Incidence and associated risk factors of hepatocellular carcinoma in a dural hepatitis B and C virus endemic area: A surveillance study

The purposes of this study were to determine the incidence of hepatocellular carcinoma (HCC) in dual hepatitis B virus (HBV) and hepatitis C virus (HCV) endemic areas and to assess the associated risk factors of HCC development in the community. During April 2004 to November 2005, 4,127 residents of Tainan County, aged 40 years or older, had participated in a comprehensive health examination. Among them, residents with HBV or HCV infection; platelet count less than or equal to 150 × 109/L; and no hepatic tumor, by liver ultrasonography, were invited to this study. Alpha-fetoprotein (AFP) screening and ultrasonography for HCC surveillance were performed. Once hepatic tumor was detected, the subjects were referred to medical centers for further confirmation and treatment. A total of 1,133 residents were eligible for this study, and 413 (36.5%), including 197 men and 216 women, with a mean age of 64.5 years, were enrolled. There were 21 cases with suspected HCC. Of the 21 cases, 18 (85.7%) accepted further studies and 11 (52.4%) were confirmed to be affected with HCC. All HCCs were unifocal with a diameter less than or equal to 4 cm. In the Kaplan–Meier survival analysis, the 2-year cumulative incidence of HCC was 4.7%. Based on the same analysis with log rank test, AFP greater than or equal to 20 ng/mL (p = 0.007), platelet count less than or equal to 100 × 109/L (p < 0.001), and liver cirrhosis (p < 0.001) were found to be the associated risk factors of HCC development. In summary, the 2-year cumulative incidence of HCC was 4.7% among adult residents with chronic HBV or HCV infection in this dual HBV and HCV endemic area. Platelet count less than 100 × 109/L, AFP level greater than 20 ng/mL, and liver cirrhosis were the associated risk factors for HCC development.

摘要本研究的目的是在B、C型肝炎高盛行社區，追蹤往年肝癌篩檢第一階段所篩出的高危險群，來了解他們的肝癌發生率及探討肝癌發生的相關因子。本研究選擇台南縣肝癌較為盛行的六個鄉鎮市(六甲鄉、下營鄉、柳營鄉、將軍鄉、後壁鄉、新營市)為研究地區。研究對象為民國93或94年有接受行動醫院檢查且為高危險群(同時符合B型肝炎表面抗原陽性或C型肝炎抗體陽性、血小板低於150x109/L、接受過超音波檢查者、無已知肝癌或其他器官之惡性腫瘤者)的個案，接受追蹤上腹部超音波及甲型胎兒蛋白檢查。符合研究案例共1133例，而其中413例(36.5％)同意接受肝癌篩檢。腹部超音波篩檢出21例(5.1％)疑似肝癌的個案，經轉診有11例(2.7％)確診為肝癌，Kaplan-Meier存活曲線分析，兩年肝癌發生率為4.7％。分析確診11例肝癌個案，超音波檢查顯示皆為單一腫瘤型態，大小為1-4 cm(平均為2.4±0.7 cm)，依據BCLC分期，所篩檢出的肝癌個案皆為早期階段肝癌，屬於可接受治癒性療法之個案。分析肝癌發生的相關因子，肝硬化、低血小板(≤100x109/L)及甲型胎兒蛋白值(≥20ng/mL)異常為發生肝癌的相關因子。分析151例腹部超音波檢查肝硬化個案中，只有低血小板(≤100x109/L)為發生肝癌的相關因子。結論，在B、C型肝炎高盛行社區肝癌高危險群，肝癌兩年發生率約為4.7％。肝癌發生的相關因子的分析，肝硬化、低血小板(≤100x109/L)及甲型胎兒蛋白值(≥20ng/mL)異常為發生肝癌的相關因子。