Community-based Screening for Hepatocellular Carcinoma in Elderly Residents in a Hepatitis B and C Endemic Area

Yen-Chieh Huang MD 1,2,†, Chih-Fang Huang MD 1,3,†, Kuo-Chin Chang MD 4,5, Shu-Fen Hung RN 4, Jing-Houng Wang MD 4,5, Chao-Hung Hung MD 4,5, Chien-Hung Chen MD, PhD 4,5, Po-Lin Tseng MD 4,5, Kwong-Ming Kee MD 4,5, Yi-Hao Yen MD 4,5, Pei-Shan Tsai RN, MPH 6, Chin-Chen Tsai MD 6, Sheng-Nan Lu MD, MPH, PhD 4,5,*

Journal of Gastroenterology and Hepatology
Accepted Article (Accepted, unedited articles published online for future issues)
DOI: 10.1111/j.1440-1746.2010.06476.x
Journal compilation © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd

Author Information
1 Departments of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;
2 Departments of Family Medicine, Antai Tian-Sheng Memorial Hospital, Tongkang, Pingtung, Taiwan;
3 Graduate Institute of Natural Healing Science, College of Science and Technology, Nanhua University, Chiayi, Taiwan;
4 Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;
5 School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan; and
6 Health Center of Zihguan Township, Kaohsiung, Taiwan.

*Correspondence: Sheng-Nan Lu MD, MPH, PhD,

*Correspondence: Sheng-Nan Lu M.D., M.P.H, Ph.D., Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao Sung 833, Kaohsiung, Taiwan. Tel: +886-7-731-7123 ext. 8301 Fax: +886-7-732-2402 E-mail: juten@ms17.hinet.netc

†* Yen-Chieh Huang, MD and Chih-Fang Huang, MD contributed equally to this study and manuscript

Publication History
Accepted manuscript online: 17 AUG 2010 12:20PM EST
Received date: 08-Jan 2010 Accepted date: 01-Aug-2010

Keywords:
alpha-fetoprotein (AFP);platelet count;community screening;hepatitis C virus (HCV);hepatocellular carcinoma (HCC)

ABSTRACT

Background and Aim: To elucidate a reasonable model and efficacy of hepatocellular carcinoma (HCC) screening on an elderly population.

METHODS: A two-staged HCC screening was conducted in an HCV-endemic area. Firstly, participants underwent blood tests for hepatitis B surface antigen (HBsAg), anti-Hepatitis C (HCV) antibody, serum fetoprotein (AFP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and platelet count, and subjects who were abnormal for any of the 6 markers were enrolled for 2nd stage ultrasonography. Suspected cases were referred for confirmation. HCC cases were followed for 4 years. All subjects were linked to national mortality and cancer register databases to identify newly developed HCC 30 months after screening.

RESULTS: 461 men and 541 women were screened for HCC, with 15.1% of them 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 (M/F = 8/8, 68.8 ± 8.0 years) cases were detected. All tumor diameters were less than 5cm and 6 of them were less than 2cm. AFP and thrombocytopenia were two independent predictive factors of HCC. Overall survival rates of detected cases were 93.8% and 56.3% in years 1, and 4, respectively. The only good prognostic predictor was “underwent curative treatment”. Besides, another 7 developed HCC and 5 of them 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 resulted in good prognosis of an aged population.

Source