Current status of primary liver cancer and decompensated cirrhosis in Japan: launch of a nationwide registry for advanced liver diseases (REAL)

Kazuya Okushin, Ryosuke Tateishi, Arata Takahashi, Koji Uchino, Ryo Nakagomi, Takuma Nakatsuka, Tatsuya Minami, Masaya Sato, Mitsuhiro Fujishiro, Kiyoshi Hasegawa, Yuichiro Eguchi, Tatsuya Kanto, Shoji Kubo, Hitoshi Yoshiji, Hiroaki Miyata, Namiki Izumi, Masatoshi Kudo, Kazuhiko Koike

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background: We developed a nationwide database that stores data of patients with primary liver cancer (PLC) and decompensated cirrhosis (DC) on an admission basis. Methods: A database was constructed using the National Clinical Database, a nationwide registry platform for various diseases in Japan. Mutual data exchange was possible with the Nationwide Follow-up Survey of Primary Liver Cancer in Japan by the Liver Cancer Study Group of Japan. The stored data on the admission of patients with PLC, DC, or both, included treatment details as well as patient characteristics. Results: A total of 37,705 admissions (29,489 PLC, 10,077 DC, and 1862 for both) in 21,376 patients from 224 hospitals were analyzed. The proportions of patients with hepatitis B, hepatitis C, and non-viral etiology were 11.9%, 36.2%, and 42.6%, respectively, in PLC, and 7.5%, 23.8%, and 55.0%, respectively, in DC. The mean ages (± standard deviation) on admission with PLC and DC were 73 ± 10 and 68 ± 13 years, respectively. The Barcelona Clinic Liver Cancer (BCLC) stage for PLC was 0, A, B, C, and D in 22.0%, 17.1%, 29.6%, 15.1%, and 5.1%, respectively. Treatment modalities for PLC were resection, ablation, transarterial chemoembolization, and systemic therapy in 18.4%, 22.8%, 33.7%, and 11.4%, respectively. A vasopressin receptor V2 antagonist was used in 38.2% in addition to conventionally used loop diuretics and aldosterone antagonists for DC. Conclusions: The distribution of treatment options for PLC on admission differed from that of the initial treatment. Newly introduced drugs are widely used in patients with DC.

Original languageEnglish
Pages (from-to)587-597
Number of pages11
JournalJournal of gastroenterology
Issue number8
Publication statusPublished - 2022 Aug


  • Decompensated cirrhosis
  • National clinical database
  • Primary liver cancer

ASJC Scopus subject areas

  • Gastroenterology


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