Improved survival of viral hepatocellular carcinoma but not non‐viral hepatocellular carcinoma from 2000 to 2020: A multi‐centre cohort study of 6007 patients from high‐volume academic centres in Japan

Abstract

Summary Background While surveillance improves the early detection of hepatocellular carcinoma (HCC), it is unclear whether this has improved prognosis in clinical practice. Aims To investigate the characteristics and prognoses of patients with viral versus non‐viral HCC over the previous two decades in Japan, while HCC surveillance has been active. Methods This multi‐centre study enrolled 6007 patients initially diagnosed with HCC between 2000 and 2020 at seven high‐volume academic centres. Patients were categorised based on dates of diagnosis: 2000–2006, 2007–2013 and 2014–2020. HCC characteristics and post‐diagnosis survival rates were compared between periods in patients with viral and non‐viral HCC. Results The percentage of patients with non‐viral HCC increased during the study period. The maximal tumour size and percentage of patients with multinodular HCC decreased significantly over time in the viral HCC group but remained unchanged in the non‐viral HCC group. Liver function at diagnosis improved over time in both groups, but to a greater extent in the viral HCC group. Survival rates increased significantly with time in the viral HCC group, but not in the non‐viral HCC group. Conclusions The prevalence of non‐viral HCC is increasing. Although the survival of patients with viral HCC improved significantly over the past two decades, there was no improvement in patients with non‐viral HCC. This was presumably due mainly to lower surveillance among patients with non‐viral HCC and failure to diagnose early‐stage HCC.

Increased prevalence but decreased survival of nonviral hepatocellular carcinoma compared to viral hepatocellular carcinoma in recent ten years

“…In our cohort, 53.5% of the patients in the nonviral HCC group did not have liver cirrhosis. Despite the lower annual incidence in the NAFLD-related (HCC group (0.44 per 1000 person-years)), several countries, including nations in Europe and Asia, have shown increased prevalence rates of nonviral HCC and its association with NAFLD 10 , 16 , 17 . There was strong evidence supporting abdominal ultrasound screening to reduce HCC mortality 12 , 13 .…”

Letter: rising incidence and poor survival in patients with non‐viral HCC – better HCC surveillance and treatment for alcohol‐associated and non‐alcohol fatty liver diseases are needed. Authors' reply

“…Manikat and Nguyen 1 in our article comparing survival improvement in patients with hepatocellular carcinoma (HCC) caused by viral versus non-viral liver diseases. 2 We envision that the lack of improvement in patients with non-viral HCC may be a global phenomenon.…”

Letter: rising incidence and poor survival in patients with nonviral HCC—better HCC surveillance and treatment for alcohol‐associated and non‐alcohol fatty liver diseases are needed

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We would like to congratulate the authors Toyoda et al on their very important study broadly covering Japan. 1 The article highlights the rising incidence of nonviral hepatocellular carcinoma (HCC), an area of increasing medical urgency. The study also found significant disparities in the survival of nonviral versus viral HCC patients.

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