Surgical treatment of hepatocellular carcinoma: Similar long-term results despite geographic variations

Abstract

Recently, the International Cooperative Study Group for hepatocellular carcinoma (HCC) proposed a new staging based on data from multiple centers across the world. The new TNM staging has been shown to be more accurate in the prognostic classification of patients after resection for HCC. This staging is the basis for the new TNM for HCC approved by the AJCC (American Joint Committee on Cancer) and UICC (Union Internationale Contre le Cancer). Although the general applicability of the new staging system has been confirmed, there still remains a marked geographic variation in the clinicopathologic factors of HCC patients based on their country of origin. Tumor size, rates of hepatitis, and degree of underlying liver damage all vary significantly among countries. Despite these geographic variations, recent data reveal similar long-term survival in Western and Eastern centers when these clinicopathologic factors are accounted for. Uniform criteria that account for these clinicopathologic differences need to be developed to assist in stratifying patients across hepatobiliary centers.

Underutilization of therapy for hepatocellular carcinoma in the medicare population

“…Over the time period of this study, these therapies and their use have evolved tremendously. 6,18,[24][25][26][27][28] Changes in practice and safety may have resulted in more patients being treated for their HCC over time. The substantial survival benefit that a patient receives from any therapy suggests that improving access to care may be the best strategy to rapidly improve HCC outcomes overall.…”

Selecting an optimal staging system for hepatocellular carcinoma

“…This is likely because the factor of severity of cirrhosis is not included in this system. The TNM has been exclusively used to stage patients undergoing surgical resection, 16,36,37 because these patients usually have a well compensated liver disease and the impact of cirrhosis factor on survival could be minimized. Another shortcoming of the TNM staging system is that it comprises only 4 staging categories (stage I to IV), which may not be enough to categorize and differentiate the outcome of patients with early to advanced stage of cirrhosis and tumor burden.…”

Adjuvant interferon therapy after curative therapy for hepatocellular carcinoma (HCC): A meta-regression approach

“…Advances in surveillance, early diagnosis, and loco-regional therapy, including surgery and ablation therapy, have started to improve the survival of patients with early-stage diseases [2][3][4]. However, the tumors recurred in more than 50% of the patients despite initial successful treatment.…”