Report of the 20th Nationwide follow-up survey of primary liver cancer in Japan

Abstract

In the 20th Nationwide Follow-up Survey of Primary Liver Cancer in Japan, data from 21 075 new patients and 40 769 previously followed patients were compiled from 544 institutions over a 2-year period from 1 January 2008 to 31 December 2009. Compared with the previous 19th survey, the population of patients with hepatocellular carcinoma (HCC) was older at the time of clinical diagnosis, included more female patients, included more patients with non-B non-C HCC, had smaller tumor diameters and more frequently received radiofrequency ablation as local ablation therapy. Cumulative survival rates were calculated for HCC, intrahepatic cholangiocarcinoma, and combined hepatocellular cholangiocarcinoma (combined HCC and intrahepatic cholangiocarcinoma) by treatment type and by background characteristics for patients newly registered between 1998 and 2009 whose final outcome was survival or death. Cumulative survival rates for HCC were calculated by dividing patients by combinations of background factors (number of tumors, tumor diameter, and Child-Pugh grade) and by treatment types (hepatectomy, local ablation therapy, and transcatheter arterial chemoembolization). Cumulative survival rates and median overall survival in patients treated by resection, transcatheter arterial chemoembolization, and local ablation therapy were calculated. The same values were also calculated by the registration date by dividing patients newly registered between 1978 and 2009 into four time period groups . The results of the analysis show that the prognosis of HCC is improving dramatically. It is expected that the data obtained from this nationwide follow-up survey will contribute to advancing clinical research, including the design of clinical trials, as well as the treatment strategy of primary liver cancer in the clinical practice setting.

Keywords: Liver Cancer Study Group of Japan; combined hepatocellular cholangiocarcinoma; cumulative survival rate; hepatocellular carcinoma; intrahepatic cholangiocarcinoma; nationwide follow-up survey.

Figure 1

Overall survival among all 100 394 registered patients with hepatocellular carcinoma during 1998–2009. The median overall survival was 53.95 months, and 5‐ and 10‐year survival rates were 46.6% and 24.7%.

Figure 2

Overall survival by Child–Pugh grade in patients with hepatocellular carcinoma treated with resection (n = 30 040). The median overall survival for patients with a Child–Pugh grade A who underwent resection was 96.89 months, and 5‐ and 10‐year survival rates were 65.8% and 44.0%.

Figure 3

Overall survival in patients with hepatocellular carcinoma treated with resection according to the TNM stage by the Liver Cancer Study Group of Japan.

Figure 4

Overall survival according to portal vein invasion in patients with hepatocellular carcinoma treated with resection.

Figure 5

Overall survival by serum α‐fetoprotein level in patients with hepatocellular carcinoma treated with resection.

Figure 6

Overall survival by Child–Pugh grade in patients with hepatocellular carcinoma treated with local ablation therapy. The median overall survival for patients with a Child–Pugh grade A who underwent local ablation therapy was 81.41 months, and 5‐ and 10‐year survival rates were 63.8% and 23.2%.

Figure 7

Overall survival by Child–Pugh grade in patients with hepatocellular carcinoma treated with transcatheter arterial chemoembolization. Cumulative survival rate by Child–Pugh score among patients with hepatocellular carcinoma treated with transcatheter arterial chemoembolization. The median overall survival for patients with a Child–Pugh grade A who underwent transcatheter arterial chemoembolization was 46.06 months, and 5‐ and 10‐year survival rates were 40.0% and 11.3%.

Figure 8

Overall survival by number of tumors in patients with hepatocellular carcinoma treated with transcatheter arterial chemoembolization.

Figure 9

Improvement of overall survival among all patients with hepatocellular carcinoma according to the registration period. A comparison of cumulative overall survival among patients newly registered between 1978 and 2009 (n = 157 758) divided into four groups by registration date. The median overall survival and cumulative survival rates (5‐year/10‐year) were 4.99 months and 11.9%/5.0% for group 1 (1978–1985, n = 5551), 25.63 months and 31.9%/10.1% for group 2 (1986–1993), 42.97 months and 39.7%/20.6% for group 3 (1994–2001, n = 53 775), and 60.81 months and 50.4%/24.0% for group 4 (2002–2009, n = 65 711).

Figure 10

Improvement of overall survival among all patients with intrahepatic cholangiocarcinoma according to the registration period. A comparison of cumulative survival rates among patients newly registered between 1978 and 2009 (n = 9130). The median overall survival and survival rates (5‐year/10‐year) were 3.71 and 11.0%/8.2% for group 1 (n = 338), 7.56 months and 14.1%/7.7% for group 2 (n = 1056), 17.02 months and 22.6%/12.2% for group 3 (n = 4552), and 20.6 months and 30.9%/10.7% for group 4 (n = 3184).