Journal of Liver Cancer

Review Article

Advancing Korean nationwide registry for hepatocellular carcinoma: a systematic sampling approach utilizing the Korea Central Cancer Registry database: Bo Hyun Kim, E Hwa Yun, Jeong-Hoon Lee, Geun Hong, Jun Yong Park, Ju Hyun Shim, Eunyang Kim, Hyun-Joo Kong, Kyu-Won Jung, Young-Suk Lim; J Liver Cancer. 2024;24(1):57-61. Published online March 26, 2024; DOI: https://doi.org/10.17998/jlc.2024.03.03

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Hepatocellular carcinoma (HCC) presents a substantial public health challenge in South Korea as evidenced by 10,565 new cases annually (incidence rate of 30 per 100,000 individuals), in 2020. Cancer registries play a crucial role in gathering data on incidence, disease attributes, etiology, treatment modalities, outcomes, and informing health policies. The effectiveness of a registry depends on the completeness and accuracy of data. Established in 1999 by the Ministry of Health and Welfare, the Korea Central Cancer Registry (KCCR) is a comprehensive, legally mandated, nationwide registry that captures nearly all incidence and survival data for major cancers, including HCC, in Korea. However, detailed information on cancer staging, specific characteristics, and treatments is lacking. To address this gap, the KCCR, in partnership with the Korean Liver Cancer Association (KLCA), has implemented a systematic approach to collect detailed data on HCC since 2010. This involved random sampling of 10-15% of all new HCC cases diagnosed since 2003. The registry process encompassed four stages: random case selection, meticulous data extraction by trained personnel, expert validation, anonymization of personal data, and data dissemination for research purposes. This random sampling strategy mitigates the biases associated with voluntary reporting and aligns with stringent privacy regulations. This innovative approach positions the KCCR and KLCA as foundations for advancing cancer control and shaping health policies in South Korea.

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Association of modifiable metabolic risk factors and lifestyle with all-cause mortality in patients with hepatocellular carcinoma
Hwi Young Kim, Hye Ah Lee, Pompilia Radu, Jean-François Dufour
Scientific Reports.2024;[Epub] CrossRef

Original Articles

Comparison of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis: Jeayeon Park, Yun Bin Lee, Yunmi Ko, Youngsu Park, Hyunjae Shin, Moon Haeng Hur, Min Kyung Park, Dae-Won Lee, Eun Ju Cho, Kyung-Hun Lee, Jeong-Hoon Lee, Su Jong Yu, Tae-Yong Kim, Yoon Jun Kim, Tae-You Kim, Jung-Hwan Yoon; J Liver Cancer. 2024;24(1):81-91. Published online January 19, 2024; DOI: https://doi.org/10.17998/jlc.2023.12.25

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Abstract PDF Supplementary Material: Background/Aim
Atezolizumab plus bevacizumab and lenvatinib are currently available as first-line therapy for the treatment of unresectable hepatocellular carcinoma (HCC). However, comparative efficacy studies are still limited. This study aimed to investigate the effectiveness of these treatments in HCC patients with portal vein tumor thrombosis (PVTT).
Methods
We retrospectively included patients who received either atezolizumab plus bevacizumab or lenvatinib as first-line systemic therapy for HCC with PVTT. Primary endpoint was overall survival (OS), and secondary endpoints included progressionfree survival (PFS) and disease control rate (DCR) determined by response evaluation criteria in solid tumors, version 1.1.
Results
A total of 52 patients were included: 30 received atezolizumab plus bevacizumab and 22 received lenvatinib. The median follow-up duration was 6.4 months (interquartile range, 3.9-9.8). The median OS was 10.8 months (95% confidence interval [CI], 5.7 to not estimated) with atezolizumab plus bevacizumab and 5.8 months (95% CI, 4.8 to not estimated) with lenvatinib (P=0.26 by log-rank test). There was no statistically significant difference in OS (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.34-1.49; P=0.37). The median PFS was similar (P=0.63 by log-rank test), with 4.1 months (95% CI, 3.3-7.7) for atezolizumab plus bevacizumab and 4.3 months (95% CI, 2.6-5.8) for lenvatinib (aHR, 0.93; 95% CI, 0.51-1.69; P=0.80). HRs were similar after inverse probability treatment weighting. The DCRs were 23.3% and 18.2% in patients receiving atezolizumab plus bevacizumab and lenvatinib, respectively (P=0.74).
Conclusion
The effectiveness of atezolizumab plus bevacizumab and lenvatinib was comparable for the treatment of HCC with PVTT.

Use of doxorubicin-eluting bead transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein invasion: a prospective study: Su Jong Yu, Yun Bin Lee, Eun Ju Cho, Jeong-Hoon Lee, Hyo-Cheol Kim, Jin Wook Chung, Jung-Hwan Yoon, Yoon Jun Kim; J Liver Cancer. 2023;23(1):166-176. Published online March 3, 2023; DOI: https://doi.org/10.17998/jlc.2023.02.08

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Abstract PDF Supplementary Material: Background/Aim
To evaluate the applicability of transarterial chemoembolization (TACE) treatment with doxorubicin drug-eluting beads (DEBs) in advanced hepatocellular carcinoma (HCC) patients with portal vein invasion (PVI).
Methods
This prospective study was approved by the institutional review board and informed consent was obtained from all participants. A total of 30 HCC patients with PVI received DEB-TACE between 2015 and 2018. The following parameters were evaluated: complications during DEB-TACE, abdominal pain, fever, and laboratory outcomes, including liver function change. Overall survival (OS), time to progression (TTP), and adverse events were also analyzed and assessed.
Results
DEBs measuring 100–300 μm in diameter were loaded with doxorubicin (150 mg per procedure). There were no complications during DEB-TACE and no significant differences in the levels of prothrombin time, serum albumin, or total bilirubin at follow-up compared to baseline. The median TTP was 102 days (95% confidence interval [CI], 42–207 days) and the median OS was 216 days (95% CI, 160–336 days). Three patients (10%) had severe adverse reactions, including transient acute cholangitis (n=1), cerebellar infarction (n=1), and pulmonary embolism (n=1), but no treatment-related death occurred.
Conclusions
DEB-TACE may be a therapeutic option for advanced HCC patients with PVI.

Case Report

Hepatocellular carcinoma diagnosed in a patient who had Fontan operation 30 years ago: a case report: Moon Haeng Hur, Haeryoung Kim, Jeong-Hoon Lee; J Liver Cancer. 2022;22(2):188-193. Published online August 31, 2022; DOI: https://doi.org/10.17998/jlc.2022.08.17

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Abstract PDF: The Fontan operation is performed in patients with a single ventricle. As the systemic venous return is directly connected to the pulmonary circulation during this procedure, chronic hepatic congestion is induced, leading to Fontan-associated liver disease (FALD) including liver cirrhosis and hepatocellular carcinoma (HCC). In this report, we present a case of HCC diagnosed in a patient who underwent the Fontan operation 30 years ago. The patient underwent regular surveillance for FALD, which revealed a 4 cm-sized hepatic mass with elevated serum alpha-fetoprotein. After surgical treatment, there was no evidence of HCC recurrence during 3 years of follow-up. As the risk of HCC and Fontan-associated liver cirrhosis increases with the duration elapsed since the operation, regular surveillance should be emphasized. Serial follow-up of serum alpha-fetoprotein levels and abdominal imaging are necessary to achieve early and accurate diagnosis of HCC in post-Fontan patients.

Notice of Retraction and Replacement

Yoon et al. Hepatocellular Carcinoma in Korea: an Analysis of the 2015 Korean Nationwide Cancer Registry: Jeong-Hoon Lee; J Liver Cancer. 2022;22(2):207-207. Published online June 8, 2022; DOI: https://doi.org/10.17998/jlc.21.1.58.e1; Retracts: J Liver Cancer 2021;21(1):58

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Validation of MELD 3.0 scoring system in East Asian patients with cirrhosis awaiting liver transplantation
Jeong-Ju Yoo, Jong-In Chang, Ji Eun Moon, Dong Hyun Sinn, Sang Gyune Kim, Young Seok Kim
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Original Articles

Hepatocellular Carcinoma in Korea: an Analysis of the 2015 Korean Nationwide Cancer Registry: Jun Sik Yoon, Han Ah Lee, Hwi Young Kim, Dong Hyun Sinn, Dong Ho Lee, Suk Kyun Hong, Ju-Yeon Cho, Jonggi Choi, Young Chang, Hyun-Joo Kong, Eunyang Kim, Young-Joo Won, Jeong-Hoon Lee; J Liver Cancer. 2021;21(1):58-68. Published online March 31, 2021; DOI: https://doi.org/10.17998/jlc.21.1.58

7,188 Views
277 Downloads
18 Citations

Abstract PDF Supplementary Material

Background/Aims
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer-related death in Korea. This study evaluated the characteristics of Korean patients newly diagnosed with HCC in 2015.
Methods
Data from the Korean Primary Liver Cancer Registry (KPLCR), a representative sample of patients newly diagnosed with HCC in Korea, were analyzed. A total of 1,558 patients with HCC registered in the KPLCR in 2015 were investigated.
Results
The median age was 61.0 years (interquartile range, 54.0-70.0 years), and men accounted for 79.7% of the subjects. Hepatitis B virus infection was the most common underlying liver disease (58.1%). According to the Barcelona Clinic Liver Cancer (BCLC) staging system, stage 0, A, B, C, and D HCCs accounted for 14.2%, 31.5%, 7.6%, 39.0%, and 7.8% of patients, respectively. Transarterial therapy (32.1%) was the most commonly performed initial treatment, followed by surgical resection (23.2%), best supportive care (20.2%), and local ablation therapy (10.7%). Overall, 34.5% of patients were treated in accordance with the BCLC guidelines: 59.2% in stage 0/A, 48.4% in stage B, 18.1% in stage C, and 71.6% in stage D. The 1-, 3-, and 5-year OS rates were 67.1%, 50.9%, and 27.0%, respectively.
Conclusions
In 2015, approximately 45% of Korean HCC cases were diagnosed at a very early or early stage, and 35% of patients underwent potentially curative initial treatment. BCLC guidance was followed in 34.5% of patients; in patients with stage B or C disease, there was relatively low adherence.

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Hepatocellular Carcinoma in Korea between 2012 and 2014: an Analysis of Data from the Korean Nationwide Cancer Registry: Young Eun Chon, Han Ah Lee, Jun Sik Yoon, Jun Yong Park, Bo Hyun Kim, In Joon Lee, Suk Kyun Hong, Dong Hyeon Lee, Hyun-Joo Kong, Eunyang Kim, Young-Joo Won, Jeong-Hoon Lee; J Liver Cancer. 2020;20(2):135-147. Published online September 30, 2020; DOI: https://doi.org/10.17998/jlc.20.2.135

4,979 Views
164 Downloads
17 Citations

Abstract PDF Supplementary Material

Background/Aims
Considering the high prevalence and mortality of hepatocellular carcinoma (HCC) in Korea, accurate statistics for HCC are important. We evaluated the characteristics of Korean patients with newly diagnosed HCC.
Methods
We retrospectively evaluated data from the Korean Primary Liver Cancer Registry (KPLCR). The baseline characteristics, treatment modalities, and overall survival (OS) of 4,572 patients with HCC registered in the KPLCR between 2012 and 2014 were investigated.
Results
At the time of HCC diagnosis, the median age was 60.0 years, with male predominance (79.6%). Hepatitis B virus infection was the most common etiology (59.1%). The rates of Barcelona Clinic Liver Cancer (BCLC) stages 0, A, B, C, and D at diagnosis were 3.9%, 36.9%, 12.5%, 39.4%, and 7.3%, respectively. The proportion of very early or early stage HCC at diagnosis (BCLC stage 0 or A) in the 2012-2014 cohort was significantly lower than that in the 2008-2011 cohort (40.8% vs. 48.3%, P<0.001). Transarterial therapy (37.5%) was the most commonly performed initial treatment, followed by surgical resection (19.8%), best supportive care (19.1%), and local ablation (10.6%). The median OS was 2.9 years, and the 1-, 3-, and 5-year OS rates were 67.7%, 49.3% and 41.9%, respectively. The OS rate of the 2012-2014 cohort was significantly higher than that of the 2008-2011 cohort (log-rank, P<0.001).
Conclusions
The OS of HCC patients registered in the KPLCR between 2012 and 2014 significantly improved. Nevertheless, as about half of the HCC patients were diagnosed at an advanced stage, vigorous and optimized HCC screening strategies should be implemented.

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Hepatocellular Carcinoma in Korea Between 2008 and 2011: an Analysis of Korean Nationwide Cancer Registry: Jun Sik Yoon, Han Ah Lee, Jun Yong Park, Bo Hyun Kim, In Joon Lee, Young Eun Chon, Suk Kyun Hong, Dong Hyeon Lee, Hyun-Joo Kong, Young-Joo Won, Eunyang Kim, Jeong-Hoon Lee; J Liver Cancer. 2020;20(1):41-52. Published online March 31, 2020; DOI: https://doi.org/10.17998/jlc.20.1.41

5,407 Views
198 Downloads
15 Citations

Abstract PDF Supplementary Material

Backgrounds/Aims
Backgrounds/Aims: In Korea, hepatocellular carcinoma (HCC) is the sixth most common cancer and results in the second-highest cancer death rate among all cancers. We aimed to describe the characteristics of patients who were newly diagnosed with HCC in Korea between 2008 and 2011.
Methods
The Korean Primary Liver Cancer Registry (KPLCR) is a random sample consisting of approximately 15% of patients with newly diagnosed primary liver cancer registered in the Korean Central Cancer Registry. We investigated the baseline characteristics, treatment modalities, and overall survival (OS) of patients with HCC registered in the KPLCR between 2008 and 2011.
Results
A total of 6,083 patients were histologically or radiologically diagnosed with HCC. The hepatitis B virus was the predominant HCC etiology (72.0%). According to the Barcelona Clinic Liver Cancer (BCLC) staging system, stages 0, A, B, C, and D accounted for 8.6%, 39.7%, 11.5%, 33.8%, and 6.9%, respectively. Transarterial therapy (41.7%) was the most commonly performed initial treatment, followed by best supportive care (21.7%), surgical resection (16.7%), and local ablation therapies (10.6%). The overall rate of adherence to the BCLC treatment guideline was only 37.7%. The 1-, 3-, and 5-year OS rates were 65.6%, 46.2%, and 36.8%, respectively.
Conclusions
Between 2008 and 2011, approximately half of patients with HCC (48.3%) were candidates for curative treatment (BCLC stage 0 or A), but one-third of patients (33.8%) had advanced HCC (BCLC stage C). Transarterial therapy was the most commonly conducted initial treatment and the 5-year OS rate was 36.8% in this period.

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Case Report

Hepatocellular Carcinoma with Segmental Portal Vein Invasion Exhibiting a Complete Response after Transarterial Radioembolization: Jun Sik Yoon, Su Jong Yu, Yun Bin Lee, Eun Ju Cho, Jeong-Hoon Lee, Yoon Jun Kim, Jung-Hwan Yoon; J Liver Cancer. 2019;19(2):159-164. Published online September 30, 2019; DOI: https://doi.org/10.17998/jlc.19.2.159

5,506 Views
78 Downloads

Abstract PDF: The treatment options available for patients with hepatocellular carcinoma (HCC) with portal vein invasion (PVI) include sorafenib, transarterial radioembolization (TARE), radiation therapy (RT), transarterial chemoembolization with RT, and proton beam irradiation. Herein, we present a case of HCC with segmental PVI that was managed via TARE. The patient had a 4 cm HCC that invaded the segment VIII portal vein branch without extrahepatic spread. Liver function was Child-Pugh grade A, and performance status was good. TARE was performed without any adverse events, and a radiological complete response (CR) was achieved. Thereafter, the patient was followed-up every 3-6 months without any further treatment, and the CR was maintained for >3 years. Therefore, TARE may be a useful alternative therapeutic option for patients with HCC exhibiting segmental PVI.

Original Articles

Tenofovir and Entecavir Have Similar Renal Adverse Events on Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization: Young Youn Cho, Young Hwan Choi, Su Jong Yu, Eun Ju Cho, Jeong-Hoon Lee, Yoon Jun Kim, Jung-Hwan Yoon; J Liver Cancer. 2019;19(2):128-135. Published online September 30, 2019; DOI: https://doi.org/10.17998/jlc.19.2.128

4,110 Views
50 Downloads
1 Citation

Abstract PDF

Background/Aims
Tenofovir disoproxil fumarate (TDF) is potentially nephrotoxic in chronic hepatitis B patients. Hepatocellular carcinoma (HCC) patients treated using transarterial chemoembolization (TACE) are at an increased risk of renal injury. The aim of this study was to determine whether TDF is associated with more renal adverse events than entecavir (ETV) in HCC patients treated with TACE.
Methods
In this retrospective single-center study, we selected 53 HCC patients who were treated with TDF from January 2012 to July 2013 and had their first TACE procedure in the same period. These patients were matched by age and sex to patients treated with ETV.
Results
There were no significant differences in baseline characteristics, including HCC factors, and nephrotoxic drug use, between the two groups. The median follow-up period was 17.0 and 20.0 months for the TDF and ETV groups, respectively. There was no difference during the follow-up period between the TDF and ETV groups in the increase in creatinine over 0.5 mg/dL (17.0% and 17.0%, P=1.00, respectively) and the decrease in eGFR over 25% (43.4% and 41.5%, P=0.84, respectively). Multivariate analysis revealed that Child-Pugh class over B (hazard ratio [HR], 7.30; 95% confidence interval [CI] 2.79-19.10; P<0.01) was associated with increase in creatinine, and Child-Pugh class over B (HR, 82.74; 95% CI 12.31-555.83; P<0.01) and Barcelona-Clinic Liver Cancer stage over B (HR, 14.93; 95% CI 1.60-139.51; P=0.02) were associated with decrease in eGFR.
Conclusions
TDF has comparable safety to that of ETV for HCC patients undergoing TACE.

Citations

Citations to this article as recorded by

Big Data Information under Proportional Hazard Mathematical Model in Analysis of Hepatitis B Virus Infection Data of Patients with Interventional Liver Cancer through Antiviral Therapy of Entecavir
Yichi Zhang, Shuai Zhao, Han Ding, Xiaoling Song, Huijie Miao, Xuya Cui, Jian Wang, Bing Han, Enas Abdulhay
Journal of Healthcare Engineering.2021; 2021: 1. CrossRef

A Case of Hepatocellular Carcinoma with Recurrent Peritoneal Metastasis after Hepatectomy Who Showed Complete Response by Surgical Resection: Hyo Young Lee, Jeong-Hoon Lee, Joon Yeul Nam, Young Chang, Hyeki Cho, Young Youn Cho, Eung Ju Cho, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon; J Liver Cancer. 2017;17(2):153-157. Published online September 30, 2017; DOI: https://doi.org/10.17998/jlc.17.2.153

1,844 Views
18 Downloads

Abstract PDF: Recurrence of hepatocellular carcinoma (HCC) after hepatic resection is quite common. Peritoneal recurrence has been considered incurable status and related to poor prognosis. Although peritoneal metastasectomy is a therapeutic option for some selected patients with a few peritoneal metastasis, the indication and therapeutic effect has not been clear. We report a
case
of a 61-year-old man achieving complete remission of recurrent peritoneal metastasis after repeated surgical resection by a multidisciplinary approach. Peritoneal metastasectomy might be a therapeutic option for selected patients with localized oligonodular peritoneal metastasis.

Case Report

Two Cases of Early Recurred Hepatocellular Carcinoma after Surgical Resection Which Showed Different Outcomes: Young Youn Cho, Jeong-Hoon Lee, Nam Joon Yi, Kwang Woong Lee, Kyung Suk Suh, Yoon Joon Kim, Jung-Hwna Yoon; J Liver Cancer. 2015;15(2):126-131. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.126

843 Views
8 Downloads

Abstract PDF: Hepatocellular carcinoma (HCC) has poor prognosis, even after curative resection. Early recurrence after curative treatment is a major cause of the poor prognosis. Pathologic factors such as vessel invasion, satellite nodule, size of tumor and pathologic grade are prognostic factors predicting early recurrence and poor prognosis. We share our experience of two
case
s which both showed early recurrence after curative hepatic resection, but eventually demonstrated different prognosis. Since the most common cause of death after potentially curative treatment is tumor recurrence, suppression of tumor recurrence might be linked to survival gain. Currently, there is no adjuvant therapy for HCC endorsed by international guidelines. However, recent studies have shown that antiviral treatment for hepatitis B virusrelated HCC and immunotherapy using autologous cytokine-induced killer cell reduced HCC recurrence. Further study is needed to select patients who will benefit from adjuvant treatments.

Original Article

Transarterial Chemoembolization versus Radiofrequency Ablation for Small Hepatocellular Carcinomas with Discrepant Features on Computed Tomography and Magnetic Resonance Imaging: Young Youn Cho, Jung Hee Kwon, Jeong-Hoon Lee, Jeong Min Lee, Jae Young Lee, Hyo-Choel Kim, Jin Wook Chung, Won-mook Choi, Eun Ju Cho, Yoon Jun Kim, Jung-Hwan Yoon, Chung Yong Kim, Hyo-Suk Lee; J Liver Cancer. 2015;15(1):19-29. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.19

1,330 Views
10 Downloads

Abstract PDF: Background/Aims
This study compared the outcomes of patients with small hepatocellular carcinomas (HCCs) who were treated using transarterial chemoembolization (TACE) or radiofrequency ablation (RFA).
Methods
This was a post-hoc analysis of a prospective study that evaluated the diagnostic efficacy of magnetic resonance imaging (MRI) and computed tomography (CT). We analyzed 41 small hepatic nodules in 32 patients that showed typical radiologic hallmarks on both CT and gadoxate-enhanced MRI (typical nodules) and 25 small hepatic nodules from 22 patients that showed atypical radiologic hallmarks on CT and typical radiologic hallmarks on MRI (discrepant nodules).
Results
There were no significant differences in the baseline characteristics of the patients with typical and discrepant nodules. Complete response rates 1 month after TACE or RFA were 75.0% (18/24) and 94.1% (16/17; P=0.20), respectively, for the patients with typical nodules and 58.8% (10/17) and 100% (8/8; P=0.05), respectively, for the patients with discrepant nodules. Treatment failure rates after TACE or RFA were 33.3% (8/24) and 5.8% (1/17; P=0.15), respectively, for the patients with typical nodules and 47.0% (8/17) and 0.0% (0/8; P=0.02), respectively, for the patients with discrepant nodules. Among patients achieving complete response, there were no significant differences in the risk of marginal recurrence.
Conclusions
RFA provided higher complete response rates and significantly lower treatment failure rates than TACE for patients with discrepant nodules of HCC. Therefore, a treatment modality such as RFA may be preferable for small HCCs which show discrepancy on two imaging modalities.

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