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Cho WR, Huang HL, Hsu NT, Huang TJ, Chang TS. Above-Standard Survival of Hepatocellular Carcinoma as the Final Outcome of Comprehensive Hepatology Care Programs in a Remote HCV-Endemic Area. Viruses 2023; 15:v15030786. [PMID: 36992494 PMCID: PMC10056201 DOI: 10.3390/v15030786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Early detection and prompt linkage to care are critical for hepatocellular carcinoma (HCC) care. Chang Gung Memorial Hospital (CGMH) Yunlin branch, a local hospital in a rural area, undertakes health checkup programs in addition to its routine clinical service. Patients with HCC are referred to CGMH Chiayi branch, a tertiary referral hospital, for treatment. This study enrolled 77 consecutive patients with newly diagnosed HCCs between 2017 and 2022, with a mean age of 65.7 ± 11.1 years. The screening group included HCC patients detected through health checkups, and those detected by routine clinical service served as the control group. Compared to the 24 patients in the control group, the 53 patients in the screening group had more cases with early stage cancer (Barcelona Clinic Liver Cancer or BCLC stage 0 + A 86.8% vs. 62.5%, p = 0.028), better liver reserve (albumin-bilirubin or ALBI grade I 77.3% vs. 50%, p = 0.031) and more prolonged survival (p = 0.036). The median survival rates of the 77 patients were >5 years, 3.3 years, and 0.5 years in the BCLC stages 0 + A, B, and C, respectively, which were above the expectations of the BCLC guideline 2022 for stages 0, A, and B. This study provides a model of HCC screening and referral to high-quality care in remote viral-hepatitis-endemic areas.
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Affiliation(s)
- Wei-Ru Cho
- Department of Hepatology and Gastroenterology, Division of Internal Medicine, Chang Gung Memorial Hospital, Yunlin 638502, Taiwan
| | - Hui-Ling Huang
- Department of Nursing, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
- Department of Information Management, National Chung Cheng University, Chiayi 621301, Taiwan
| | - Nien-Tzu Hsu
- Biostatistics Center of Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan
| | - Tung-Jung Huang
- Department of Thoracic Medicine, Division of Internal Medicine, Chang Gung Memorial Hospital, Yunlin 638502, Taiwan
| | - Te-Sheng Chang
- Department of Hepatology and Gastroenterology, Division of Internal Medicine, Chang Gung Memorial Hospital, Yunlin 638502, Taiwan
- Department of Hepatology and Gastroenterology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan
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Huang WC, Lin YC, Chen PJ, Hsu NT, Tu CL, Chang TS, Hung CH, Kee KM, Chao WH, Lu SN. Community-Based Screening for Hepatitis B and C Infectivity Using Two Quantitative Antigens to Identify Endemic Townships. Viruses 2022; 14:v14020304. [PMID: 35215896 PMCID: PMC8879708 DOI: 10.3390/v14020304] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 02/01/2023] Open
Abstract
Screening and linkage to care are essential to achieve viral hepatitis elimination before 2030. The accurate identification of endemic areas is important for controlling diseases with geographic aggregation. Viral activity drives prognosis of chronic hepatitis B and hepatitis C virus infection. This screening was conducted in Chiayi County from 2018–2019. All residents aged 30 years or older were invited to participate in quantitative HBsAg (qHBsAg) and HCV Ag screening. Among the 4010 participants (male:female = 1630:2380), the prevalence of qHBsAg and HCV Ag was 9.9% (396/4010) and 4.1% (163/4010), respectively. High-prevalence townships were identified, three for qHBsAg > 15% and two for HCV Ag > 10%. The age-specific prevalence of qHBsAg was distributed in an inverse U-shape with a peak (16.0%, 68/424) for subjects in their 40 s; for HCV, prevalence increased with age. Concentrations of qHBsAg < 200 IU/mL were found in 54% (214/396) of carriers. The rate of oral antiviral treatment for HCV was 75.5% (114/151), with subjects younger than 75 years tending to undergo treatment (85.6% vs. 57.4%, p < 0.001). QHBsAg and HCV Ag core antigens can reflect the concentration of the viral load, which serves as a feasible screening tool. Using quantitative antigen screening for hepatitis B and C in community-based screening, two hyperendemic townships were identified from an endemic county.
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Affiliation(s)
- Wei-Cheng Huang
- Department of Geriatric, Chang Gung Memorial Hospital Chiayi Branch, Puzi 61363, Taiwan;
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan;
| | - Yu-Chen Lin
- Chiayi County Health Bureau, Taibao 60044, Taiwan; (Y.-C.L.); (W.-H.C.)
| | - Po-Ju Chen
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan;
| | - Nien-Tzu Hsu
- Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan;
| | - Chia-Ling Tu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Chiayi Branch, Puzi 61363, Taiwan; (C.-L.T.); (T.-S.C.)
| | - Te-Sheng Chang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Chiayi Branch, Puzi 61363, Taiwan; (C.-L.T.); (T.-S.C.)
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (C.-H.H.); (K.-M.K.)
| | - Chao-Hung Hung
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (C.-H.H.); (K.-M.K.)
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan
| | - Kwong-Ming Kee
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (C.-H.H.); (K.-M.K.)
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan
| | - Wen-Hua Chao
- Chiayi County Health Bureau, Taibao 60044, Taiwan; (Y.-C.L.); (W.-H.C.)
| | - Sheng-Nan Lu
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (C.-H.H.); (K.-M.K.)
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan
- Taiwan National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei 115204, Taiwan
- Correspondence: ; Tel.: +886-7-731-7123 (ext. 8301); Fax: +866-7-732-2402
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Chang TS, Chang KC, Chen WM, Hsu NT, Lee CY, Lin YC, Huang WC, Chiu WN, Hu JH, Huang TJ, Chen MY, Lu SN. Village-to-village screening for hepatitis B and C using quantitative HBsAg and anti-HCV testing with reflex HCV core antigen tests in the remote communities of a resource-rich setting: a population-based prospective cohort study. BMJ Open 2021; 11:e046115. [PMID: 34233977 PMCID: PMC8264874 DOI: 10.1136/bmjopen-2020-046115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Community-based screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) is essential for hepatitis elimination. This study attempted to increase screening accessibility and efficacy by using alternative tools. DESIGN Population-based prospective cohort study. SETTING Hepatitis elimination program at Yunlin County, Taiwan. PARTICIPANTS All 4552 individuals participated in 60 screening sessions of a community-based HBV and HCV screening project in five rural townships with approximately 95 000 inhabitants in central-western Taiwan. INTERVENTIONS To increase accessibility, 60 outreach screening sessions were conducted in 41 disseminative sites. Quantitative HBV surface antigen (qHBsAg) and anti-HCV testing with reflex HCV core antigen (HCV Ag) tests were employed as alternative screening tools. MAIN OUTCOME MEASURES Calculate village-specific prevalence of HBsAg, anti-HCV and HCV Ag and establish patient allocation strategies according to levels of qHBsAg HCV Ag and alanine aminotransferase (ALT). RESULTS Of 4552 participants, 553, 697 and 290 were positive for HBsAg, anti-HCV and HCV Ag, respectively; 75 of them had both HBsAg and anti-HCV positivity. The average (range) number of participants in each screening session was 98 (31-150). The prevalence rates (range) of HBsAg, anti-HCV and HCV Ag were 12.1% (4.3%-19.4%), 15.3% (2.6%-52.3%) and 6.4% (0%-30.2%), respectively. The HCV Ag positivity rate among anti-HCV-positive participants was 42% (0%-100%). Using cut-off values of >200 IU/mL for qHBsAg, >3 fmol/L for HCV Ag and >40 IU/mL for ALT as criteria for patient referral, we noted an 80.2% reduction in referral burden. Three villages had high anti-HCV prevalences of 52.3%, 53.8% and 63.4% with corresponding viraemic prevalences of 23.2%, 30.1% and 22% and thus constituted newly identified HCV-hyperendemic villages. CONCLUSION Outreach hepatitis screening increases accessibility for residents in rural communities. Screening HBV and HCV through qHBsAg and HCV Ag tests provides information concerning viral activities, which might be conducive to precise patient allocation in remote communities.
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Affiliation(s)
- Te-Sheng Chang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kao-Chi Chang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Wei-Ming Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Nien-Tzu Hsu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Chih-Yi Lee
- Department of Laboratory Medicine, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Yu-Chih Lin
- Department of Family Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Wei-Cheng Huang
- Department of Geriatric, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Wen-Nan Chiu
- Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Jin-Hung Hu
- Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Tung-Jung Huang
- Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Gueishan, Taiwan
| | - Sheng-Nan Lu
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
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Tsai JS, Su PL, Yang SC, Chang CC, Lin CY, Yen YT, Tseng YL, Lai WW, Lin CC, Su WC. EGFR-TKI plus bevacizumab versus EGFR-TKI monotherapy for patients with EGFR mutation-positive advanced non-small cell lung cancer-A propensity score matching analysis. J Formos Med Assoc 2021; 120:1729-1739. [PMID: 33865672 DOI: 10.1016/j.jfma.2021.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/19/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recent study showed that the combination of erlotinib and bevacizumab had better disease control than erlotinib monotherapy in patients with advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). However, there is lack of real-world evidence for this therapeutic regimen. We aimed to compare outcomes between patients with EGFR mutant NSCLC treated with EGFR-tyrosine kinase inhibitors (TKI) and bevacizumab and those treated with EGFR-TKI alone in a real-world setting. METHODS Patients with advanced EGFR-mutant NSCLC who received first-line EGFR-TKI in a tertiary referral center from October 1, 2013 to December 31, 2019 were retrospectively analyzed. We performed 1:2 propensity score-matching: one EGFR-TKI and bevacizumab recipient with two patients who received EGFR-TKI alone. Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan-Meier method. The prognostic factors were analyzed using Cox proportional hazards regression analysis. RESULTS Total 313 patients were enrolled. After propensity score matching, 45 patients who received first-line EGFR-TKI and bevacizumab and 89 patients who received EGFR-TKI alone were analyzed. The combination group showed improved PFS (17.0 vs. 11.0 months; hazard ratio [HR] = 0.48; p = 0.002) compared to the monotherapy group. In subgroup analysis of patients with an L858R mutation, the combination group showed longer PFS (23.1 vs. 10.7 months; HR = 0.40; p = 0.011) and OS (not reached vs. 40.6 months; HR = 0.27; p = 0.040) than the EGFR-TKI monotherapy group. CONCLUSION Our data suggest that the combination of EGFR-TKI and bevacizumab could improve PFS in patients with EGFR-mutant NSCLC. In patients harboring L858R mutation, the combination therapy provides better OS than TKI alone.
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Affiliation(s)
- Jeng-Shiuan Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Lan Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Lin Tseng
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Wu-Chou Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center of Applied Nanomedicine, National Cheng Kung University, Tainan, Taiwan
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