| Summary: | 博士 === 高雄醫學院 === 醫學研究所 === 85 === SummaryChapter 1
Hepatitis B Vaccination and Hepatocellular Carcinoma in Taiwan
Objective. In 1984, Taiwan started a large-scale hepatitis B
vaccination program, enabling us to test the hypothesis that
prevention of hepatitis B virus infection eventually decreases
the incidence of hepatocellular carcinoma. Methods. Groups
aged 0-9 years and 10-100 years in every calendar year were
defined as the study group and the reference group,
respectively. We calculated the adjusted mortality rate ratios
for liver carcinoma by age and gender between 1974 and 1993
Results. The adjusted mortality rate ratios of liver carcinoma
in the study group decreased significantly between 1992 and
1993, whereas in the reference group it did not show the same
result. A significantly declining trend of liver carcinoma
mortality rate ratios was observed in the study group after
1984, whereas the same trend was not found in the reference
group.
Conclusions. Our results support the hypothesis that hepatitis B
vaccination can decrease the incidence of hepatocellular
carcinoma.Chapter 2 Differentiation of childhood hepatocellular
carcinoma according to age in Taiwan
Background We undertook to investigate the distribution of
childhood HCC according to age, and the role of HBV in the
etiology of HCC before and after the age of four years.
Methods From the cancer registry of Taiwan for the period
between 1979 and 1992 we collected 377 young patients (under 16
years of age) suffering from liver cancer, coded 155 according
to the International Classification of Diseases. We analyzed the
data for characteristics of childhood HCC. Results There
were 122 histologically proven HCC patients. Their age
distribution is an upward curve before the age of four years.
Beginning at the age of zero year, the curve inclines to a
maximum at the age of one year, then it declines to a trough at
the age of four years, after which it inclines along a nearly
straight line up to the age of 15 years. Up to the age of four
years girls tend to dominate the sexes, after that boy patients
tend to outnumber girls by 2:1. Conclusions Our
epidemiological findings indicate the HCC among children is
differentiated according to age and to some extent sex. HBV is
the major etiologic factor of HCC beyond four years of age,
whereas HBV is not the etiologic factor of HCC under four years
of age. Inherited germline mutant genes or somatic genetic
mutation are possible etiology.Chapter 3 Survival Rate of
Childhood Liver Cancer in Taiwan Objective: Studies of the
survival rate of liver cancer in children are scarce. Our aim
was to study the survival rate of childhood liver cancer.
Methods: We searched for cases of liver cancer in 0 to 16 year
old children in the Taiwan Cancer Registry for the period
between 1988 and 1992 With the help of identification number and
birth date we linked 109 cases with the Death Registry of the
National Health Department of Taiwan for the 1988 to 1994 period
and calculated the five year survival rate using Actuarial Life
Table. Results: Their overall five-year survival rate was 19%.
Of the 49 histopathologically diagnosed patients 28% survived
beyond five years and of the 60 clinically diagnosed cases 11%.
The five-year survival rate of the 28 HCC patients was 17%,
whereas that of the 17 HB patients was 47%. Conclusions: Five-
year survival rate from childhood liver cancer was poor.Chapter
4 Survival Rate of Liver Cancer in Taiwan Objective: Studies
of the survival rate of liver cancer are scarce. Our aim was to
study the survival rate of liver cancer. Methods: We searched
for cases of liver cancer in the Taiwan Cancer Registry in 1987.
With the help of identification number and birth date we linked
2002 cases with the Death Registry of the National Health
Department of Taiwan for the 1987 to 1992 period and calculated
the five year survival rate using Actuarial Life Table.
Results: Their overall five-year survival rate was 15%. Of the
752 histopathologically diagnosed patients 17% survived beyond
five years and of the 1250 clinically diagnosed cases 13%. The
five-year survival rate of the 660 HCC patients was 17%, whereas
that of the 33 CC patients was 9%. Conclusions: Five-year
survival rate of liver cancer was poor.
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