Status of hepatocellular carcinoma in South Korea
In South Korea, liver cancer is the 4th most common cancer in men and 6th most common cancer in women. However, the incidences of liver cancer among Korean men and women have been declining from 1999 to 2010. The reason for the declining incidence appears secondary to decreased hepatitis B virus (HBV) infection, which is the leading risk factor for hepatocellular carcinoma (HCC), with successful implementation of HBV vaccination since 1983. Despite recent advances in the treatment of HCC, including liver transplantation (LT), radiofrequency ablation (RFA), transarterial embolization, and the use of molecularly targeted agents, many patients cannot be cured due to the advanced stage of HCC at the time of diagnosis in South Korea. While the 5-year survival rate of HCC patients in Korea is relatively lower than other cancers, it has been gradually increased from the early 1990s to the late 2000s. The reason for the improvement in 5-year survival rates is attributed that early detection of HCC becomes possible by well-established surveillance program in high-risk populations for HCC in Korea. In Korea, national surveillance program for HCC was established in 2003, in which repeated applications of screening tests [serum α-fetoprotein (AFP) and liver ultrasound] at 6-month intervals have been recommended in patients at high risk for developing HCC, such as men and women older than 40 years of age with positive hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV) or underlying liver cirrhosis. It is essential that the nationwide surveillance program for HCC should be effectively executed in high-risk patients for developing HCC. Optimal application of multidisciplinary team approach and active involvement in clinical studies with new agents in HCC patients are critically important not only for the management of advanced HCC patients but also for the improvement in natural history and therapeutic outcomes of HCC patients in the future.