Incidence and associated risk factors of hepatocellular carcinoma in a dural hepatitis B and C virus endemic area: A surveillance study

The purposes of this study were to determine the incidence of hepatocellular carcinoma (HCC) in dual hepatitis B virus (HBV) and hepatitis C virus (HCV) endemic areas and to assess the associated risk factors of HCC development in the community. During April 2004 to November 2005, 4,127 residents of Tainan County, aged 40 years or older, had participated in a comprehensive health examination. Among them, residents with HBV or HCV infection; platelet count less than or equal to 150×10(9)/L; and no hepatic tumor, by liver ultrasonography, were invited to this study. Alpha-fetoprotein (AFP) screening and ultrasonography for HCC surveillance were performed. Once hepatic tumor was detected, the subjects were referred to medical centers for further confirmation and treatment. A total of 1,133 residents were eligible for this study, and 413 (36.5%), including 197 men and 216 women, with a mean age of 64.5 years, were enrolled. There were 21 cases with suspected HCC. Of the 21 cases, 18 (85.7%) accepted further studies and 11 (52.4%) were confirmed to be affected with HCC. All HCCs were unifocal with a diameter less than or equal to 4 cm. In the Kaplan-Meier survival analysis, the 2-year cumulative incidence of HCC was 4.7%. Based on the same analysis with log rank test, AFP greater than or equal to 20 ng/mL (p=0.007), platelet count less than or equal to 100×10(9)/L (p<0.001), and liver cirrhosis (p<0.001) were found to be the associated risk factors of HCC development. In summary, the 2-year cumulative incidence of HCC was 4.7% among adult residents with chronic HBV or HCV infection in this dual HBV and HCV endemic area. Platelet count less than 100×10(9)/L, AFP level greater than 20 ng/mL, and liver cirrhosis were the associated risk factors for HCC development.