Trends in clinical characteristics, treatment and prognosis of hepatocellular carcinoma.
OBJECTIVE
This study was undertaken to evaluate the serial changes of various factors in patients with hepatocellular carcinoma, including hepatitis viruses, age distribution, female-to-male ratio, size and the number of hepatocellular carcinoma tumors at initial detection, the types of treatment and survival during a 12-year period.


METHODS
Seven hundred and four consecutive patients with hepatocellular carcinoma lesions observed from Jan 1989 to Dec 2000 (12 years) at the Internal Medicine Department, Saga Prefectural Hospital Koseikan were retrospectively enrolled in the study. The follow-up period was divided into four terms as follows: 1989-91, 1992-94, 1995-97 and 1998-2000. The serial changes of causal hepatitis viruses, age distribution, gender ratio, tumor size, the number of hepatocellular carcinoma tumors at initial detection, the types of treatment and survival were analyzed and compared among the four different terms.


RESULTS
Regarding viral markers, the association of an HCV infection has become more predominant in hepatocellular carcinoma cases, while the ratio of hepatocellular carcinoma patients infected with HBV has decreased during this 12-year period. In addition, the rate of hepatocellular carcinoma measuring 3 cm or less in diameter or solitary hepatocellular carcinoma at initial detection has increased during the 12-year period. The female-to-male ratio has increased from 33.6% in 1989-1991, 34.8% in 1992-1994, 48.7% in 1995-1997 to 60.6% in 1998-2000, respectively. Due to increased early detection, the types of treatment for hepatocellular carcinoma have shifted from arterial interventional therapy to local ablation therapy combined with or without interventional therapy. Therefore, although the age distribution of all 704 hepatocellular carcinoma patients has shifted to slightly older ages as shown by the ages of 64.1 years old, 63.4 years old, 66.6 years old and 67.3 years old in the four terms, respectively, the survival of the patients with hepatocellular carcinoma proved to had become significantly longer than before during the 12-year period.


CONCLUSIONS
Hepatocellular carcinoma patients tended to show an increased prevalence of HCV, a higher age distribution, an increasing female prevalence, an earlier detection, advanced multidisciplinary therapies and prolonged survival in the last 12 years.
Dohmen
Kazufumi
K
Clinical Research Center, National Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki 856-8562, Japan. doumen@nmc.hosp.go.jp
Shigematsu
Hirohisa
H
Irie
Koji
K
Ishibashi
Hiromi
H
D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015984:Causality; D002423:Cause of Death / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends