title: Hepatocellular carcinoma: Exploring the impact of ethnicity on molecular biology.
abstract: Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the third leading cause of cancer-related death. The high rate of diagnosis in non-curable stages and the lack of novel active treatments make it necessary to review all the possible sources of misleading results in this scenario. The incidence of HCC shows clear geographical variation with higher annual incidence in Asia and Africa than in Western countries; we aimed to review the literature to find if there are different trends in the main activated molecular pathways. Hyperactivation of RAS/RAF/MEK/ERK and PI3K/AKT/mTOR signalling and epithelial to mesenchymal transition (EMT) process are more prevalent in the Western population; however, fibroblast growth factor (FGF), transforming growth factor β (TGFβ) and Notch pathways seems to be more relevant in Asian population. Whether these variations just reflect the distinct distribution of known causes of HCC or proper ethnical differences remain to be elucidated. Nevertheless, these clearly different patterns are relevant to regional or worldwide clinical trial design. If this information is neglected by sponsors and researchers the rate of failure in HCC trials will not improve.
authors.affiliation: Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Lamarca
authors.affiliation: Cancer Molecular Pathology and Therapeutic Targets Research Group, IdiPAZ, La Paz University Hospital, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Mendiola
authors.affiliation: Faculty of Life Sciences, University of Manchester, Manchester, UK. Electronic address: Jorge.Barriuso@manchester.ac.uk.
authors.forename: Jorge
authors.initials: J
authors.lastname: Barriuso
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000378:metabolism*; D042002:Chromatin Assembly and Disassembly; D058750:Epithelial-Mesenchymal Transition; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000378:metabolism*; D009389:Neovascularization, Pathologic; D015398:Signal Transduction
keywords: Countries; Differences; Hepatocellular carcinoma; Molecular biology; Response to treatment; Sorafenib