J Korean Med Sci.  2016 Mar;31(3):403-409. 10.3346/jkms.2016.31.3.403.

Trends and Patterns of Hepatocellular Carcinoma Treatment in Korea

• Hong YM
• Yoon KT
• Cho M
• Kang DH
• Kim HW
• Choi CW
• Park SB
• Heo J
• Woo HY
• Lim W

• KMID: 2363501
• DOI: http://doi.org/10.3346/jkms.2016.31.3.403

Abstract

Multiple therapeutic modalities are available for hepatocellular carcinoma (HCC) treatment. We aimed to evaluate the trends for HCC treatment in Korea. Recent trends and patterns in treatment modalities were assessed in HCC patients who first registered for the Health Insurance Review Assessment Service between 2008 and 2012. From 2009 to 2012, 57,690 patients were diagnosed with HCC. Transcatheter arterial chemoembolization (TACE) was the most common treatment modality for initial treatment. Curative treatment modalities like hepatic resection, liver transplantation, and local ablation therapy increased gradually. The 3 most common treatment modalities (hepatic resection, local ablation therapy, TACE) used after initial treatment in 2009 were studied. Following initial hepatic resection, 44.5% of patients required re-treatment. TACE was the most common modality (in 48.3% of cases), while 15.0% of patients received local ablation therapy. After local ablation therapy, 55.4% of patients were re-treated, wherein 45.0% of patients received TACE and 31.5% received local ablation therapy. Following initial TACE, 73.9% patients were re-treated, most commonly with TACE (57.7%) followed by local ablation therapy (12.8%). While there were no significant differences between the initial and re-treatment modalities, various multiple treatments followed the initial treatment. The treatment modalities were interchangeable.

Keyword

Carcinoma; Hepatocellular; Treatment; Trend; Korea

MeSH Terms

Aged
Carcinoma, Hepatocellular/epidemiology/pathology/*therapy
Chemoembolization, Therapeutic
Combined Modality Therapy/trends
Cross-Sectional Studies
Databases, Factual
Female
Humans
Insurance Claim Review
Liver Neoplasms/epidemiology/pathology/*therapy
Liver Transplantation
Male
Middle Aged
Niacinamide/administration & dosage/analogs & derivatives
Phenylurea Compounds/administration & dosage
Prevalence
Protein Kinase Inhibitors/administration & dosage
Republic of Korea/epidemiology
Niacinamide
Phenylurea Compounds
Protein Kinase Inhibitors

Figure

• 

  Fig. 1 Treatment trends after initial treatment in 2009. Treatment trends after initial treatment were analyzed for 3 of the most common initial treatment modalities (hepatic resection, local ablation therapy, and transarterial chemoembolization [TACE]).

Reference

1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009; 59:225–249.

2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 127:2893–2917.

3. Jung KW, Won YJ, Park S, Kong HJ, Sung J, Shin HR, Park EC, Lee JS. Cancer statistics in Korea: incidence, mortality and survival in 2005. J Korean Med Sci. 2009; 24:995–1003.

4. Ahmed F, Perz JF, Kwong S, Jamison PM, Friedman C, Bell BP. National trends and disparities in the incidence of hepatocellular carcinoma, 1998-2003. Prev Chronic Dis. 2008; 5:A74.

5. Kim SR, Kudo M, Hino O, Han KH, Chung YH, Lee HS; Organizing Committee of Japan-Korea Liver Symposium. Epidemiology of hepatocellular carcinoma in Japan and Korea. A review. Oncology. 2008; 75:Suppl 1. 13–16.

6. National Cancer Information Center [Internet]. accessed on 20 August 2015. Available at http://www.cancer.go.kr/mbs/cancer/.

7. Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, Ayuso C, Sala M, Muchart J, Solà R, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002; 359:1734–1739.

8. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, Fan ST, Wong J. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002; 35:1164–1171.

9. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008; 359:378–390.

10. Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J, Ye S, Yang TS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009; 10:25–34.

11. The Korean Liver Cancer Study Group [Internet]. accessed on 20 August 2015. Available at http://www.klcsg.or.kr/.

12. Kwak HW, Park JW, Nam BH, Yu A, Woo SM, Kim TH, Kim SH, Koh YH, Kim HB, Park SJ, et al. Clinical outcomes of a cohort series of patients with hepatocellular carcinoma in a hepatitis B virus-endemic area. J Gastroenterol Hepatol. 2014; 29:820–829.

13. Terada T, Maruo H. Unusual extrahepatic metastatic sites from hepatocellular carcinoma. Int J Clin Exp Pathol. 2013; 6:816–820.

14. Park JW, Chen M, Colombo M, Roberts LR, Schwartz M, Chen PJ, Kudo M, Johnson P, Wagner S, Orsini LS, et al. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study. Liver Int. 2015; 35:2155–2166.

15. Shi M, Lu LG, Fang WQ, Guo RP, Chen MS, Li Y, Luo J, Xu L, Zou RH, Lin XJ, et al. Roles played by chemolipiodolization and embolization in chemoembolization for hepatocellular carcinoma: single-blind, randomized trial. J Natl Cancer Inst. 2013; 105:59–68.

16. Meng MB, Cui YL, Lu Y, She B, Chen Y, Guan YS, Zhang RM. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol. 2009; 92:184–194.

17. Wang Y, Deng T, Zeng L, Chen W. Efficacy and safety of radiofrequency ablation and transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma: a meta-analysis. Hepatol Res. 2016; 46:58–71.

18. Yang HJ, Lee JH, Lee DH, Yu SJ, Kim YJ, Yoon JH, Kim HC, Lee JM, Chung JW, Yi NJ, et al. Small single-nodule hepatocellular carcinoma: comparison of transarterial chemoembolization, radiofrequency ablation, and hepatic resection by using inverse probability weighting. Radiology. 2014; 271:909–918.

19. Okuda H. Hepatocellular carcinoma development in cirrhosis. Best Pract Res Clin Gastroenterol. 2007; 21:161–173.

20. Marrero JA, Lencioni R, Ye SL, Kudo M, Bronowicki JP, Chen XP, Dagher L, Furuse J, Geschwind JF, de Guevara LL, et al. Final analysis of GIDEON (Global Investigation of Therapeutic Decisions in Hepatocellular Carcinoma [HCC] and of Its Treatment with sorafenib [Sor]) in >3000 Sor-treated patients (pts): clinical findings in patients with liver dysfunction. J Clin Oncol. 2013; 31:abstr 4126.