Current approaches to the treatment of early hepatocellular carcinoma.
For patients with early-stage hepatocellular carcinoma (HCC), potentially curative treatment options exist, including liver transplantation, surgical resection, and ablation therapy. These treatments are associated with survival benefits, and outcomes are optimized by identification of appropriate patients. However, further studies are needed to definitively confirm optimal treatment approaches for all patients. Treatment patterns vary in different parts of the world as a result of geographic differences in the incidence and presentation of the disease. In particular, because of successful screening programs, a high proportion of tumors that are identified in Japan are amenable to curative treatments, which are appropriate in a smaller proportion of patients in the west, although screening is now widely carried out in industrialized countries. Differences in the applicability of transplantation are also evident between the west and Asia. Although existing treatments for early-stage HCC are supported by considerable evidence, there remain significant data gaps. For example, further data, ideally from randomized controlled trials, are needed regarding: the use of neoadjuvant and adjuvant therapy to decrease the rate of recurrence after resection or ablation, further investigation of the role of chemoprevention following resection, and prospective analysis of outcomes of living donor compared with deceased donor liver transplantation.
Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China. slye@shmu.edu.cn
Sheng-Long
SL
Ye
Tadatoshi
T
Takayama
Jeff
J
Geschwind
Jorge A
JA
Marrero
Jean-Pierre
JP
Bronowicki
D055011:Ablation Techniques; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007564:Japan; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D019520:Living Donors; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D016896:Treatment Outcome