Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.116
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
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.
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.
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.
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.
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.