Differences in hepatitis viral etiology of hepatocellular carcinoma in Taiwan and China

We read with great interest the recent article by de Martel et al. comparing the relative contribution of hepatitis B virus (HBV) and hepatitis C virus in hepatocellular carcinoma (HCC) worldwide. The authors elucidated the distribution of hepatitis B and hepatitis C in causing HCC in various countries with different Human Development Index (HDI) values, ranging from high HDI to very low HDI. They found that the hepatitis viral etiology was more predominant in countries with medium, low, and very low HDI. They did a great job, and HEPATOLOGY published this important work. Unfortunately, in the table and figures, the name of our country, “Taiwan,” is listed incorrectly. The authors use “China, Taiwan” instead of “Taiwan,” which is the appropriate term. Taiwan differs from China in many social and anthropological aspects. To narrow the issue down to viral etiology of HCC, the data in de Martel et al.’s article were self-explanatory. In their Fig. 3, the role of HBV in causing HCC was around 70% in China, whereas it was around 50% in Taiwan. For hepatitis C virus, the role was only around 5% in China, in contrast to 27% in Taiwan. These differences were clearly depicted in their Fig. 5. In addition, genotypes of HBV are different between China and Taiwan. Whereas the predominant HBV in China is genotype C, it is genotype B in Taiwan. Moreover, the situations regarding hepatitis B immunization also differ between the two countries. Taiwan was the first country in the world to implement universal vaccination of newborns against HBV infection, and the program was launched in 1984, whereas China started it in 1992. Furthermore, the genotype distribution of hepatitis D virus also differs. In Taiwan, besides the globally common genotype 1, genotypes 2 and 4 are also found, whereas these two genotypes of hepatitis D virus have not been reported in China. Because Taiwan is not a part of China, we urge the authors to report results for China and Taiwan separately; and in the future, when the name of our country is used, please just use “Taiwan” and do not add any other country’s name before or after it. Ding-Shinn Chen, M.D. Yun-Fan Liaw, M.D. Chien-Jen Chen, M.P.H., Sc.D. Jaw-Ching Wu, M.D., Ph.D. Wan-Long Chuang, M.D., Ph.D. Cheng-Yuan Peng, M.D., Ph.D. Rong-Nan Chien, M.D. Hepatitis Research Center National Taiwan University Hospital Taipei, Taiwan Liver Research Unit Chang Gung Memorial Hospital Taoyuan, Taiwan Genomics Research Center Academia Sinica Graduate Institute of Epidemiology and Preventative Medicine National Taiwan University Taipei, Taiwan Division of Gastroenterology Institute of Clinical Medicine Veterans General Hospital-Taipei National Yang-Ming University Taipei, Taiwan Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung, Taiwan Division of Hepatogastroenterology Department of Internal Medicine China Medical University Hospital Taichung, Taiwan Liver Research Unit Chang Gung Memorial Hospital and University Keelung, Taiwan