Optimizing curative management of hepatocellular carcinoma

Abstract

The goal of curative management of hepatocellular carcinoma is to provide the best chance of remission. However, recurrence rates for both local and distant relapse are high. Patient subgroups at higher risk of these events can be identified based on histological patterns that are closely linked to specific molecular subtypes. Patient outcome has improved with more effective therapeutic strategies thanks to technological advances in surgical techniques and percutaneous ablation. The main goal of controlling the cause of liver disease is to decrease distant/late recurrence and prevent deterioration of hepatic function. Ongoing trials testing the combination of neoadjuvant and/or adjuvant regimens with these procedures as well as routine tumour molecular analysis may modify therapeutic algorithms for hepatocellular carcinoma in the future.

Hepatocellular carcinoma in patients with non-alcoholic steatohepatitis – epidemiology, risk factors, clinical implications and treatment

“…The 5-year survival is 60% from the time of resection, with low, lower than 3%, perioperative mortality. Frequent cancer recurrences, reaching 70% in the course of 5 years, pose a major problem [ 54 , 55 ]. Long-term results of thermal tumour ablation 2 cm in size are comparable to the results of liver resection surgery [ 54 , 55 ].…”

“…Frequent cancer recurrences, reaching 70% in the course of 5 years, pose a major problem [ 54 , 55 ]. Long-term results of thermal tumour ablation 2 cm in size are comparable to the results of liver resection surgery [ 54 , 55 ]. After transplantation, due to HCC in patients meeting the Milan criteria, cancer recurrences occur in 10% to 15% of cases.…”

“…After transplantation, due to HCC in patients meeting the Milan criteria, cancer recurrences occur in 10% to 15% of cases. After broadening eligibility criteria, in larger lumps, they occur far more often [ 55 , 56 ]. In order to improve the results of liver transplantation, many centres adopted various auxiliary criteria, including α-fetoprotein (AFP) concentration in serum, which turned out to be helpful in determining the risk of recurrence, and therefore in the assessment of prognosis.…”

“…Their percentage increased from 2003 to 2011 in the USA from 6.3% to 19.2% respectively [ 15 ]. Moreover, NASH is an increasingly frequent indicator for LTx due to HCC, but it results in numerous clinical implications [ 55 ]. Patients with NASH and confirmed liver cancer directed for surgical treatment are usually elderly people, with concomitant diseases, with less developed liver failure and usually larger lumps in comparison to patients with HCC of different aetiologies.…”

Reduced IκBα promotes hepatocellular carcinoma cell proliferation and migration via regulation of NF‑κB/Erbin axis

“…Hepatocellular carcinoma (HCC) is one of the most malignant cancer types worldwide, especially in east Asia ( 1 ). Although significant improvements in diagnosis and treatment have been accomplished, the mortality rate for patients with HCC remains high, with ~782,000 deaths worldwide annually ( 1 – 3 ). The rapid and unnoticeable development and metastases of HCC are crucial to its progression, resulting in unresectable vascular thrombi, intrahepatic satellite nodules or cancer recurrence ( 4 , 5 ).…”