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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Hepatocellular carcinoma in the Asia pacific region
Man-Fung Yuen1, Jin-Lin Hou, Anuchit Chutaputti
1Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. mfyuen@hkucc.hku.hk
Insights
Hepatocellular carcinoma (HCC) is a major liver cancer globally, especially in the Asia Pacific. Declining hepatitis B and C rates may reduce future HCC incidence, despite rising obesity and diabetes risks.
Area of Science:
- Hepatology
- Oncology
- Epidemiology
Background:
- Hepatocellular carcinoma (HCC) is a leading cause of cancer death in the Asia Pacific, driven by chronic hepatitis B (HBV) and hepatitis C (HCV) infections.
- While incidence is static, older age and male sex are key risk factors, with HBV predominant in most countries except Japan, Singapore, and Australia/New Zealand.
Purpose of the Study:
- To analyze the epidemiological trends and risk factors of hepatocellular carcinoma (HCC) in the Asia Pacific region.
- To project the future impact of vaccination programs and changing risk factors on HCC prevalence.
Main Methods:
- Review of epidemiological data on HCC incidence, mortality, and risk factors in the Asia Pacific.
- Analysis of trends related to HBV and HCV infection prevalence and transmission routes.
- Assessment of the influence of demographic factors, vaccination programs, and emerging risk factors like obesity and diabetes.
Main Results:
- HCC incidence has remained static, with significant risk associated with older age and male gender.
- Chronic HBV infection is the primary cause (75-80%) in most Asia Pacific nations, with HCV being more prevalent in specific countries.
- Slight survival improvements are attributed to earlier diagnosis rather than treatment efficacy, as most patients present with advanced disease.
Conclusions:
- Universal HBV vaccination and reduced HCV transmission are expected to decrease HCC burden in the future.
- However, rising rates of obesity and diabetes, alongside ongoing HCV transmission via injection drug use, may counteract these declines.
- Early diagnosis and effective management remain critical for improving HCC patient outcomes in the interim.
Abstract:
Primary liver cancer, particularly hepatocellular carcinoma (HCC) remains a significant disease worldwide. It is among the top three causes of cancer death in the Asia Pacific region because of the high prevalence of its main etiological agents, chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. In this region, the incidence of HCC has been static over recent decades. Older age is a major risk factor; the incidence increasing sharply after age 40 years. There is a male predilection, with male to female ratio of 3:1, except in elderly Japanese with equal sex incidence or female predominance. In most Asia-Pacific countries, chronic HBV infection accounts for 75-80% of cases; Japan, Singapore and Australia/New Zealand are exceptions because of higher prevalence of HCV infection. In spite of advances in surgery, liver transplantation and newer pharmaco/biological therapies, the survival rate has improved only slightly over recent decades, and this could be attributable to earlier diagnosis ('lead-time bias'). The majority of patients present with advanced diseases, hence reducing the chance of curative treatment. The importance of HCC may decrease in two to three decades when the prevalence of chronic HBV infection decreases as a result of the universal HBV vaccination programs implemented in late 1980s in most Asia-Pacific countries, and because of reduced incidence of medical transmission of HCV. However, transmission of HCV by injection drug use, and rising prevalence of obesity and diabetes, both independent risk factors for HCC, may partly offset this decline.
