New Strategies for Liver Cancer Prevention–Metabolic Risk Factors Are Associated With Hepatocellular Carcinoma in Taiwan

May 22, 2018

Liver cancer has been the leading cancer death in Taiwan until 2004, when overcome by lung cancer. After that, liver cancer remains the second leading cancer death till now. Currently, there are more than 11,000 new liver cancer patients per year in Taiwan, and there were 8,323 patients died of liver cancers in 2016. Thus, liver cancer has been one of the most important health issue in Taiwan.

Majority of liver cancer is hepatocellular carcinoma (HCC), which is well known to be associated with chronic viral hepatitis B and chronic viral hepatitis C. Almost 85% of HCC in Taiwan are associated with chronic viral hepatitis and cirrhosis. However, for those HCC patients with no chronic viral hepatitis (non-viral HCC), the risk factors are uncertain since the case number is usually small in individual hospital.

From 2005 to 2011, 3,843 patients with HCC were recruited into the Taiwan Liver Cancer Network, which is belonged to NHRI Biobank. Of these patients, 411 (10.69%) who were negative for hepatitis B virus (HBV), surface antigen, HBV DNA, and anti-hepatitis C virus (HCV) antibody were classified as non-viral HCC. Detailed clinical analyses of these patients were compared with age- and sex-matched patients with HBV-HCC or HCV-HCC for the associated metabolic risk factors.

Our study demonstrated that (1) fatty liver (by echography), (2) diabetes mellitus history and (3) high triglyceride levels (>160 mg/dL), are all significantly associated with non-viral-HCC, when compared with the matched patients with HBV- or HCV-HCC. When the HCC patients were further divided into four groups based on history of alcoholism and cirrhotic status, the group without alcoholism and without cirrhosis exhibited the strongest association with the metabolic risk factors. Based on trend analyses.

Since the incidence of viral hepatitis associated HCC is decreasing due to the success of universal vaccination for HBV and the great improvement in the efficacy of antiviral therapy, the viral hepatitis associated HCC is expected to decrease remarkably in the future 10 years. In contrast, the prevalence of metabolic syndrome is continuing to increase in Taiwan in recent years. Since our study has well demonstrated the strong association of metabolic risk factors and HCC, the strategies for cancer prevention, prediction, and surveillance for HCC modification should be modified. For example, we should try to improve the prevention and treatment for fatty liver and metabolic disease, tell these patients that they also have the risk of liver cancer, establish the cancer risk data in these patients and determine whether regular surveillance for HCC is necessary or not. In this way, we will still be able to decrease the HCC incidence in Taiwan after chronic viral hepatitis are eradicated.


Our trend analysis also demonstrated that the more metabolic risk factors that the HCC patients have, the higher proportion of non-viral HCC patients in this group. In the group of non-alcoholic and non-cirrhotic HCC patients, (A) for male patients who have more than 2 risk factors, near 70% were non-viral HCC; (B) For female patients having more than 2 risk factors, up to 90% were non-viral HCC.

For the full text of our publication in Hepatology Communication, please visit:


Media contact:

Shiu-Feng Huang, Investigator and Attending Physician, Biobank, Department of Research Planning and Development, National Health Research Institutes, TEL: +886-37-246166 ext.35316, E-mail:;

Nathalie Huang, Secretariat, National Health Research Institutes, TEL: +886-37-246-166 ext.32113, E-mail:

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