Abstract
Liver cancer, including hepatocellular carcinoma (HCC), is the fifth most common cause of cancer deaths in Japan. The main treatment options for HCC are surgical resection, liver transplantation, radiofrequency ablation (RFA), transarterial chemoembolization (TACE), and systemic chemotherapy. Here, recent medical treatments for HCC, including surgery, percutaneous ablation, transcatheter arterial chemoembolization/transcatheter arterial embolization, and drug therapy, are reviewed with a focus on Japan.
1. Introduction
Liver cancer, which includes hepatocellular carcinoma (HCC), is the fifth most common cause of cancer deaths in Japan (1). Liver cancer commonly arises against a background of chronic liver disease, such as hepatitis B and C infection, alcoholic hepatitis, and non-alcoholic steatohepatitis (NASH) (2).
Regarding HBV, the development of HBV-derived HCCs as a distribution of HCCs has not decreased despite the administration of nucleoside analogues in Japan (3). Regarding HCV, direct-acting antivirals have been approved in most
countries including Japan, the sustained virologic response (SVR) rates improved dramatically (4,5). As a result, the development of HCV-derived HCCs has decreased dramatically. However, the problem of liver carcinogenesis after
elimination of HCV remains, that is, post-SVR HCCs (6). NASH-related HCC has been increasing in frequency, and thus, has become a problem all over the world (7). Treatment options vary widely because two factors⎯tumor status Journal of Nippon Medical School J-STAGE Advance Publication (January 25, 2022) (e.g., diameter, number, progression) and liver function⎯affect the treatment choice. The main treatment options are surgical resection, liver transplantation (LT), radiofrequency ablation (RFA), transarterial chemoembolization, systemic chemotherapy, and radiation (8,9). However, the general prognosis is still poor, with overall survival (OS) rates of 3%–5% (10). On the other hand, treatment algorithms differ from region to region depending on the medical background (11). Therefore, it is important to know the standard treatment for HCC in each region. Here, recent medical treatments for HCC, including surgery, percutaneous ablation, transcatheter arterial chemoembolization (TACE)/transcatheter arterial embolization (TAE), and drug therapy, are
reviewed with a focus on Japan.