Surveillance, diagnosis, treatment, and outcome of liver cancer in Japan

Abstract

Background: Hepatocellular carcinoma (HCC) is the fifth most common type of cancer and the third leading cause of cancer-related death worldwide. HCC is most common in Asia, but its prevalence is rapidly increasing in Western countries; consequently, HCC is a global medical issue that urgently needs to be addressed. Japan is the only developed country that has experienced both hepatitis B-related and hepatitis C-related HCC and has a long history of innovation when it comes to new diagnostic and therapeutic modalities, such as computed tomography angiography, anatomical resection, ablation, and transarterial chemoembolization. Among these innovations, a nationwide surveillance program was well established by the 1980s, and such a long-term national program does not exist anywhere else in the world.

Summary: More than 60% of the initially detected HCCs in Japan are Barcelona Clinic Liver Cancer stage 0 or A, which can undergo curative therapies such as resection, ablation, or transplantation. The recent 5-year survival rate of HCC patients in Japan was 43% and the median survival time was 50 months. In addition, both incidence and mortality rates are drastically declining as a result of the successful surveillance program, careful diagnostic flow, and extensive repeated treatments.

Key message: Japan's successful model in the surveillance, diagnosis, and treatment of HCC should be adopted as widely as possible to improve the survival of HCC patients worldwide.

Keywords: Diagnosis; Hepatocellular carcinoma; Prognosis; Surveillance/screening; Treatment algorithm.

Fig. 1

Total deaths from HCC in Japan (1958-2006).

Fig. 2

a Global incidence of hepatocellular carcinoma per 100,000 population for men, clearly showing that the incidence is rapidly decreasing in Japan. b Global incidence of hepatocellular carcinoma per 100,000 population for women, clearly showing that the incidence is rapidly decreasing in Japan.

Fig. 3

Deaths from liver cancer and mortality rate in Japan.

Fig. 4

Changes in liver cancer treatment outcomes: 5-year survival rate. Reproduced with permission from Kudo M [5].

Fig. 5

Changes in liver cancer treatment outcomes: Median survival time. Reproduced with permission from Kudo M [5].