- Volume 17 Issue 6
High Prevalence of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B Infection in Thailand
- Wanich, Nattawat (Department of Medicine, Thammasat University Hospital) ;
- Vilaichone, Ratha-Korn (Department of Medicine, Thammasat University Hospital) ;
- Chotivitayatarakorn, Peranart (Department of Medicine, Thammasat University Hospital) ;
- Siramolpiwat, Sith (Department of Medicine, Thammasat University Hospital)
- Published : 2016.06.01
Background: Chronic hepatitis B (CHB) infection is one of the important causes of hepatocellular carcinoma (HCC) in Thailand, involved in the pathogenesis and leading to a development of HCC with or without cirrhotic changes of the liver. This study was aimed to investigate the predictive factors for HCC among CHB patients in a tertiary care center in Thailand. Materials and Methods: We conducted a retrospective study of CHB patients with or without HCC during the period of January 2009 and December 2014 at Thammasat University Hospital, Pathumthani, Thailand. Data on clinical characteristics, biochemical tests and radiologic findings were collected from review of medical records. Results: A total of 266 patients were diagnosed with CHB in Thammasat university hospital during the study period. However, clinical information of only 164/266 CHB patients (98 males, 66 females with mean age of 49.4 years) could be completely retrieved in this study. The prevalence of HCC in CHB infection in this study was 38/164 (23.2%). CHB patients with HCC had a mean age older than those without HCC (59.5 vs 47 years, P-value = 0.01). Furthermore, history of upper GI bleeding, tattooing, blood transfusion, and chronic alcoholism were significantly more common in CHB patients with HCC than patients without HCC (13.2% vs 3.2% P-value 0.03, OR = 4.6, 95%CI = 1.2-18.1, 20% vs 3.9%, P-value = 0.01, OR= 6.1, 95% CI= 1.6-23.6, 20% vs 6.3%, P-value = 0.03, OR = 3.8, 95%CI =1.1-12.7, 62.2% vs 30.3%, P-value <0.0001, OR = 3.7, 95%CI= 1.7-8.1 respectively). Interestingly, more CHB patients with HCC had evidence of cirrhosis than those without HCC (78.9% vs 20.4%, P-value <0.0001, OR = 14.6, 95%CI = 5.8-36.7). In CHB patients with HCC, surgical therapy provided longer survival than radiofrequency ablation (RFA) (72 vs 46.5 months, P-value= 0.04). The mean survival time after HCC diagnosis was 17.2 months. Conclusions: HCC remains a major problem among patients with CHB infection in Thailand. Possible risk factors are male gender, history of upper GI bleeding, chronic alcoholism, tattooing, blood transfusion and evidence of cirrhosis. For early stage HCC patients, surgical treatment provided longer survival time than RFA. Most HCC patients presented with advanced disease and had a grave prognosis. Appropriate screening of CHB patients at risk for HCC might be an appropriate approach for early detection and improvement of long-term outcomes.
Chronic hepatitis B infection;hepatocellular carcinoma development;risk factors;Thailand
- Bosch FX, Ribes J, Borras J, et al (1999). Epidemiology of primary liver cancer. Semin Liver Dis, 19, 271-85. https://doi.org/10.1055/s-2007-1007117
- Chunlertrith K, Sukeepaisarnjaroen W, Mairiang P, et al (2000). Clinico-epidemiology of hepatitis C viral infection in northeastern Thailand.Southeast. Southeast Asian J Trop Med Public Health, 31, 273-6.
- Liang T, Chen EQ, Tang H. (2013). Hepatitis B virus gene mutations and hepatocarcinogenesis. Asia Pac J Cancer Prev, 14, 4509-13 https://doi.org/10.7314/APJCP.2013.14.8.4509
- Mendy ME, Welzel T, Lesi OA, et al (2010). Hepatitis B viral load and risk for liver cirrhosis and hepatocellular carcinoma in The Gambia, West Africa. J Viral Hepat, 17, 115-22. https://doi.org/10.1111/j.1365-2893.2009.01168.x
- Michielsen P, Ho E (2011). Viral hepatitis B and hepatocellular carcinoma. Acta Gastroenteral Belq, 74, 4-8.
- Parkin DM, Bray F, Ferlay J, et al (2005). Global cancer statistics, 2002. CA cancer J Clin, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
- Pollack HJ, Kwon SC, Wang SH, et al (2014). Chronic hepatitis B and liver cancer risks among Asian immigrants in New York City: Results from a large Community-Based screening evaluation and treatment program. Cancer Epidemiol Biomarkers Prev, 23, 2229-39. https://doi.org/10.1158/1055-9965.EPI-14-0491
- Pourhoseingholi MA, Fazeli Z, Zali MR, et al (2010). Burden of hepatocellular carcinoma in Iran; Bayesian projection and trend analysis. Asia Pac J Cancer Prev, 11, 859-62.
- Somboon K, Siramolpiwat S, Vilaichone RK (2014). Epidemiology and survival of hepatocellular carcinoma in the Central Region of Thailand. Asian Pac J Cancer Prev, 15, 3567-70. https://doi.org/10.7314/APJCP.2014.15.8.3567
- Taylor BC, Yuan JM, Shamliyan TA, et al (2009). Clinical outcomes in adults with chronic hepatitis B in association with patient and viral characteristics: A systematic review of evidence. Hepatol, 49, S85-95. https://doi.org/10.1002/hep.22929
- Wiangnon S, Kamsa-ard S, Suwanrungruang K, et al (2012). Trend in incidence of hepatocellular carcinoma, 1990-2009, KhonKaen, Thailand. Asian Pac J Cancer Prev, 13, 1065-8. https://doi.org/10.7314/APJCP.2012.13.3.1065