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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Background/Aim The profile of patients with hepatocellular carcinoma (HCC) has changed globally; the role of etiology in predicting prognosis of HCC patients remains unclear. We aimed to analyze the characteristics and prognosis of Korean patients with HCC according to disease etiology.
Methods This retrospective observational study included patients diagnosed with HCC between 2010 and 2014 in a single center in Korea. Patients with HCC aged <19 years old, had coinfection with other viral hepatitis, had missing follow-up data, were Barcelona Clinic Liver Cancer stage D, or died before 1 month were excluded.
Results A total of 1,595 patients with HCC were analyzed; they were classified into the hepatitis B virus (HBV) group (1,183 [74.2%]), hepatitis C virus (HCV) group (146 [9.2%]), and non-B non-C (NBNC) group (266 [16.7%]). The median overall survival of all patients was 74 months. The survival rates at 1, 3, and 5 years were 78.8%, 62.0% and 54.9% in the HBV group; 86.0%, 64.0%, and 48.6% in the HCV group; and 78.4%, 56.5%, and 45.9% in the NBNC group, respectively. NBNC-HCC has a poorer prognosis than other causes of HCC. Survival was significantly longer in the HBV group with early-stage HCC than in the NBNC group. Furthermore, survival was shorter in patients with early-stage HCC and diabetes mellitus (DM) than in those without DM.
Conclusions The etiology of HCC affected clinical characteristics and prognosis to some extent. NBNC-HCC patients showed shorter overall survival than viral-related HCC patients. Additionally, the presence of DM is an additional important prognostic factor in patients with early-stage HCC.
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J Liver Cancer. 2021;21(1):69-75. Published online March 31, 2021
Hepatocellular carcinoma (HCC) primarily originates in the liver with hepatic differentiation. However, HCCs are not homogenous, and approximately 35% of HCC cases are classified as histopathological variants that present distinct pathologic characteristics. In particular, the lymphocyte-rich variant is the rarest subtype accounting for less than 1% of HCCs, which is not well known to date about molecular features and pathophysiology. Herein, we present a case of a patient who was suspected of metastatic liver cancer and confirmed as lymphocyte-rich HCC pathologically. A 78-year-old woman who underwent a right hemicolectomy for colon cancer was referred to our hospital for a newly detected liver mass. We could not make a decision because of insufficient evidence for diagnosis from imaging studies. After resection, we found that it was a lymphocyte-rich HCC. The pathologic features and prognostic trends of this subtype are also discussed.
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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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Over the past decade, standard first-line systemic treatment of advanced hepatocellular carcinoma (HCC) has been based on sorafenib, a multi-kinase inhibitor. Regorafenib, another tyrosine kinase inhibitor, is the only second-line therapy that has been globally approved after progression under sorafenib treatment. Recently, immunotherapeutic agents have emerged as promising treatment options in many different malignancies, including advanced HCC. Nivolumab is the first immunotherapy approved by the Food and Drug Administration for use in HCC patients with advanced-stage second-line after sorafenib failure. In this report, a case of advanced HCC with multiple lung metastases in which a complete response and maintained progression-free status was achieved with nivolumab, following the failure of transarterial chemoembolization and sorafenib is presented. We hope this report may help expand the clinical application of second-line treatment.
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J Liver Cancer. 2020;20(1):41-52. Published online March 31, 2020
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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Implications of the first edition of the Korean expert consensus-based practice recommendations for transarterial chemoembolization in the management of hepatocellular carcinoma Jin Wook Chung Journal of Liver Cancer.2023; 23(2): 235. CrossRef
Surgical resection versus ablation for early hepatocellular carcinoma: The debate is still open Bo Hyun Kim Clinical and Molecular Hepatology.2022; 28(2): 174. CrossRef
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J Liver Cancer. 2019;19(2):108-116. Published online September 30, 2019
Background/Aims Programmed death receptor 1 (PD-1) is a promising new target for treatment of patients with hepatocellular carcinoma (HCC). A high expression level of programmed death-ligand 1 (PD-L1) is a possible prognostic indicator for poor outcome in other malignancies. Here, we investigated the clinical significance of PD-1 and PD-L1 in patients with HCC.
Methods We enrolled patients with HCC who underwent surgical resection at Severance Hospital between 2012 and 2017 and investigated the levels of PD-L1 in HCC tissues (tPD-L1) and PD-L1/PD-1 in serum (sPD-L1/sPD-1). We also aimed to determine whether expression levels correlated with clinical and histological features.
Results A total of 72 patient samples were analyzed. The median sPD-L1 and sPD-1 levels were 25.72 and 341.44 pg/mL, respectively. A positive correlation was detected between tPD-L1 and sPD-1 levels (R2=0.426, P<0.001). The median sPD-1 level increased linearly with tPD-L1 score (P=0.002). During the follow-up period, HCC recurred in eight (11.1%) patients and liverrelated mortality occurred in eight (11.1%) patients. Higher sPD-L1 levels (≥19.18 pg/mL) tended to be associated with liver-related mortality (hazard ratio 6.866; 95% confidence interval, 0.804-58.659, P=0.078). sPD-1 levels of patients treated with nivolumab as a second-line therapy changed serially, and a >50% reduction in sPD-1 levels was observed immediately after nivolumab administration. However, sPD-1 level was not associated directly with prognosis in patients with advanced HCC.
Conclusions The results demonstrated that PD-L1 and PD-1 levels changed according to the immunotherapy. However, no significant association with clinical outcome in patients with HCC was detected.
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Background/Aims Hepatocellular carcinoma (HCC) with Barcelona Clinic Liver Cancer (BCLC)
intermediate stage includes a highly heterogeneous population. Here, we aimed to subclassify
hepatocellular carcinoma with BCLC intermediate stage for better prognostification. Methods Between 2003 and 2008, 325 patients who were newly diagnosed as HCC with
BCLC intermediate stage were considered eligible. Tumor factor and liver function were used
for sub-classification. Overall survival (OS) was analyzed using Kaplan-Meier method with a
comparison by log-rank test. Results A total of 325 patients with intermediate stage HCC were analyzed. Patients with
tumor size ≥7 cm, tumor number ≥4 and Child-Pugh class B had the worse OS compared
to those with tumor size <7 cm, tumor number <4 and Child-pugh class A, respectively (all
P<0.05). These three variables affected the OS independently from multivariate Cox regression
analysis (all P<0.05). So, using these three variables, patients were finally sub-classified as
those with fulfilling none of three factors (B-a), one of three factors (B-b), two of three factors
(B-c) and all of three factors (B-d) with the median OS of 39.2, 20.6, 12.0 and 8.3 months with
statistical significances (all P<0.05 between B-a and B-b, between B-b and B-c, and between
B-c and B-d), respectively. Conclusions Sub-classification of HCC with BCLC intermediate stage may be useful in not only
prognostification but also guidance of treatment strategies. (J Liver Cancer 2016;16:17-22)
Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis. However, surgical
resection is the treatment of choice as curative aim for early HCC with preserved liver function.
A 5 year survival rate after curative resection is over 50%. We experienced a case of rapidly
recurred HCC with bone metastasis after surgical resection. In our case, microscopically
microvessel invasion was present after resection. Microvascular invasion (MVI) is an important
factor to influence survival and/or HCC recurrence. So we suggested the patients with MVI
need to follow up intensively and adjuvant therapy may be considered.
Myung Eun Song, Sangheun Lee, Mi Na Kim, Dong-Jun Lee, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Chae Yoon Chon, Kwang-Hyub Han, Jinsil Seong, Do Young Kim
Journal of the Korean Liver Cancer Study Group. 2013;13(2):152-157. Published online September 30, 2013
A 63-year-old man patient was referred for treatment of infiltrative hepatocellular carcinoma with hilar invasion after transarterial chemoembolization. Serum alkaline phosphatase and bilirubin were elevated, liver dynamic CT showed infiltrative type mass in left hepatic lobe and right hepatic dome with hilar invasion and left intrahepatic duct dilatation. Also CT showed obliteration of left portal vein and metastasis of lymph node around common bile duct. He was diagnosed as hepatocellular carcinoma (UICC stage IV-A, BCLC stage C). With the percutaneous transhepatic biliary drainage and the concurrent chemoradiation therapy and the 4th cycle of hepatic arterial infusion chemotherapy for infiltrative mass, viable tumor was decreased in resectable size at eight months from initial diagnosis.
Hepatocelluar carcinoma (HCC) is the most common primary liver cancer in the world and the most prevalent cancer among
patients liver cirrhosis. The management of HCC depends on tumor stage and the degree of liver dysfunction. Patients with
intermediate-stage HCC are ineligible for surgical or local ablative treatments. Current treatment guidelines recommend
trans-arterial chemoembolization (TACE) for intermediate stage of HCC. However, tumor recurrence after TACE is universal
and the survival benefit is relatively small. Hence, new strategies are needed to improve the outcome of HCC patients undergoing
TACE. Recently, the combination of target agents with TACE has shown promising overall survival in advanced HCC. It is
necessary to investigate new treat strategy how to increase treatment outcome of advanced HCC by new treat strategy.
Acute pancreatitis is a rare but severe postprocedural complication after transcatheter arterial chemoembolization (TACE) of
hepatocellular carcinoma with an incidence of 1.7-4%. The proposed mechanism of this complication is inadvertent
embolization through collateral vessels or regurgitation of chemotherapeutic agents to the arteries of other organs. Here, we
present a fatal necrotizing pancreatitis case which developed 10 days after TACE, caused by the regurgitation of the
chemotherapeutic agents to the pancreas during the procedure. The patient recovered with conservative care at first, but after
suffering from several times of recurrent pancreatitis, he died of peritoneal septic shock 5 months after the initial pancreatitis
attack.
Bun Kim, Jae Hoon Min, Seung Up Kim, Jun Yong Park, Kwang Hoon Lee, Do Youn Lee, Jin Sub Choi, Young Deuk Choi, Nam Hoon Cho, Young Nyun Park, Sang Hoon Ahn, Kwang Hyub Han, Chae Yoon Chon, Do Young Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):51-57. Published online February 28, 2012
Advanced hepatocellular carcinoma (HCC) is difficult to treat and the survival is poor. Here, we present a patient diagnosed as
advanced HCC (stage IIIa) which was supervening with early renal cell cancer (stage I). The patient was treated with
pre-operational transarterial chemoembolization (TACE) and surgical resection (right hepatectomy, right nephrectomy, and
cholecystectomy). Sorafenib were taken continually after surgery. Multiple recurred HCC nodules in remnant liver were detected
2 months later after surgery. Combined treatment modalities including 4 sessions of TACE, and 12 cycles of 5-flurouracil
(FU)/carboplatin based hepatic arterial infusional chemotherapy (HAIC) induced complete response. After the diagnosis of
advanced HCC, the patient survived 36 months and experienced disease-free status for 19 months.
Hepatocellular carcinoma(HCC) is one of the cancers with poor prognosis. Transarterial chemoembolization(TACE) has been
widely used for treating unresectable HCC. Although TACE is considered as a less invasive and relative safe procedure, severe
complications such as hepatic failure, pulmonary embolism, liver abscess, biloma formationcan occur rarely after TACE. These
complications sometimes may lead to fatal clinical situation, even death. We reported a case of HCC recurred extensively during
treatment of biliary complication after TACE. A 44-year-old male with HCC was admitted due to fever for 3 days after
undergoing TACE. Three weeks before the admission, he had been diagnosed with HCC recurrence which presented as two
arterial enhancing nodules in MRI and treated with TACE. CT scan showed 7 cm sized air containing fluid collections with
necrosis suggestive of liver abscess and 15 cm sized biloma formation. Because the patient was in septic shock at admission,
percutaneous catheter drainage was performed with use of broad spectrum antibiotics. After treatment of 3 months, the sizes of
hepatic abscess and biloma were remarkably decreased. However, 1 month later, large size tumor recurrence and perihepatic
lymph node metastasis were found on a follow-up CT scan. In this case, the cause of rapid growing recurrence after TACE is
uncertain, but the development of unanticipated complication seems to affect the progression to poor prognosis. Therefore, early
recognization of predisposing factors with proper management would be needed to prevent these serious complications after
TACE.
Hepatocellular carcinoma (HCC) is the third most common malignancy in Korea. Despite recent advances in the area of
HCC, a considerable number of HCC patients require non-surgical treatments and systemic therapies because of poor liver
function or intermediate to advanced cancer stages at the time of diagnosis. Unfortunately, chemotherapy for advanced HCC
has limited response rates and provides a marginal survival benefit. Several studies have supported potential advantages of
hepatic arterial infusion chemotherapy (HAIC), designed to improve chemotherapy benefits by increasing the amount of
chemotherapy delivered to the site of the tumor and to minimizes the side-effects of the chemotherapy. However, there hasn’t
been any report showing different responses between systemic chemotherapy and HAIC for the same patient. Herein, we
report a case of HCC showing progressive disease in systemic chemotherapy, but partial response in HAIC with the same
regimen for the same patient with portal vein thrombosis. This case implies HAIC might be alternative option for HCC
patient showing ineffective response to systemic chemotherapy, even with the same regimen.