Article Figures & Data
Figures
- Figure 1.
Right, Tainan county, located in southern Taiwan, comprised 31 townships; left, male mortality rates for HCC were >40/105 in 21 townships.
- Figure 2.
Flowchart of the community-based screening for HCC conducted in Tainan, Taiwan, 2004.
Tables
- Table 1.
High-risk subjects' distribution and response rates to US by risk factors and viral etiology in the community-based screening for HCC in Tainan, Taiwan, 2004
High-risk subjects, n (%) Responder to US, n (%) Total 3,242 (100) 2,983 (92.2) Risk factors Platelet count <150 × 109/L 2,928 (90.3) 2,697 (92.1) AFP >20 ng/mL 87 (2.9) 67 (77.0) Both 227 (7.0) 219 (79.1) Viral etiology HBsAg(+) alone 465 (14.3) 440 (94.6) Anti-HCV(+) alone 1,291 (39.8) 1,151 (89.2) Both 123 (3.8) 106 (86.2) Neither 1,363 (42.1) 1,286 (94.4) - Table 2.
Distributions of responders by risk factors and viral etiology and confirmed HCC cases found in each group
Risk factors Viral etiology HBsAg(+), n (%) Anti-HCV(+), n (%) Both, n (%) Neither, n (%) Total, n (%) Platelet count <150 × 109/L Received US 390 (13.1) 961 (32.2) 87 (2.92) 1,259 (42.2) 2,697 (90.4) Confirmed 3 (0.77) 13 (1.35) 2 (2.29) 3 (0.24) 21 (0.78) AFP >20 ng/mL Received US 18 (0.60) 34 (1.14) 4 (0.13) 11 (0.37) 67 (2.25) Confirmed 6 (33.3) 7 (20.6) 2 (50.0) 2 (18.2) 17 (25.4) Both Received US 32 (1.07) 156 (5.23) 15 (0.50) 16 (0.54) 219 (7.34) Confirmed 5 (15.6) 27 (18.0) 1 (6.67) 1 (6.25) 34 (15.5) Total Received US 440 (14.8) 1,151 (38.6) 106 (3.55) 1,286 (43.1) 2,983 (100.0) Confirmed 14 (3.18) 47 (4.09) 5 (4.72) 6 (0.47) 72 (2.41) Platelet + both Received US 422 1,117 102 1,275 2,916 Confirmed 8 (1.90) 40 (3.58) 3 (2.94) 4 (0.31) 55 (1.89) AFP + both Received US 50 190 19 27 286 Confirmed 11 (22.0) 34 (17.9) 3 (15.8) 3 (11.1) 51 (17.8) - Table 3.
Estimation of HCC detection rates using platelet count, AFP, or both as the tool of risk group identification
Viral etiology (1)* (2) (3) = (2) ÷ (1) (4) (6) = (3) - (5) % Thrombocytopenia in HCC cases Cases included by thrombocytopenia Estimated HCC cases Cases included by AFP Cases included by thrombocytopenia or AFP Estimated undetected cases B 42 8 19 11 14 5 (26.3) C 63 40 63 34 47 16 (25.4) B + C 50 3 6 3 5 1 (16.7) NBNC 30 4 13 3 6 7 (53.8) Total, n (%) 55 (54.5) 101 (100) 51 (50.5) 72 (71.3) 29 (28.7) - Table 4.
Numbers of subjects and cases of primary liver cancer in variant screen status
Status of two-staged HCC screening No. subjects No. cases Total screening cases 56,702 119 (1) Low-risk group by first-stage screening 53,460 17 High-risk group 3,242 102 (2) Nonresponder to US 259 10 Responder to US 2,983 92 (3) Negative US results 2,804 15 Known HCC cases 42 42 Suspected cases 137 77 (4) Refuse referral 13 3 Refer for confirmation 124 74 (5) No definite malignancy by hospital 52 2 Confirmed HCC cases 72 72 - Table 5.
Cases of primary liver cancer found from National Cancer Registration Database by status of second-stage screening, periods and screening markers
Status of second-stage screening n Period* I II III Total cases (2) Nonresponder to US 259 7 (1, 4, 2)† 1 (0, 1, 0) 2 (1, 1, 0) 10 (2, 6, 2) (3) Negative US results 2,804 0 4 (1, 3, 0) 11 (8, 3, 0) 15 (9, 6, 0) (4) Refuse referral 13 2 (0, 1, 1) 0 1 (0, 0, 1) 3 (0, 1, 2) (5) No definite malignancy by hospital 52 1 (1, 0, 0) 0 1 (1, 0, 0) 2 (2, 0, 0) Total 3,128 10 5 15 30 Platelet count <150 × 109/L 2 1 10 13 AFP >20 ng/mL 3 0 1 4 Both 5 4 4 13 ↵* Period I, during the screening (from April to December 2004); period II: within 6 months after the screening (from January to June 2005); and period III: between 7 and 12 months after the screening (from July to December 2005).
↵† Number of cases with platelet count <150 × 109/L, number of cases with platelet count <150 × 109/L and AFP >20 ng/mL, number of cases with AFP >20 ng/mL.
- Table 6.
Validity of first-stage screening, second-stage screening, and the whole two-stage screening based on National Cancer Registration Database
First-stage screening liver cancer Second-stage screening liver cancer Two-stage screening liver cancer (+) (-) Total (+) (-) Total (+) (-) Total Screening (+) 102 3,140 3,242 77 60 137 77 60 137 Screening (-) 17 53,443 53,460 25 3,080 3,105 42 56,523 56,565 Total 119 56,583 56,702 102 3,140 3,242 119 56,583 56,702 Sensitivity 102/119 = 85.7% 77/102 = 75.5% 77/119 = 64.7% Specificity 53,443/56,583 = 94.5% 3,080/3,140 = 98.1% 56,523/56,583 = 99.9% Accuracy 53,545/56,702 = 94.4% 3,157/3,242 = 97.4% 56,600/56,702 = 99.8% PPV 102/3,242 = 3.15% 77/137 = 56.2% 77/137 = 56.2% NPV 53,443/53,460 = 99.97% 3,080/3,105 = 99.2% 56,523/56,565 = 99.9% - Table 7.
Comparison among four two-stage community-based HCC screenings
References* Model 1 (9)* Model 2 (10, 2, 15)* Model 3 (19)* Model 4 First author Wu JC Chen CJ, 1995 Lu SN Current study Year published 1988 Chen TH, 2002 Yang HI, 2002 2006 Sample size of screening 1,894 Male/female: 12,026/1,800 (Low)† 1,694, (High)† 4,616 56,702 Screening makers in first stage AFP HBsAg, anti-HCV, AFP, aspartate aminotransferase, alanine aminotransferase, family history Platelet (A), (P), (B)‡ % High-risk subjects identified from population 1% Male/female: 30.9%/34.6% (Low) 6.1%, (High)17.9% (A) 0.64%, (P) 5.33%, (B) 5.70% Estimated sensitivity for HCC detection Not available >90% 48% (A) 50.5%, (P) 54.5%, (B) 71.3% Second-stage Screening tools US in hospital US in community US, AFP in community US in community PPV of first-stage marker(s) 21% Not available (Low) 0%, (High) 4.27% 17.8%, 1.89%, 2.41% Surveillance program for high-risk group Nil Cirrhosis every 3 mo, others every 6 mo Nil Limited to HBsAg(+), anti-HCV(+), or cirrhosis ↵* (9), Wu JC, Liver 1988; (10), Chen CJ, J Formosan Med Assoc 1995; (2), Chen THH, Int J Cancer 2002; (15), Yang HI, NEJM 2002; (18), Lu SN, Cancer 2006.
↵† (Low) and (High), low and high prevalence areas of hepatitis C and hepatocellular carcinoma.
↵‡ (A), AFP alone; (P), platelet count alone; (Both), combination of both AFP and platelet count.
Volume 17, Issue 7
