title: Community-based screening for hepatocellular carcinoma in elderly residents in a hepatitis B- and C-endemic area.
abstract: OBJECTIVE
  The aim of the present study was to elucidate a reasonable model and the efficacy of hepatocellular carcinoma (HCC) screening on an elderly population.
  
  
  METHODS
  Two-stage HCC screening was conducted in a hepatitis C virus (HCV)-endemic area. First, participants underwent blood tests for hepatitis B surface antigen (HBsAg), anti-HCV antibody, serum α-fetoprotein (AFP), aspartate aminotransferase, alanine aminotransferase, and platelet count. Patients who were abnormal for any of the six markers were enrolled for second-stage ultrasonography. Suspected cases were referred for confirmation. HCC cases were followed for 4 years. All patients were linked to national mortality and cancer register databases to identify newly-developed HCC, 30 months after screening.
  
  
  RESULTS
  A total of 461 males and 541 females were screened for HCC, with 15.1% testing positive for HBsAg and 44.3% positive for anti-HCV. Among them, 619 (61.8%) met the criteria of ultrasonographic screening; 527 (85.1%) responded, and 16 confirmed HCC (male/female = 8/8, 68.8±8 years) cases were detected. All tumor diameters were less than 5 cm, and six were less than 2 cm. AFP and thrombocytopenia were two independent predictive factors of HCC. The overall survival rates of detected cases were 93.8% and 56.3% was 1 and 4 years, respectively. The only good prognostic predictor was "underwent curative treatment". Another seven non-HCC residents developed HCC after screening, and five of these were with either thrombocytopenia or AFP elevation.
  
  
  CONCLUSIONS
  Under economical consideration, AFP and platelet count should be feasible screening markers of risk identification. Early detection and prompt treatment results in good prognosis in an aged population.
authors.affiliation: Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Yen-Chieh
authors.initials: YC
authors.lastname: Huang
authors.forename: Chih-Fang
authors.initials: CF
authors.lastname: Huang
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Chang
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Hung
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Hung
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Tseng
authors.forename: Kwong-Ming
authors.initials: KM
authors.lastname: Kee
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Yen
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Tsai
authors.forename: Chin-Chen
authors.initials: CC
authors.lastname: Tsai
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
mesh_terms: D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000821:virology; D003153:Community Health Services; D055088:Early Detection of Cancer; D019353:Endemic Diseases; D005260:Female; D006299:Health Services for the Aged; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000821:virology; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; D014408:Biomarkers, Tumor; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase