Secular trends and geographic variations of hepatitis B virus and hepatitis C virus‐associated hepatocellular carcinoma in Taiwan

Abstract

Etiological variations in hepatocellular carcinoma (HCC) exist across different geographic areas. To gain better control of HCC, we retrospectively studied the secular trends and geographic variations in hepatitis B virus (HBV)-related and hepatitis C virus (HCV)-related HCCs in Taiwan. A total of 18,423 HCC cases enrolled in 8 medical centers from 1981 to 2001 were reviewed. Overall, 67% of male HCC in Taiwan was related to HBV infection whereas 55.2% of female HCC in Taiwan was related to HCV infection. The mean age of patients with HBV-related HCC was 53.2 6 13.6 years, while the mean age of patients with HCV-related HCC was 65.1 6 9.1 years (p < 0.001). The male/female ratio was 6.4 for HBV-related HCC, while it was 1.7 for the HCV-related HCC (p < 0.001). The percentage of HBV-related HCC progressively decreased from 81.5 to 66.2% in males, and from 66.7 to 41.4% in females over the study period. Our study demonstrates that the percentage of HBV-related HCC has progressively decreased over the last 20 years. The relative decrease in HBV-related HCC was not due to a decrease in HBV-related HCC death. Instead, it was caused by an increase in HCV-related HCC. Prevention of new HCV infection and the treatment of chronic hepatitis C should be the primary goals, which will result in better control of HCC in the future, even in an HBV-endemic area like Taiwan. ' 2006 Wiley-Liss, Inc.Key words: hepatocellular carcinoma; hepatitis B virus; hepatitis C virus; secular trend; geographic variation; Taiwan Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world, especially in sub-Saharan Africa and Southeast Asia. Since 1984, it has been the leading cause of cancer death in Taiwan, 1 accounting for approximately 7,000 death annually. In addition, around 8,000 new HCC cases are diagnosed each year. 2 High-risk groups for HCC include patients chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV), liver cirrhosis patients, and people with a family history of HCC. Chronic HBV and HCV infections are the 2 major etiologies of HCC in Taiwan. 3 About 15-20% of the general population in Taiwan are chronic carriers of hepatitis B surface antigen (HBsAg). 4 HBV carriers have a 20-to 98-fold increased risk of HCC, 5,6 especially among the hepatitis B e antigen (HBeAg)-positive group. 7 A recent prospective study has further confirmed that positivity for HBeAg is associated with an increased risk of HCC. 8 To combat HBV infection in Taiwan, a mass immunization program has been launched on July 1, 1984, aiming first at the prevention of perinatal mother-to-infant, chronic HBV infection. 9 This nationwide vaccination program has markedly decreased the HBV carrier rate 10 and childhood HBVrelated HCCs (B-HCCs). 11 An 80-85% decrease in HCC among Taiwanese adults up to 3-4 decades later is anticipated. 12 The prevalence of anti-HCV antibody (anti-HCV) is 2-4% among the general population of Taiwan, 13 while it ranges from 0.95 to 2.2% in Taiwanese blood donors. 13,14 The anti-HCV prevalen...

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…Maleto-female ratios are around 3 in high-risk countries [43], and they tend to be higher in patients with HBV than in those with HCV [44][45][46].…”

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

“…In Western countries, nonviral etiology (such as alcoholism or NAFLD) is the main cause of liver cirrhosis and the HCC incidence is low 1, 2, 3, 4. In Taiwan, hepatitis B virus (HBV) infection is a major risk factor for HCC 5, 6, 7, 8, 9. 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 Taiwan, hepatitis B virus (HBV) infection is a major risk factor for HCC 5, 6, 7, 8, 9. 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.…”

“…The HBsAg‐negative but HBV DNA‐positive patients were considered to have occult HBV infection. Thus, the patients with NBNC‐HCC noted in the published reports might have included a significant number of occult HBV cases, especially in endemic areas of HBV, such as Taiwan 7, 8…”

Worldwide variation in the relative importance of hepatitis B and hepatitis C viruses in hepatocellular carcinoma: a systematic review

“…According to the World Health Organisation (WHO), approximately 350 million people are chronically infected with HBV (WHO, 2004) and 170 million with HCV (WHO and the Viral Hepatitis Prevention Board, 1999) worldwide. There are no comparable statistics for the number of individuals coinfected with both HBV and HCV.The relative importance of HBV and HCV infections in HCC aetiology is known to vary greatly from one part of the world to another (Parkin, 2006), and can change over time (Lu et al, 2006). In order to investigate this issue, we collated all published data on the prevalence of chronic HBV and HCV infection among HCC cases.…”