Wednesday, December 28, 2011

Recent Trends of Japanese Hepatocellular Carcinoma due to HCV

Recent Trends of Japanese Hepatocellular Carcinoma due to HCV in Aging Society;

Hiraoka A, Hidaka S, Shimizu Y, Utsunomiya H, Imai Y, Tatsukawa H, Tazuya N, Yamago H, Yorimitsu N, Tanihira T, Hasebe A, Miyamoto Y, Ninomiya T, Kawasaki H, Hirooka M, Abe M, Hiasa Y, Matsuura B, Onji M, Michitaka K; Hepato-Gastroenterology 59 (118), (Dec 2011)


Background/Aims: The mean age of hepatocellular carcinoma (HCC) patients has increased (more then 65 years old). We want to identify the recent trend of the clinical features of HCC patients due to hepatitis C virus (HCV) (HCV-HCC).

Methodology: From 2000 to 2009, 855 naive HCC patients were admitted. HCV-HCC patients were divided into two groups, first period group (2000-04, n=270) and second period group (2005-09, n=343) and the clinical features of HCV-HCC were investigated.

Results: There was no difference in gender, TNM stage and percentages of HCV-HCC between the periods. On the other hand, the ratio of HCV-HCC patients with worse liver function (Child-Pugh B or C), elderly (more then 75 years old) and the population of patients treated with low invasive radiofrequency ablation were increased (30.0% to 42.0%, 17.2% to 35.8% and 25.1% to 36.2%, respectively; p<0.01). The 1y-, 3y- and 5y-survival rate of HCV-HCC did not show differences (82.1%, 60.5% and 44.7% vs. 81.8%, 56.9% and 37.7%, respectively; p=0.219).

Conclusions: The ratio of aged HCV-HCC as well as HCV-HCC patients with worse liver function was increased. The less invasive treatment for HCC in these patients and the quick anti-viral treatment for HCV patients should be considered to avoid occurrence of HCC in Japan.

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A rapidly aging society is occurring not only in Japan, but also in other Asian and Western countries. Although surgical resection is an effective therapy for HCC, its invasiveness and difficulty to be performed repeatedly are serious obstacles, especially for elderly patients and patients with LC. In addition, liver transplantation is an important therapy for HCC. However, the shortage of donors is a major issue and such therapy is not suitable for elderly patients.

RFA, which has a low level of invasiveness, is now used as therapy for HCC worldwide. In addition to developments in US and CEUS methods (14) the increasing number of elderly patients with HCC in Japan is considered to be the reason for the increasing number of RFA procedures performed as initial treatment for HCC. Although there were larger percentages of elderly patients and patients with poor Child-Pugh class results in HCV-HCC in our study, no significant difference in regard to survival rate of HCV-HCC was seen between the periods (Figure 2). It is thought that low invasive RFA contributed to keep the high survival rate in the second period.

HCV is a major basal hepatic disease related to HCC in Japan. Tsukuma et al. reported that age over 60 years increased the odds ratio for occurrence of HCC in chronic liver disease in a series of cases treated in the 1990s (15). Nishiguchi et al. reported that interferon therapy reduced the risk for HCC and improved the survival rate in patients with LC related to HCV (LC-C) (16,17). In that regard, Yoshida et al. reported that interferon therapy for LC-C reduced the occurrence rate of HCC, especially in cases with sustained viral response (SVR) (18) and Arase et al. also reported the efficacy of interferon therapy for preventing HCC in aged patients with HCV (19).

In the past decade, the aging of society accelerated in Japan. Although the frequency of HCV-HCC in total cases did not change statistically from the first to the second period in our study, the frequencies of elderly HCV-HCC patients without LC and those with advanced LC (Child-Pugh B or C) doubled, respectively. Interferon therapy should be used more aggressively in patients with HCV for preventing HCC and the progression of LC. Interferon therapy for extermination of HCV to prevent progression of LC and avoid the occurrence of HCC should be considered in patients with HCV as early as possible. The background of HCC is rapidly changing with the progression of aging society in Japan.

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1. Bruix J, Sherman M: Management of hepatocellular carcinoma. Hepatology 2005;
2. Saito K, Kotate F, Ito N, et al.: Gd-EOB-DTPA enhanc

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