Establish Evidience of Alpha-Fetoprotein in the Screening of Hepatocellular Carcinoma: Community- and Hospital-Based Longitudinal Studies.

In Taiwan, hepatocellular carcinoma(HCC) it is the leading cause of mortality and contributed to estimated 8000 deaths annually. More than 90% cases are associated with chronic hepatitis B virus (HBV) or hepatitis C virus(HCV) infection. Early diagnosis and appropriate treatment could improve success rates of treatment and prolong the survival. Hence, high risk group should receive HCC surveillance regularly to detect HCC in early stage. In Taiwan, most physicians used abdomen ultrasonography (US) examination and serum alpha-fetoprotein (AFP) detection for HCC surveillance. Using US as the screening test, the accuracy rate is dependent on the experience of operator. Regarding AFP, the elevation of AFP in adult life should be differentiated in hepatocarcinogenesis or chronic liver disease. The Asian Pacific Association for the Study of the Liver (APASL) recommended that combined US and AFP in high risk group for the detection of HCC. However, the update guideline (2010 version) from the American Association for Study of Liver Diseases (AASLD) recommended, deleting APF and using US only in HCC surveillance. Which is a conflict in Eastern HCC-prevelant areas, and is disfavored by most physicians in Eastern conutries. In an evidence-based time, only a higher level evidence established to carry more conviction. The aims of this study are to conduct a longitudinally large-scaled follow-up studies in community and hospital to clarify the role of AFP in HCC surveillaing and to elucidate the epidemiologic and clinical meaning of non-liver related AFP elevation in community screening by using the database and elucidate the This study is devided into three parts including community cohort substudy, hospital HCC cohort substudy and hospital followed-up chronic hepatitis cohort substudy. In first part, using the REVEAL study cohort which enrolled approximate 20000 residents from 7 township and followed since 1991 to 2004 to make cross-sectional and longitudinal analyses. In second part, using the established database in our hospital-Kaohsiung Chang Gung memorial hospital which included approximate 10000 diagnosed HCC cases since 1986 to make a elucidation. In last part, using computerized database from the laboratory department in our hospital which screened approximate 100000 person trip of chronic HBV or HCV patients with regular HCC surveillance to make a analysis. The duration of this study is planed to take two years and every substudies would be finished in approximate 8 months. Although this study is not to elucidate new issues, like those papers published by the REVEAL study, would offer complete and high-level evident results using large-scaled and longitudinally followed materials to make a distinct reference from Western clinical guidelines.

Project ID:PC10107-0375
External Project ID:NSC101-2314-B182-018