Hepatocellular carcinoma in the Asia pacific region

Authors


  • 1

    Asia-Pacific Working Party on Prevention of Hepatocellular Carcinoma
    Geoffrey C Farrell [Convenor], Australian National University Medical School, The Canberra Hospital, ACT, Australia
    Henry L-Y Chan [Co-convenor and Secretary], Department of Medicine and Therapeutics, The Chinese University of Hong Kong,
    Hong Kong
    Man-Fung Yuen, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
    Deepak N Amarapurkar, Bombay Hospital and Medical Research Center, Mumbai, India
    Anuchit Chutaputti, Phramongkutklao Hospital, Thailand
    Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
    Jin-Lin Hou, Hepatology Unit, Nanfang Hospital, Guangzhou, China
    Kwang-Hyub Han, Yonsei University College of Medicine, Seoul, Korea
    Jia-Horng Kao, Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
    Seng-Gee Lim, National University Hospital, Singapore
    Rosmawati Mohamed, University Malaya Medical Centre, Kuala Lumpur, Malaysia
    Jose Sollano, University of Santo Tomas, Manila, Philippines
    Yoshiyuki Ueno, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan

Professor Man-Fung Yuen, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong. Email: mfyuen@hkucc.hku.hk

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.

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