Chang Wy

Hepatitis C virus infection among teenagers in an endemic township in Taiwan: epidemiological and clinical follow-up studies

The aim of the study was to elucidate the epidemiological features of Hepatitis C virus (HCV) infection among teenagers in an endemic area by conducting a mass screening study. We also investigated the clinical outcome of the anti-HCV-positive subjects by conducting subsequent short-term and long-term follow-up studies. All 2837 students of two junior middle schools in Tzukuan, aged 13-16 years, were invited to be screened for anti-HCV, HBsAg, AST and ALT in October 1995. A total of 2726 (96%) students responded. Anti-HCV, HCV RNA and aminotransferase levels were evaluated among anti-HCV-positive students 1 month and 30 months later, respectively. A total of 38 (1.4%; M/F = 22/16) participants were anti-HCV-positive. The anti-HCV-positive students had higher rates of exposures to transfusion, anti-HCV-positive families and surgery. The prevalence (2.8%) of the 7 maritime villages was markedly higher than that (0.7%) of the other 8 villages (P < 0.001). Subsequent follow-up studies demonstrated that there might be 5 cases of acute or recent HCV infection, and 6 cases who had recovered from chronic HCV infection.

The tertiary prevention of hepatocellular carcinoma in chronic hepatitis C patients

Pegylated interferon‐alpha plus ribavirin combination (PegIFN/RBV) therapy possesses positive effect in the secondary prevention of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients. The current study aimed to assess its efficacy in the tertiary prevention and to validate the performance of the MHC class I polypeptide‐related chain A (MICA) level in the prediction of hepatocellular carcinoma (HCC) recurrence.

ABDOMINAL SPLENOSIS MIMICKING HEPATIC TUMOR: A CASE REPORT

Diagnosis of abdominal splenosis is often undiagnosed until treatment for splenic rupture or splenectomy. This report describes a patient with splenosis mimicking hepatic tumor. The patient had a history of splenic trauma with splenectomy and chronic hepatitis C. After routine abdominal ultrasound revealed a liver nodule, further imaging studies, including magnetic resonance imaging, computed tomography and angiography, were performed. After the patient eventually underwent surgery, pathology revealed splenic tissue. Despite its distinguishable clinical features, splenosis is difficult to identify by modern imaging modalities. Therefore, accurate and timely diagnosis of this disease requires constant vigilance.

Alpha‐fetoprotein in patients with hepatocellular carcinoma after transcatheter arterial embolization

To assess the usefulness of α‐fetoprotein (AFP) in monitoring treatment effects of transcatheter arterial embolization (TAE) in hepatocellular carcinoma (HCC) patients, a total of 31 sets of AFP levels after TAE in 21 HCC patients were analysed by linear regression between logarithmic AFP levels and days. Eleven sets of AFP data with poor linear declination were accompanied with poor TAE results except in one patient who had chronic hepatitis with acute exacerbations. Twenty sets of data with good linear declination in the first month after TAE indicated good TAE results. Seven of them showed no evidence of tumour recurrence nor elevated AFP levels within a follow‐up of 6 months. The mean, standard deviation and range of half‐lives of AFP in the non‐recurrent group were 5.0, 1.6 and 2.9–7.2 days, respectively. The others experienced late tumour recurrence that was detected by rebound of AFP levels except one who had another non‐AFP‐secreting HCC. Thus, the results might be used as a reference in monitoring the treatment effects of TAE and the timing selection of repeated TAE.

Impact of tumor size on the prognosis of hepatocellular carcinoma in patients who underwent liver resection

Background: Health burdens of hepatocellular carcinoma (HCC) are emerging quickly in the world, including in Taiwan. Surgical resection has been recognized as the first‐line treatment for early tumors. This study aimed to investigate the prognostic risk factors for mortality and recurrence rate in Taiwan, which has a high prevalence of chronic viral hepatitis. Methods: A total of 397 HCC patients receiving tumor resection were consecutively examined in central Taiwan from 2008 to 2014. A hospital‐based patient cohort was designed to collect serological markers to further assess liver function. We modified the Kaplan–Meier method according to the competing death risks for comparing recurrence and used multivariate Cox proportional hazard regression to adjust for significant risk factors. Results: In addition to advanced fibrosis, tumor size ≥5 cm was significantly associated with higher mortality within the 5‐year period when compared with <5 cm (43.3% vs. 13.2%, p < 0.0001). Patients with tumor size ≥5 cm also easily progressed to early recurrence within two years when accounting for death as a competing risk (20.1% vs. 10.1%, p = 0.01). Higher AFP levels played a major role in further predicting higher mortality in those patients. We determined that there were a 4.5‐fold and 2.2‐fold higher mortalities in patients with size ≥5 cm/AFP ≥20 ng/mL and with size ≥5 cm/AFP< 20 ng/mL, respectively, when compared to patients with small tumors. Conclusion: Tumor size ≥5 cm might be a good predicting factor for death and early recurrence when considering death as a competing risk.

Lower protein expression levels of MHC class I chain-related gene A in hepatocellular carcinoma are at high risk of recurrence after surgical resection

MHC class I chain-related gene A (MICA) variants have been associated with hepatocellular carcinoma (HCC). Their association with MICA expression in cancer cells and cancer recurrence is unknown. SNP rs2596542 of MICA was tested in 193 HCC patients with surgical resection. The corresponding MICA expression in the cancer tissue was measured by immunochemistry microarray. Patients with the SNP rs2596542 A allele had significantly lower MICA expression in tumor tissue than did those with the GG genotype (24.7u2009±u200915.1% vs. 41.5u2009±u200923.4%, Pu2009<u20090.001). Patients who had HCC recurrence had significantly lower MICA expression in tumor tissue (34.2u2009±u200921.8% vs. 24.0u2009±u200919.8%, Pu2009=u20090.03). Cox regression analysis revealed that the factors independently predictive of HCC recurrence included low MICA expression (hazard ratio [HR]/95%confidence intervals [CI]: 2.77/1.07–7.14, Pu2009=u20090.035) and tumor size (HR/CI: 5.22/2.11–12.96, Pu2009<u20090.001). Compared to patients with tumors <5u2009cm and MICA expression >30%, patients with either one and both two risk factors had HCC HRs of 9.76 (C.I. 1.27–75.03, Pu2009=u20090.03) and 27.30 (C.I. 3.46–215.6, Pu2009=u20090.002), respectively. We concluded that low cellular MICA expressions were at a greater risk of HCC recurrence after curative treatment.