目前台灣地區肝癌流行與醫療趨勢

Epidemiology and Treatment Trend on Liver Cancer in Taiwan

台灣是世界上有名的B型肝炎盛行區，因此肝癌患者中，B型肝炎表面抗原陽性者約80～90％，其家屬帶原率與肝癌之發生率亦比一般人高。在台灣已經成為男性惡性腫瘤死因中的第一位，每年將近五千人因之喪命。以慢性肝炎病人為例，B肝表面抗原陽性的人數比起B肝表面抗原陰性者，發生肝癌相對危險性是2倍。B型肝炎表面帶原雖然是陰性，有高達50-70％患者合併C型肝炎病毒感染，在台灣，C型肝炎帶原者約有30萬。故出現一般肝癌患者中，C型肝炎也是肝癌患者很重要因子。此外，能使肝臟受損和肝癌有關之毒性物質，其中最具代表性就是黴菌所產生的黃麴毒素。至於其他因素：包括免疫機轉的缺損、營養不良、感染、長期酗酒、服用過量藥物如類固醇、荷爾蒙、動情素及先天性新陳代謝之缺陷等，亦有人報告和肝癌有關。原發性肝癌的治療包括手術切除、放射治療、化學治療、免疫治療、介入治療和中藥治療等。其中肝癌以手術切除效果最好，因此早期發現有些肝癌初期病人經手術切除後，是可以治好，而且術後活存長期10年至25以上，生活品質和工作能力有如正常人。但很可惜肝癌能動手術切除只5％的少數病人。

Taiwan is an area of high prevalence for HBV. The HBsAg positive patients account for the vast majority (around 80-90%) of liver cancer sufferers. Their family members also have higher HBV carrier rate and cancer liver incidence rate. Among all types of cancer, liver cancer is the biggest killer of men, with around 5,000 dying from the disease every year. Taking the patients with chronic hepatitis for example, the liver cancer incidence of the HBsAg positive patients is two times higher than the HBsAg negative patients’. Around 50-70% of the HBsAg negative patients also have hepatitis C virus infection. There are around 300 thousand hepatitis C carrier sufferers in Taiwan. Hepatitis C is thought to be another important cause of general liver cancers. The therapies of primary liver cancer include surgical excision, radiation treatment, chemical treatment, immune treatment, interventional therapy and TCM treatment. The surgical excision is thought as the best effective method to treat liver cancer. After surgical excision, some early-detected patients with low-grade liver cancer can be cured. They have good quality of life and good ability of working as well as overall survival of 10-25 years. Unfortunately, the percentage of liver cancers patients who are available for surgical excision is only 5%.