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Improved survival in patients with hepatocellular carcinoma over 30 years in Japan: Analysis of nationwide prospective registry of 148,161 patients.

4054 Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third most common cause of cancer death in the world. To our best knowledge, only few nationwide survival data is available; USA (SEER Database), Japan and Korea. Liver Cancer Study Group of Japan started nationwide registry along with follow-up survey since 1965. In this report we analyzed improvement of overall survival (OS) in patients with HCC in Japan.


METHODS
We analyzed follow-up data of 148,161 HCC patients who were prospectively registered between 1978-2005 and analyzed the OS according to 5-year interval.


RESULTS
The 5-year overall survival rate was found to be 5.1% in patients who registered in the period A (1978-1980), 13.9% in the period B (1981-1985), 24.9% in the period C (1986-1990), 32.0% in the period D (1991-1995), 38.8% in the period E (1996-2000) and 42.7% in the period F (2001-2005). Median survival time (MST) was found to be 4, 16, 26, 36, 44, and 50 months in the period A, B, C, D, E, and F, respectively. All of OSs in resection, ablation, TACE, and transarterial infusion chemotherapy (HAIC) were also significantly improved period by period. The latest 5-year survival rate of 42.7 % is much better than that of 13 % in United States in the same period according to American Cancer Society Annual Report in 2010 and 18.2% in Korea according to Korean Cancer Registry Database. This drastic improvement of OS in HCC patents in Japan is attributed to the introduction of nationwide surveillance program in 1980, nationwide establishment of resection and TACE procedure in 1985, and invention of ethanol injection therapy in 1990, introduction of HAIC for advanced HCC and introduction of radiofrequency ablation in 2000.


CONCLUSIONS
Overall survival in patients with HCC in Japan was much improved from MST of 4 to 50 months over 30 years, which may be the best in the world. Further improvement in OS will be expected by the introduction of molecular targeted agents, such as sorafenib and other agents under clinical trials.