Mei-Hwei Chang1, San-Lin You2, Chien-Jen Chen3, Chun-Jen Liu4, Ming-Wei Lai5, Tzee-Chung Wu6, Shu-Fen Wu7, Chuan-Mo Lee8, Sheng-Shun Yang9, Heng-Cheng Chu10, Tsang-Eng Wang11, Bor-Wen Chen12, Wan-Long Chuang13, Maw-Soan Soon14, Ching-Yih Lin15, Shu-Ti Chiou16, Hsu-Sung Kuo17, Ding-Shinn Chen18. 1. Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: changmh@ntu.edu.tw. 2. Department of Public Health, College of Medicine, Bigdata Research Center, Fu-Jen Catholic University, New Taipei, Taiwan. 3. Academia Sinica, Taipei, Taiwan. 4. Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan. 5. Division of Hepatogastroenterology, Department of Pediatrics, Chang Gung University and Hospital, Linkou, Taiwan. 6. Department of Pediatrics, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan. 7. Department of Pediatrics, Division of Gastroenterology, China Medical University Hospital, Taichung, Taiwan. 8. Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 9. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Faculty of Medicine, National Yang-Ming University, Taichung, Taiwan. 10. Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan. 11. Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan. 12. Department of Pediatrics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan. 13. Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 14. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Changhua Christian Hospital, Chang-Hua, Taiwan. 15. Division of Gastroenterology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan. 16. Institute of Public Health, National Yang-Ming University, and Ministry of Health and Welfare, Health Promotion Administration, Taipei, Taiwan. 17. Ministry of Health and Welfare, Centers for Disease Control, Taipei, Taiwan. 18. Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Academia Sinica, Taipei, Taiwan.
Abstract
BACKGROUND & AIMS: The incidence of hepatocellular carcinoma (HCC) increases with age, but protective antibody responses decrease with time after infants are immunized against hepatitis B virus (HBV). We investigated whether immunization of infants against HBV prevents their developing HCC as adults. We also searched for strategies to maximize the cancer-preventive effects. METHODS: We collected data from 2 Taiwan HCC registry systems on 1509 patients (6-26 years old) diagnosed with HCC from 1983 through 2011. Data on history of HBV immunization and prenatal maternal levels of HBV antigens of all HCC patients born after July 1984 were retrieved from the HBV immunization data bank of the Taiwan Center for Disease Control. We collected data on birth cohort-specific populations (6-26 years old) of Taiwan using the National Household Registry System. Rates of HCC incidence per 10(5) person-years were derived by dividing the number of patients with HCC by the person-years of the general population. Relative risks (RR) for HCC were estimated by Poisson regression analysis in vaccinated vs unvaccinated birth cohorts. We stratified patients by age group to evaluate the association of birth cohorts and HCC risks. RESULTS: Of the 1509 patients with HCC, 1343 were born before, and 166 were born after, the HBV vaccination program began. HCC incidence per 10(5) person-years was 0.92 in the unvaccinated cohort and 0.23 in the vaccinated birth cohorts. The RRs for HCC in patients 6-9 years old, 10-14 years old, 15-19 years old, and 20-26 years old who were vaccinated vs unvaccinated were 0.26 (95% confidence interval [CI], 0.17-0.40), 0.34 (95% CI, 0.25-0.48), 0.37 (95% CI, 0.25-0.51), and 0.42 (95% CI, 0.32-0.56), respectively. The RR for HCC in 6- to 26-year-olds was lower in the later vs the earlier cohorts (born in 1992-2005 vs 1986-1992; P < .001 and 1986-1992 vs 1984-1986; P < .002). Transmission of HBV from highly infectious mothers and incomplete immunization were associated with development of HCC. CONCLUSIONS: Based on an analysis of 1509 patients with HCC in Taiwan, immunization of infants against HBV reduces their risk of developing HCC as children and young adults. Improving HBV vaccination strategies and overcoming risk factors could reduce the incidence of liver cancer.
BACKGROUND & AIMS: The incidence of hepatocellular carcinoma (HCC) increases with age, but protective antibody responses decrease with time after infants are immunized against hepatitis B virus (HBV). We investigated whether immunization of infants against HBV prevents their developing HCC as adults. We also searched for strategies to maximize the cancer-preventive effects. METHODS: We collected data from 2 Taiwan HCC registry systems on 1509 patients (6-26 years old) diagnosed with HCC from 1983 through 2011. Data on history of HBV immunization and prenatal maternal levels of HBV antigens of all HCCpatients born after July 1984 were retrieved from the HBV immunization data bank of the Taiwan Center for Disease Control. We collected data on birth cohort-specific populations (6-26 years old) of Taiwan using the National Household Registry System. Rates of HCC incidence per 10(5) person-years were derived by dividing the number of patients with HCC by the person-years of the general population. Relative risks (RR) for HCC were estimated by Poisson regression analysis in vaccinated vs unvaccinated birth cohorts. We stratified patients by age group to evaluate the association of birth cohorts and HCC risks. RESULTS: Of the 1509 patients with HCC, 1343 were born before, and 166 were born after, the HBV vaccination program began. HCC incidence per 10(5) person-years was 0.92 in the unvaccinated cohort and 0.23 in the vaccinated birth cohorts. The RRs for HCC in patients 6-9 years old, 10-14 years old, 15-19 years old, and 20-26 years old who were vaccinated vs unvaccinated were 0.26 (95% confidence interval [CI], 0.17-0.40), 0.34 (95% CI, 0.25-0.48), 0.37 (95% CI, 0.25-0.51), and 0.42 (95% CI, 0.32-0.56), respectively. The RR for HCC in 6- to 26-year-olds was lower in the later vs the earlier cohorts (born in 1992-2005 vs 1986-1992; P < .001 and 1986-1992 vs 1984-1986; P < .002). Transmission of HBV from highly infectious mothers and incomplete immunization were associated with development of HCC. CONCLUSIONS: Based on an analysis of 1509 patients with HCC in Taiwan, immunization of infants against HBV reduces their risk of developing HCC as children and young adults. Improving HBV vaccination strategies and overcoming risk factors could reduce the incidence of liver cancer.
Authors: Jinping Liu; Wei Tang; Anuradha Budhu; Marshonna Forgues; Maria O Hernandez; Julián Candia; Yujin Kim; Elise D Bowman; Stefan Ambs; Yongmei Zhao; Bao Tran; Xiaolin Wu; Christopher Koh; Pallavi Surana; T Jake Liang; Maria Guarnera; Dean Mann; Manoj Rajaure; Tim F Greten; Zhanwei Wang; Herbert Yu; Xin Wei Wang Journal: Cell Date: 2020-06-10 Impact factor: 41.582
Authors: Shiv K Sarin; Manoj Kumar; Mohammed Eslam; Jacob George; Mamun Al Mahtab; Sheikh M Fazle Akbar; Jidong Jia; Qiuju Tian; Rakesh Aggarwal; David H Muljono; Masao Omata; Yoshihiko Ooka; Kwang-Hyub Han; Hye Won Lee; Wasim Jafri; Amna S Butt; Chern H Chong; Seng G Lim; Raoh-Fang Pwu; Ding-Shinn Chen Journal: Lancet Gastroenterol Hepatol Date: 2019-12-15
Authors: Saleh A Alqahtani; Faisal M Sanai; Ashwaq Alolayan; Faisal Abaalkhail; Hamad Alsuhaibani; Mazen Hassanain; Waleed Alhazzani; Abdullah Alsuhaibani; Abdullah Algarni; Alejandro Forner; Richard S Finn; Waleed K Al-Hamoudi Journal: Saudi J Gastroenterol Date: 2020-10 Impact factor: 2.485