Significance of prospective follow-up cohort study in diagnosis and treatment of primary hepatic cancer among HBsAg carriers

Objective To investigate the clinical and etiological significance of regular follow up study of cohort of HBsAg carriers in diagnosis and treatment of primary hepatic cancer (PHC). Methods A prospective follow up study lasting 8 years and 3 months was conducted among 744 HBsAg positive persons and 895 HBsAg negative persons in Qidong, Jiangsu Province, a high incidence area of PHC. A serum store was established. Survey of detailed individual history was made. Results (1) The year incidence rate of PHC was significantly higher in the HBsAg group (177.29/100,000) than in the HBsAg group (69.53/100,000, RR =16.93) ( P 0.01). There was no significance difference in the incidence rates of other tumors between these two groups ( P 0.05). (2) The average time between the onset of hepatitis and the diagnosis of PHC was 14.5 years with a median time of 13 years. The average time between the diagnosis of cirrhosis and the diagnosis of PHC was 6.4 years with a median time of 5.5.year. (3) Bad economic condition, longer history of drinking, longer smoking history, history of hepatitis and chronic gastrointestinal diseases, and family of PHC could be found more frequently in the PHC group than in the non PHC group ( P 0.001). There was no difference in other personal habit, personal history, disease history, and family hirsute between these two groups ( P 0.05). (4) The tumor resection rate (16.44%) and one year survival rate (31.51%) were significantly higher among the PHC patients in the prospective cohort than those in the PHC patients diagnosed and treated individually in local hospitals (8 7% and 9 7% respectively, P 0 01). Conclusion HBV is closely correlated with PHC. Males, persons aged between 20 and 60, HBsAg positive persons and /or persons with hepatitis history and family hepatitis history are high risk population for PHC. Regular follow up of these populations by AFP examination combined with B ultrasonography contributes to early diagnosis of PHC and significantly improves the curative effect.