title: Excess mortality from hepatocellular carcinoma in an HCV-endemic township of an HBV-endemic country (Taiwan).
abstract: Taiwan is an endemic area of hepatitis B virus (HBV). All previous studies have concluded that HBV is the major cause of hepatocellular carcinoma (HCC) in Taiwan. An HBV- and hepatitis C virus (HCV)-endemic township, Tzukuan, in southern Taiwan has been identified with the prevalence of 24% for HB surface antigen (HBsAg) and 37% for anti-HCV antibodies. To elucidate the aetiology of HCC and impact of HCV in this township, we conducted a case-control study and compared HBV-related liver cancer mortality in Tzukuan and Taiwan as a whole. Based on cancer registration datasets of 2 medical centres from 1991 to 1995, we recruited 18 male and 9 female HCC cases from the study township. Their mean age (+/- standard deviation) was 60.3 (+/- 7.3) years. Randomly sampled from a community-based survey, 4 age- (+/- 2 years) and sex-matched residents were selected as community controls for each HCC case. The HBsAg carrier rate was 40.7% in cases and 25.0% in controls (P = 0.1). Anti-HCV positive rate was 88.9% in cases and 53.7% in controls (P = 0.008). Age-adjusted liver cancer mortality in Tzukuan (36.5 per 10(5)) was significantly higher than that of Taiwan as a whole (20 per 10(5)). Based on the HBsAg-positive rate among HCC patients (40.7% in Tzukuan and 77.4-86.6% in Taiwan), the estimated HBV-related liver cancer mortality was similar in Tzukuan (14.9 per 10(5)) and Taiwan (15.8-17.3 per 10(5)). We concluded that HCV was the major risk factor for excess liver cancer mortality in this HCV-endemic township of the HBV-endemic country.
authors.affiliation: Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital, Taiwan. juten@ms17.hinet.net
authors.forename: S N
authors.initials: SN
authors.lastname: Lu
authors.forename: C M
authors.initials: CM
authors.lastname: Lee
authors.forename: C S
authors.initials: CS
authors.lastname: Changchien
authors.forename: C J
authors.initials: CJ
authors.lastname: Chen
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality*; D016022:Case-Control Studies; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology*; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D013624:Taiwan / Q000453:epidemiology