Hirayuki Enomoto1, Yoshiyuki Ueno2, Yoichi Hiasa3, Hiroki Nishikawa1,4, Shuhei Hige5, Yasuhiro Takikawa6, Makiko Taniai7, Toru Ishikawa8, Kohichiroh Yasui9, Akinobu Takaki10, Koichi Takaguchi11, Akio Ido12, Masayuki Kurosaki13, Tatsuya Kanto14, Shuhei Nishiguchi15,16. 1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan. 2. Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan. 3. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan. 4. Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Japan. 5. Department of Hepatology, Sapporo Kosei General Hospital, Sapporo, Japan. 6. Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan. 7. Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 8. Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan. 9. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 10. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 11. Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan. 12. Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. 13. Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan. 14. Hepatitis Information Center, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Tokyo, Japan. 15. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan. nishiguchi@heartfull.or.jp. 16. Department of Gastroenterology, Kano General Hospital, 7-5-15, Tenjin-bashi, Kita-ku, Osaka, 531-0041, Japan. nishiguchi@heartfull.or.jp.
Abstract
BACKGROUND: We recently reported the real-world changes in the etiologies of liver cirrhosis (LC) based on nationwide survey data and assessed the etiologies of LC with hepatocellular carcinoma (HCC). METHODS: Fifty-five participants from 68 institutions provided data on 23,637 patients with HCC-complicated LC. The changing trends in etiologies were assessed. We further analyzed the data from 29 hospitals that provided the annual number of newly identified HCC-complicated LC patients from 2008 to 2016 (N = 9362) without any missing years and assessed the transition in the real number of newly identified HCC-complicated LC cases. RESULTS: In the overall cohort, hepatitis C virus (HCV) infection (60.3%) and hepatitis B virus (HBV) infection (12.9%) were the leading and third-most common causes of HCC-complicated LC in Japan, respectively. HCV infection was found to be the leading cause throughout Japan. The rate of viral hepatitis-related HCC decreased from 85.3 to 64.4%. Among non-viral etiologies, notable increases were observed in nonalcoholic steatohepatitis (NASH)-related HCC (from 1.5 to 7.2%) and alcoholic liver disease (ALD)-related HCC (from 8.5 to 18.6%). Regarding the real number of newly diagnosed patients, the number of patients with viral hepatitis-related HCC decreased, while the number of patients with non-viral HCC, particularly NASH-related HCC, increased. CONCLUSIONS: Viral hepatitis has remained the main cause of HCC in Japan. However, the decrease in viral hepatitis-related HCC, particularly HCV-related HCC highly contributed to the etiological changes. In addition, the increased incidence of non-viral HCC, particularly NASH-related HCC, was involved in the changing etiologies of HCC-complicated LC in Japan.
BACKGROUND: We recently reported the real-world changes in the etiologies of liver cirrhosis (LC) based on nationwide survey data and assessed the etiologies of LC with hepatocellular carcinoma (HCC). METHODS: Fifty-five participants from 68 institutions provided data on 23,637 patients with HCC-complicated LC. The changing trends in etiologies were assessed. We further analyzed the data from 29 hospitals that provided the annual number of newly identified HCC-complicated LC patients from 2008 to 2016 (N = 9362) without any missing years and assessed the transition in the real number of newly identified HCC-complicated LC cases. RESULTS: In the overall cohort, hepatitis C virus (HCV) infection (60.3%) and hepatitis B virus (HBV) infection (12.9%) were the leading and third-most common causes of HCC-complicated LC in Japan, respectively. HCV infection was found to be the leading cause throughout Japan. The rate of viral hepatitis-related HCC decreased from 85.3 to 64.4%. Among non-viral etiologies, notable increases were observed in nonalcoholic steatohepatitis (NASH)-related HCC (from 1.5 to 7.2%) and alcoholic liver disease (ALD)-related HCC (from 8.5 to 18.6%). Regarding the real number of newly diagnosed patients, the number of patients with viral hepatitis-related HCC decreased, while the number of patients with non-viral HCC, particularly NASH-related HCC, increased. CONCLUSIONS: Viral hepatitis has remained the main cause of HCC in Japan. However, the decrease in viral hepatitis-related HCC, particularly HCV-related HCC highly contributed to the etiological changes. In addition, the increased incidence of non-viral HCC, particularly NASH-related HCC, was involved in the changing etiologies of HCC-complicated LC in Japan.
Authors: Zobair Younossi; Maria Stepanova; Janus P Ong; Ira M Jacobson; Elisabetta Bugianesi; Ajay Duseja; Yuichiro Eguchi; Vincent W Wong; Francesco Negro; Yusuf Yilmaz; Manuel Romero-Gomez; Jacob George; Aijaz Ahmed; Robert Wong; Issah Younossi; Mariam Ziayee; Arian Afendy Journal: Clin Gastroenterol Hepatol Date: 2018-06-14 Impact factor: 11.382