Hepatocellular carcinoma in Taiwan

Area of Science:

• Hepatology
• Viral Oncology
• Public Health

Background:

• Hepatocellular carcinoma (HCC) is a significant health concern in Taiwan, with increasing incidence rates.
• Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the primary drivers of HCC, accounting for over 90% of cases.
• HBV, particularly genotype C and high viral load, plays a dominant role, while HCV's relative importance has grown in recent decades.

Purpose of the Study:

• To analyze the epidemiological trends and etiological factors of HCC in Taiwan.
• To evaluate the impact of public health interventions on HBV and HCV infection rates and subsequent HCC incidence.
• To project future trends in HCC occurrence and identify emerging causes.

Main Methods:

• Analysis of age-adjusted incidence rates and etiological data from Taiwanese populations.
• Review of epidemiological studies, including nested case-control and prospective cohort studies, on HBV and HCV carriers.
• Assessment of the effectiveness of the national hepatitis B vaccination program and hepatitis C treatment initiatives.

Main Results:

• The incidence of HCC has doubled in Taiwan since the 1980s, mainly due to HBV and HCV.
• Hepatitis B e-antigen (HBeAg) positive carriers and high HBV DNA levels (>10(5) copies/mL) significantly increase HCC risk.
• Neonatal hepatitis B vaccination has drastically reduced HBsAg carrier rates and childhood HCC incidence.
• National HCV treatment programs initiated in 2003 are expected to decrease virally-induced HCC by 85% by 2040.

Conclusions:

• Public health interventions, including vaccination and antiviral therapy, are effective in controlling viral-induced HCC in Taiwan.
• A substantial decline in HCC incidence is projected, shifting the primary causes towards non-viral factors like non-alcoholic steatohepatitis.
• Continued efforts are crucial to manage remaining viral infections and address emerging causes of HCC.