

mentioning

confidence: 99%

“…In 1984, Taiwan became the first country in the world to establish a universal HBV vaccination program for newborns/infants 11, 12. HBV vaccination has successfully reduced the incidence of HCC in children and adolescents 11, 12. In addition, antiviral therapy for HBV and hepatitis C virus (HCV) has been practiced in Taiwan since 2003,13, 14, 15 resulting in a decrease in overall HCC incidence over the last decade.…”

mentioning

confidence: 99%

Metabolic risk factors are associated with non‐hepatitis B non‐hepatitis C hepatocellular carcinoma in Taiwan, an endemic area of chronic hepatitis B

Huang

Chang

Hong

et al. 2018

Hepatology Communications

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Metabolic risk factors, such as obesity, fatty liver, high lipidemia, and diabetes mellitus are associated with increased risk for nonviral hepatocellular carcinoma (HCC); however, few nonviral HCC studies have stratified patients according to underlying etiologies. From 2005 to 2011, 3,843 patients with HCC were recruited into the Taiwan Liver Cancer Network. Of these patients, 411 (10.69%) who were negative for hepatitis B virus (HBV), surface antigen, HBV DNA, and anti‐hepatitis C virus (HCV) antibody were classified as non‐HBV non‐HCV (NBNC)‐HCC. Detailed clinical analyses of these patients were compared with age‐ and sex‐matched patients with HBV‐HCC or HCV‐HCC for the associated metabolic risk factors. For this comparison, 420 patients with HBV‐HCC and 420 patients with HCV‐HCC were selected from the 3,843 patients with HCC. Multivariate analyses showed fatty liver (by echography), high triglyceride levels (>160 mg/dL), and diabetes mellitus history to be significantly associated only with NBNC‐HCC and not with the matched patients with HBV‐ or HCV‐HCC. When the patients with HCC were further divided into four groups based on history of alcoholism and cirrhotic status, the group without alcoholism and without cirrhosis exhibited the strongest association with the metabolic risk factors. Based on trend analyses, patients with NBNC‐HCC with or without alcoholism were significantly different from the matched patients with HBV‐ or HCV‐HCC, except for patients with alcoholism and cirrhosis, in having more than two of the above three risk factors. Conclusion: Metabolic risk factors are significantly associated with nonviral HCC, especially for patients without alcoholism in Taiwan. Because the prevalence of viral HCC is decreasing due to the success of universal vaccination and antiviral therapy, strategies for cancer prevention, prediction, and surveillance for HCC will require modification. (Hepatology Communications 2018;2:747‐759)

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Decreased Incidence of Hepatocellular Carcinoma in Hepatitis B Vaccinees: A 20-Year Follow-up Study

Abstract: The prevention of hepatocellular carcinoma by this HBV vaccine extends from childhood to early adulthood. Failure to prevent hepatocellular carcinoma results mostly from unsuccessful control of HBV infection by highly infectious mothers.

Cited by 526 publications

References 18 publications

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

International Trends in Liver Cancer Incidence Rates

Metabolic risk factors are associated with non‐hepatitis B non‐hepatitis C hepatocellular carcinoma in Taiwan, an endemic area of chronic hepatitis B

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