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. 2019 Apr;54(4):367-376.
doi: 10.1007/s00535-018-1532-5. Epub 2018 Nov 29.

A nationwide survey on non-B, non-C hepatocellular carcinoma in Japan: 2011-2015 update

Ryosuke Tateishi  1 , Koji Uchino  2 , Naoto Fujiwara  2 , Tetsuo Takehara  3 , Takeshi Okanoue  4 , Masataka Seike  5 , Hitoshi Yoshiji  6 , Hiroshi Yatsuhashi  7 , Masahito Shimizu  8 , Takuji Torimura  9 , Mitsuhiko Moriyama  10 , Isao Sakaida  11 , Hiroyuki Okada  12 , Tetsuhiro Chiba  13 , Makoto Chuma  14 , Kazuhiko Nakao  15 , Hajime Isomoto  16 , Yutaka Sasaki  17 , Shuichi Kaneko  18 , Tsutomu Masaki  19 , Kazuaki Chayama  20 , Kazuhiko Koike  2
Affiliations

A nationwide survey on non-B, non-C hepatocellular carcinoma in Japan: 2011-2015 update

Ryosuke Tateishi et al. J Gastroenterol. 2019 Apr.

Abstract

Background: We previously reported that the incidence of hepatocellular carcinoma (HCC) with non-viral etiologies increased rapidly between 1991 and 2010 in Japan.

Methods: To update this investigation, we enrolled patients who were initially diagnosed as having non-B, non-C HCC at participating hospitals between 2011 and 2015. In addition to the patient characteristics investigated in the previous report, we also investigated the duration of alcohol consumption. The overall survival rate was analyzed using the Kaplan-Meier method, and the hazard function against the body mass index (BMI) was plotted using cubic splines.

Results: A total of 2087 patients were enrolled. The proportion of patients with non-viral etiologies has continued to increase from 10.0% in 1991 to 32.5% in 2015. Patients were also older (median ages, 70-73 years) and more obese (median BMIs, 23.9-24.2 kg/m2), and the proportions of patients with diabetes mellitus (46.1% to 51.6%), hypertension (42.7% to 58.6%), dyslipidemia (14.6% to 22.9%), and fatty liver (24.0% to 28.8%) had all increased significantly. There was a significant inverse relationship between the duration and the amount of daily alcohol consumption. The improvement in the overall survival was relatively small, with a decreased proportion of patients under surveillance (41.3% to 31.6%). A hazard function plot showed a curve similar to that in our previous report, with a lowest hazard of ~ 26 kg/m2.

Conclusions: The proportion of HCC patients with non-viral etiologies continues to increase in Japan. Lifetime total amount of alcohol consumption may be a risk factor.

Keywords: Alcoholic liver disease; Hepatocellular carcinoma; Non-alcoholic fatty liver disease.

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Figures

Fig. 1
Fig. 1
Trend in background liver diseases among patients with hepatocellular carcinoma in Japan. The current and previous cohorts were combined. A marked increase in the proportion of patients categorized as non-B, non-C was observed at the participating hospitals (P < 0.0001, Cochran–Armitage test)
Fig. 2
Fig. 2
Duration and daily amount of alcohol consumption. Those who consumed a larger amount of alcohol daily tended to require a shorter duration of drinking to develop hepatocellular carcinoma (P < 0.0001, Cochran–Armitage test)
Fig. 3
Fig. 3
Overall survival of 2011–2015 cohort (solid line) and 1991–2010 cohort (dotted line)
Fig. 4
Fig. 4
Estimated hazard function of BMI. The relative hazard was lowest at a BMI of ~ 26 kg/m2 for both the 2011–2015 cohort (solid line) and the 1991–2010 cohort (dotted line)
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