Case-01: Epidemiology

This section outlines how the data of MDV can be used by reviewing some cases.

Case Study (Epidemiology)

Database Analysis of Patients with Hepatocellular Carcinoma and Treatment Flow in Early and Advanced Stages


Akada K, Koyama N, Taniguchi S, et al. Database analysis of patients with hepatocellular carcinoma and treatment flow in early and advanced stages [J]. Pharmacol Res Perspect. 2019;7(4):e00486.


  • Prognosis of advance hepatocellular carcinoma (HCC) is not as developed when compared to treatment modalities and diagnosis in Japan.
  • Different treatment flows are seen for each kind of HCC stage based on Barcelona Clinic Liver Cancer (BCLC) staging system but it is not well understood in Japan.

Objectives of the Study

To understand the following content by utilizing real world data from Japanese claim database.

  • 1Baseline characteristics and treatment flow of HCC patients;
  • 2Variances in treatments between early and advanced stages;
  • 3Impact of tumor stage progression

Study Design and Criteria

Study Design: Retrospective Cohort Study

Target Period: April 1, 2008 - January 31, 2017

Inclusion Criteria

  • 1Patient who have both following criteria
  • a.Had a definitive diagnosis of HCC
  • ICD10 code: C220
  • b.Had a history of diagnosis marker for HCC
  • α‐fetoprotein (AFP)
  • des‐γ‐carboxy prothrombin (DCP)
  • 2Have one of the following treatments
  • Transcatheter arterial chemoembolization (TACE)
  • Transcatheter arterial embolization (TAE)
  • Hepatectomy
  • Radiofrequency ablation (RFA)
  • Percutaneous ethanol injection (PEI)
  • Hepatic arterial infusion chemotherapy (HAIC)


Have sorafenib chemotherapy with (>) 180 days of follow-up period after definitive diagnosis of HCC

  • 3Have cancer stage data with primary HCC patients

Characteristics of Patients with Hepatocellular Carcinoma


Serum Laboratory Values and Child Pugh Scores


First-line Treatments for HCC Patients


Sankey Diagram of Treatment Flow for HCC Patients

Change of treatments from first to fourth line were observed in early (A) stages


Sankey Diagram of Treatment Flow for HCC Patients

Change of treatments from first to fourth line were observed in advanced (B) stages



  • The study outlines the clear differences in baseline characteristics and treatment flow between early and advanced stages.
  • Further analysis could be considered and beneficial regarding treatment selection and forecasting outcome such as survival with longer follow-up data on the database used for this study.

Service used for the Case Study:


  • BCLCBarcelona Clinic Liver Cancer
  • HAICHepatic arterial infusion chemotherapy
  • HBVHepatitis B virus
  • HCCHepatocellular carcinoma
  • HCVHepatitis C virus
  • RFARadiofrequency ablation
  • TACETranscatheter arterial chemoembolization

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