Sartorius K, Sartorius B, Aldous C, Govender P S, Madiba T E
Faculty of Commerce, University of the Witwatersrand, Johannesburg, South Africa; Public Health Medicine, School of Nursing and Public Health, University of the Kwazulu-Natal, Durban, South Africa; SAMRC/UKZN Gastrointestinal Cancer Research Centre, South Africa.
Public Health Medicine, School of Nursing and Public Health, University of the Kwazulu-Natal, Durban, South Africa; SAMRC/UKZN Gastrointestinal Cancer Research Centre, South Africa.
Cancer Epidemiol. 2015 Jun;39(3):284-90. doi: 10.1016/j.canep.2015.04.006. Epub 2015 Apr 25.
The problems of screening costs, as well as poor data, potentially lead to the underestimation of the incidence of hepatocellular carcinoma (HCC). In particular, this is problematic in developing countries with limited resources and poor data. The study develops a model to inform policy makers of the true incidence and potential extra cost of HCC in a developing country context.
Using Globocan 2012 data, we employed an ecological correlation design at country level to associate HCC incidence data with relevant determinant data like HBV-HCV and other exposure factors. A Poisson regression model was used to estimate potentially missed incident cases of HCC by country and region based on the country risk factor covariate values.
The results indicated that HBV and HCV prevalence were significantly associated with HCC incidence (p<0.001) and potentially accounted for 94%% of incident HCC in 2012. We estimated a total of 120,772 potentially missed incident HCC cases in 2012. These cases are largely predicted for South Asia (>21,000), North Asia (>15,000), Western Africa (14,500) and Eastern Africa (12,500).
Developing countries, with poorer quality data and a high historical burden of hepatitis, were predicted to have the majority of missed HCC cases in 2012 based on our model. These countries are, therefore, less able to detect, budget for or manage HCC. The high cost of HCC treatment, as well as its economic implications, poses a challenge in resource poor settings.
筛查成本问题以及数据质量差，可能导致肝细胞癌（HCC）发病率被低估。特别是在资源有限且数据质量差的发展中国家，这一问题尤为突出。本研究建立了一个模型，旨在让政策制定者了解在发展中国家背景下HCC的真实发病率及潜在额外成本。
利用2012年全球癌症负担数据，我们在国家层面采用生态关联设计，将HCC发病率数据与相关决定因素数据（如乙肝-丙肝及其他暴露因素）相关联。基于国家风险因素协变量值，使用泊松回归模型估计各国及各地区可能漏报的HCC发病病例。
结果表明，乙肝和丙肝患病率与HCC发病率显著相关（p<0.001），并可能占到2012年HCC发病病例的94%。我们估计2012年共有120,772例可能漏报的HCC发病病例。这些病例主要预测集中在南亚（>21,000例）、北亚（>15,000例）、西非（14,500例）和东非（12,500例）。
根据我们的模型预测，在2012年，数据质量较差且肝炎历史负担较重的发展中国家漏报的HCC病例占多数。因此，这些国家在检测、预算或管理HCC方面的能力较弱。HCC治疗的高成本及其经济影响，在资源匮乏地区构成了一项挑战。
