Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2018; 10(1): 116-123
Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.116
High burden of hepatocellular carcinoma and viral hepatitis in Southern and Central Vietnam: Experience of a large tertiary referral center, 2010 to 2016
Song-Huy Nguyen-Dinh, Albert Do, Trang Ngoc Doan Pham, Doan Y Dao, Trinh Nhu Nguy, Moon S Chen Jr
Song-Huy Nguyen-Dinh, Trinh Nhu Nguy, Liver Tumor Department, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
Albert Do, Section of Digestive Diseases, Department of Internal Medicine, Yale University, New Haven, CT 06510, United States
Albert Do, Trang Ngoc Doan Pham, Doan Y Dao, Vietnam Viral Hepatitis Alliance, Ho Chi Minh City 7000, Vietnam
Trang Ngoc Doan Pham, School of Public Health, University of Illinois, Chicago, IL 60302, United States
Doan Y Dao, Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX 75390, United States
Moon S Chen Jr, Davis Comprehensive Cancer Center, University of California, Sacramento, CA 95817, United States
Author contributions: Do A, Pham TND and Chen Jr MS contributed to data analysis, interpretation and manuscript preparation; Nguyen-Dinh SH and Nguy TN contributed to data acquisition and analysis; Dao DY contributed to editing and reviewing; all authors contributed to final article approval.
Supported by Cho Ray Hospital (to SH and TN); Vietnam Viral Hepatitis Alliance (to Dao DY and Pham TND); National Institutes of Health T32 training, No. T32 DK 007017-40 (to AD); National Institutes of Health T32 training, No. T32 DK 745-18 (to DD); and National Cancer Institute, No. U54CA153499 (to MC).
Institutional review board statement: Institutional board review of this study was obtained and approved for the methods reported in this study.
Informed consent statement: Informed consent was not obtained owing to de-identified information and risk of personal identification is low.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: Technical appendix and dataset available from corresponding author at mschenjr@ucdavis.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Moon S Chen Jr, PhD, UC, Davis Comprehensive Cancer Center, University of California, 2450 48th Street, Suite 1600, Sacramento, CA 95817, United States. mschenjr@ucdavis.edu
Telephone: +1-916-7341191 Fax: +1-916-7035003
Received: November 6, 2017
Peer-review started: November 7, 2017
First decision: December 4, 2017
Revised: December 15, 2017
Accepted: January 15, 2018
Article in press: January 15, 2018
Published online: January 27, 2018
Abstract
AIM

To examine the largest tertiary referral center in southern and central Vietnam from 2010 to 2016, evaluating epidemiological trends of hepatocellular carcinoma (HCC) and viral hepatitis B-C in this resource-limited setting.

METHODS

We extracted data of patients receiving care from Cho Ray Hospital (Ho Chi Minh City), the largest oncology referral center in southern and central Vietnam, from 2010 to 2016. We collected information on patient age, gender, geographic distribution, and disease characteristics including disease stage, tumor biomarker levels [serum alpha-fetoprotein (AFP), AFP-L3 isoform percentage, and prothrombin induced by induced by vitamin K absence-II], and serological testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections.

RESULTS

Data from 24091 HCC patients were extracted, with sample demographics comprising mostly male (81.8%) and older age (however with 8.5% younger than 40 years old). This patient sample included a geographic catchment population of 56 million people (60% of the country’s total population of 92.7 million), derived from 38 provinces and municipalities in Vietnam. Chronic HBV infection was found in 62.3% of cases, and chronic HCV infection in 26.0%. HBV and HCV co-infection was seen in 2.7%. Cirrhosis was found in an estimated 30% to 40% of cases. Nine percent of patients were not found to have chronic viral hepatitis. Twenty three point two percent of the patients had a normal AFP level. A total of 2199 patients were tested with AFP-L3 and PIVKA II over two years, with 57.7% having elevated AFP-L3%, and 88.5% with elevated PIVKA II levels. Over this 7-year period, the incidence of HCC increased, with a large proportion of cases (overall 40.8%) presenting initially an advanced stage, not amendable to surgical or locoregional therapy.

CONCLUSION

HCC contributes significant health care burden in southern and central Vietnam, with increasing case volume over this seven-year period. Viral hepatitis likely explains this high HCC prevalence.

Keywords: Hepatocellular carcinoma, Hepatitis B virus, Hepatitis C virus, Alpha-fetoprotein

Core tip: Hepatocellular carcinoma remains a serious public health issue in Vietnam, and is closely associated with chronic hepatitis B and C virus (HBV and HCV) infections. In one of the largest tertiary referral hospitals in southern and central Vietnam, the clinical volume has been increasing from 2010 to 2016, with most patients having chronic HBV or HCV infections, and most patients initially at an advanced stage, precluding curative treatment. Public health, policy, and institutional efforts are needed to reduce the burden that this disease places on the Vietnamese people in Vietnam.