Niigata University Hospital Center for Liver Diseases was established in 2009, following a notice issued in 2007 aimed at developing the care system for liver diseases. The center provides proper medical information to increase awareness on hepatitis C (HCV) and manages the medical expense subsidy system for viral hepatitis in Niigata Prefecture. The center cooperates with national government organizations and publishes an annual report on viral hepatitis in Niigata Prefecture. Additionally, the center works towards viral hepatitis eradication but employs strategies based on local settings because of a lack of doctors. A large number of Japanese citizens have not been tested for hepatitis C. Furthermore, the hepatitis E, hepatitis A and drug-resistant hepatitis B virus must be carefully monitored. The center, therefore, plays an important role in terms of providing citizens with a good healthcare environment through various medical expense support systems related to liver cancer and liver cirrhosis.

A 77-year-old woman with chronic hepatitis C received radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). One year after RFA, the patient underwent resection of solitary no. 8a lymph node metastasis. However, 7 months after surgery, computed tomography (CT) scan revealed recurrence of hepatic and splenic hilar lymph node metastases. Sorafenib therapy was initiated, and subsequent dynamic magnetic resonance imaging (MRI) performed at the eighth month of therapy indicated a complete response (CR), sustained for 3 years even after gradual dose reduction of sorafenib, prior to subsequent complete discontinuation. The patient remains in remission 4 years after cessation of sorafenib therapy. Complete response rate to sorafenib therapy is roughly 1%, and it remains unclear whether sorafenib therapy should be continued following achievement of CR. We report a case of long-term sustained CR with off-therapy to sorafenib in advanced HCC.

An 87-year-old man with an enlarged hepatic tumor was referred to our institute by a medical examination center. He had been diagnosed with a malignant liver tumor through several contrast imaging studies. Because of the patient's age, the underlying disease, and the absence of bile duct invasion on imaging, radiofrequency ablation (RFA) was selected as a treatment option. A histological examination during the RFA procedure revealed the tumor to be a cholangiocellular carcinoma. In addition, the deposition of Thorotrast, a contrast agent used in the 1930s to 1950s, was suspected in the background liver collected simultaneously. Radiofrequency ablation was performed twice for recurrent lesions, and the tumor was controlled for roughly 3 years following the initial treatment. A case of intrahepatic cholangiocellular carcinoma due to Thorotrast deposition was observed and successfully controlled by RFA. Since intrahepatic cholangiocellular carcinoma from Thorotrast deposition occurs multicentrically and intrahepatically, RFA and other local therapies may present effective options for older patients with cholangiocarcinoma who are at a higher risk of surgical resection intolerance.

We experienced a case of autochthonous hepatitis E by hepatitis E virus (HEV) genotype 4. The phylogenetic tree analysis indicated that the HEV isolate obtained from the patient was segregated into the HEV subgenotype 4a (HEV-4a) cluster. The patient had no history of travel abroad, e.g., to China, where HEV-4a strains are endemic. The source and the route of the HEV-4a infection were unknown. Strains of HEV-4a may be indigenous to Japan despite remaining undetected to date, either in swine or wild animals. Additional HEV subgenotypes circulating in swine and wild animals in Japan require investigation to reveal the characteristics of HEV-4a infection in autochthonous cases in Japan.

Lenvatinib (LEN) is a standard of care for patients with advanced hepatocellular carcinoma that has a high objective response rate (ORR). However, LEN is indicated only for patients with reserved liver function. We, therefore, posited that using LEN in **** (BCLC) stage B2 or B3 may be beneficial and conducted a prospective observational study in this context. In this paper, we report the results of that study in 15 initial patients. Three patients terminated LEN at 4.9 months of the median observation period, two because of disease progression and one because of an adverse event. The objective response rate (ORR) was 13% and 67% in response evaluation criteria in solid tumors (RESCIT) v1.1 and modified response evaluation criteria in solid tumors (mRECIST), respectively. We wish to continue the study to confirm survival benefits.

In this multicenter study, we evaluated the efficacy and safety of 12-week sofosbuvir/velpatasvir (SOF/VEL) treatment. We enrolled 43 consecutive patients with decompensated cirrhosis caused by hepatitis C virus (HCV) infection, 72% and 28% of them were positive for genotype 1 and 2, respectively. At baseline, 79% of the patients were Child-Pugh (CP) class B and 19% were CP class C. All patients completed the 12-week SOF/VEL treatment without any severe adverse events. At post-treatment week 12, 41 patients achieved a sustained virological response (95%), and 21 showed improvement in CP class. The remaining two patients were lost to follow-up. Encephalopathy was a frequent adverse event (16%), but was well-controlled by outpatient management. In conclusion, 12-week SOF/VEL treatment is effective and safe for patients with decompensated cirrhosis caused by HCV infection.