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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Hospital- and community-based screenings for hepatocellular carcinoma in Taiwan
1Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
Insights
Hepatocellular carcinoma (HCC) screening in Taiwan, using hepatitis B virus (HBV) and hepatitis C virus (HCV) markers, improves survival. Early detection and treatment of high-risk individuals are key to reducing HCC
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) is a leading cause of cancer death in Taiwan.
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are primary risk factors.
- Neonatal HBV vaccination since 1984 has reduced childhood HCC incidence.
Purpose of the Study:
- To evaluate the effectiveness of HCC screening protocols in Taiwan.
- To identify optimal strategies for HCC prevention and control.
- To assess the impact of screening on patient survival rates.
Main Methods:
- Two-stage screening: identifying high-risk individuals followed by ultrasound (US).
- Utilizing markers like HBsAg, anti-HCV, and platelet count for risk stratification.
- Community-based screening programs implemented for over two decades.
Main Results:
- Secular survival improvement observed in HCC patients.
- Screening benefits, including prolonged survival, are most significant in early, curable stages.
- Platelet count identified as a useful marker in HCV-endemic areas.
Conclusions:
- A two-stage screening protocol (risk identification + US) is recommended.
- Active surveillance, antiviral therapy, and early detection are crucial for HCC management.
- Continued efforts in prevention and control are necessary to decrease HCC sequelae.
Abstract:
In Taiwan, hepatocellular carcinoma (HCC) has been the leading cause of cancer incidence and mortality in recent decades. The majority of patients have hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. The HBV carrier rate and incidence of HCC in children have declined with the implementation of a hepatitis B vaccination program for newborns since 1984. A combination of α-fetoprotein and ultrasonography (US) has been used for surveillance in patients with chronic HBV and HCV infection in intervals of 3-6 and 6-12 months for cirrhosis and chronic liver disease, respectively. A secular survival improvement in HCC patients has been demonstrated. A reasonable screening protocol should include two stages. The first stage is identification of high-risk subjects and the second stage is US screening of high-risk subjects. Community-based HCC screening programs have been conducted for more than two decades in Taiwan. The commonly used first-stage markers are HBsAg and anti-HCV, while the platelet count should be a useful marker in HCV-endemic communities. The benefit of HCC screening was shown by a prolonged overall survival. However, this was limited to the early curable stage in elderly subjects. Prevention and control of HCC have multiple modalities. Identification of a high-risk group for active surveillance, effective antiviral treatment for chronic HBV and HCV infection, and early detection and prompt treatment of HCC should decrease the sequelae of HCC in Taiwan.
