2008-2014 Liver Cancer Society Liver Cancer Registration Project Analysis Results
Liver cancer patients’ 5-year average survival rate is only 40%
Screening and treatment for underlying liver disease
The Korean Society of Liver Cancer (Chairman Young-nyeon Park) and the Planning Committee (Director Yeon-Seok Seo) said that liver cancer continues to be the leading cause of cancer deaths in Koreans.
Liver cancer is a carcinoma that occupies the 6th largest incidence of carcinoma in Korea in 2017 (the incidence rate of 17.0 people in the age standardized 10 million people). The number of liver cancer incidences was 13,214 in 1999 (based on the crude incidence rate) [명/10만명]: 28.0), showing a rather increasing trend with 16,181 (32.4) persons in 2010. In 2017, 15,405 (30.1) persons were reported.
According to the analysis of data on the Randomized Liver Cancer Registration Project by the Liver Cancer Registration Project Committee (Director Jeong-Hoon Lee), the Korean Liver Cancer Society found that among 10,655 patients newly diagnosed with liver cancer in 2008-2014, the proportion of patients diagnosed with liver cancer in stage 3 was 33.8% in 2008. In 2014, the rate increased to 39.4% in 2014, and the rate of diagnosis in the fourth stage was unchanged from 6.9% in 2008 to 7.3% in 2014.
[그림] Age standardization incidence rate by major cancer types (Source: National Cancer Registration Statistics in 2017)
The cancer mortality rate due to liver cancer was 10,611 (based on the survey mortality rate) [명/10만명]: 20.7), which ranks second among the causes of death due to carcinoma, and the absolute number of deaths due to liver cancer has increased without decreasing over the past 15 years. In the randomized liver cancer registration project data analysis, the 3-year and 5-year average survival rates of 10,655 patients diagnosed with liver cancer in 2008-2014 were 49.3% and 41.9%, respectively, which is a significant survival rate when compared with 2008-2011 and 2003-2005 data. Although an increase can be seen, liver cancer is still a disease with a low survival rate and a poor prognosis.
[그림] Five-year survival rate for major cancers (Source: National Cancer Registration Statistics in 2017)
As the cause of liver cancer, hepatitis B was the largest with 61.1%, followed by alcoholic hepatitis 12.5%, hepatitis C 10.6%, and other causes of 8.4%. In order to prevent the occurrence of liver cancer, early diagnosis and treatment for each underlying liver disease are of paramount importance.
In particular, it is emphasized that subjects with risk factors (cirrhosis, hepatitis B, hepatitis C) must undergo liver ultrasound and AFP tests twice a year for early diagnosis of liver cancer through national examination and promotion of the Liver Association. As the proportion of patients diagnosed with advanced liver cancer is still high, the importance of early liver cancer screening should be further emphasized.
The occurrence of liver cancer can be prevented through diagnosis and appropriate treatment of the cause of liver disease.
Diseases that cause chronic liver damage include hepatitis B, hepatitis C, alcoholic liver disease, and non-alcoholic fatty liver disease. If inflammation in the liver continues, cirrhosis and liver cancer are caused. In most cases, liver cancer can be prevented and early liver cancer can be diagnosed by finding out whether there is such a disease and performing appropriate treatment and liver cancer surveillance if diagnosed.
In chronic hepatitis B and C patients, an appropriate antiviral drug can significantly suppress the occurrence of liver cancer.
Chronic hepatitis B is the main cause of liver cancer in Korea and accounts for 60-70% of all liver cancer incidences. Although the prevalence of hepatitis B infection has been decreasing since the national vaccination program was implemented in the early 1980s, the 2018 survey found that the hepatitis B surface antigen retention rate is still high at 3.2% among those in their 30s to 50s.
The 5-year incidence of liver cancer in patients with chronic hepatitis B without antiviral therapy is 0.6-2.4%, especially when cirrhosis is accompanied, increases to 9.7-15.5%.
Recently, the use of antiviral drugs for hepatitis B virus has shown a remarkable decrease in the incidence of liver cancer.In one study, the 5-year incidence of liver cancer in patients without antiviral treatment was 13.7%, compared to 3.7% in patients receiving antiviral treatment. In other studies, the annual incidence of liver cancer in patients treated with antiviral drugs was 0.37%, and the annual incidence of liver cancer in patients with cirrhosis was 0.65%.
Since a large number of hepatitis B patients remain asymptomatic and progress to liver cirrhosis and liver cancer, early screening tests are required to find hepatitis B virus carriers, and periodic liver cancer surveillance tests and appropriate treatment for those with hepatitis B virus Should be implemented.
Chronic hepatitis C is also a major cause of liver cancer in Korea, accounting for 10-15% of all liver cancer incidences. Chronic hepatitis C has no symptoms, so many patients do not recognize the infection, and are often found in advanced conditions such as chronic hepatitis, cirrhosis, and liver cancer.
Unlike hepatitis B virus, unlike hepatitis B virus, a preventive vaccine has not been developed until now. However, due to the recent remarkable development of antiviral drugs, taking oral antiviral drugs for 2 to 3 months can be cured in most cases. It is possible. In several studies of chronic hepatitis C patients, the incidence of liver cancer was prevented by more than 70% when hepatitis C was cured through antiviral treatment.
However, patients who had already progressed to cirrhosis before the start of antiviral treatment had 4.5 times more liver cancer than those who did not. Therefore, if hepatitis C is diagnosed and treated with antiviral agents before progressing to cirrhosis, the occurrence of liver cancer can be prevented in most cases.
Alcoholic liver disease is also a major cause of liver cancer, and drinking alcohol can prevent liver cancer.
Alcohol, along with viral hepatitis, is one of the main causes of chronic hepatitis, cirrhosis and liver cancer, and accounts for 12.5% of liver cancer in Korea.
In particular, when chronic hepatitis B or C infection is accompanied, the risk of liver cancer is significantly higher than that of non-drinkers even with a small amount of alcohol. Regardless of the type of alcohol, the amount and frequency of alcohol consumption mainly affect the incidence of liver cancer, and drinking more than a standard of 3 drinks a day (the amount of alcohol in one standard drink is 10 g, equal to 50 ml of soju at 20 degrees) increases the incidence of liver cancer by 1.16 times. Reported.
Women show a higher frequency of liver damage than men even if they drink the same amount of alcohol due to less alcohol-degrading enzymes and higher body fat percentage than men. For health reasons, it is best to refrain from drinking, but if you need to drink alcohol Relatively safe alcohol intake is less than 2 cups per day in men, less than 1 cup per day in women, and it is known that the incidence of alcohol-dose-dependent liver cancer increases with each additional drink a day. In alcoholic liver disease, drinking alcohol is the most important treatment. Previous meta-analysis results show that drinking alcohol reduces the risk of liver cancer by about 6-7% every year.
Non-alcoholic fatty liver disease is the most common cause of chronic liver disease in recent years and can be treated through weight loss.
The incidence of non-alcoholic fatty liver disease has increased rapidly in recent decades, and is now the most common cause of chronic liver disease.
In particular, 60% of diabetic or obese patients over 50 years of age have non-alcoholic steatohepatitis with advanced fibrosis, which can lead to cirrhosis or liver cancer. In most cases of liver deterioration due to non-alcoholic fatty liver disease, when it progresses to liver cirrhosis or liver cancer, the fat in the liver is lost, so it is not known that non-alcoholic fatty liver disease is the causative disease. It is believed that the majority of liver cancer patients are due to this disease.
In a recent study, the rate of liver cancer of unknown cause in Korea reaches 9.5%, and it is known to be on the rise. Liver cancer associated with non-alcoholic fatty liver disease is closely related to metabolic syndrome, and it is believed to occur due to the progression of cellular and gene damage caused by chronic inflammation. However, as no effective treatment has been established, about 25% of nonalcoholic steatohepatitis patients progress to liver cirrhosis, and 10-25% of them are predicted to develop liver cancer, so appropriate measures are needed. During high-intensity jogging or active physical activity, the incidence of liver cancer decreases by 44-46%, and the incidence of liver cancer decreases by 30% each time the body mass index decreases by 5 kg/m2, and one cup of coffee a day. Drinking is known to reduce the incidence of liver cancer by 14%, so it is important to prevent liver cancer through appropriate lifestyle improvement.
summary
The Korean Society of Liver Cancer said, “If liver damage continues due to chronic liver disease, liver cirrhosis and liver cancer occur. If liver damage is eliminated through appropriate treatment, the occurrence of liver cirrhosis and liver cancer can be prevented.” He emphasized that it is important to prevent liver cancer by controlling liver damage by antiviral treatment in cases of hepatitis and hepatitis C, abstaining from alcohol in case of alcoholic liver disease, and weight control in case of non-alcoholic fatty liver disease.”
February 2 of every year is the day of liver cancer, and patients with risk factors must undergo two tests (liver ultrasound/serum AFP) twice a year to diagnose liver cancer early.