Personalized treatment of patients with very early hepatocellular carcinoma.
Hepatocellular carcinoma (HCC), in its very early stage, is heterogeneous both in terms of liver function (i.e., presence or absence of portal hypertension, model for end-stage liver disease score, Child-Pugh score 5 or 6, bilirubin level) and tumor characteristics (i.e., location, alpha-fetoprotein values, pathological features such as microvascular invasion, tumor grade and satellitosis). Existing evidence in comparing different curative options for patients with very early HCC is poor due to small sample sizes and lack of solid subgroup analyses. Large observational studies are available, with the potential to identify effective interventions in different subgroup of patients and to discover which treatments work "in a real world setting". These studies suggest some important treatment selection strategies in very early HCC patients. According to extent of liver resection, and liver function, percutaneous ablation or liver resection are the recommended first line therapies in these patients. Laparoscopic surgery (resection or ablation) is the preferable strategy when the tumor is in the surface of the liver or close to extra-hepatic organs. Due to scarce donor resources and competition with patients at high transplant benefit (HCC patients unsuitable for non-transplant radical therapies and non-HCC patients with decompensated cirrhosis), transplantation is recommended only as second line therapy in patients with very early stage HCC in case of tumor recurrence or liver failure after ablation or liver resection.
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. Electronic address: alessandro.vitale@unipd.it.
Alessandro
A
Vitale
Department of Internal Medicine III, Division of Gastroenterology/Hepatology, Liver Cancer (HCC)-Study Group, Medical University, Vienna, Austria; Department of Gastroenterology, Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria.
Markus
M
Peck-Radosavljevic
Gastroenterology Unit, Department of Internal Medicine, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, University of Genoa, Genoa, Italy.
Edoardo G
EG
Giannini
AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.
Eric
E
Vibert
Department of Internal Medicine III, Division of Gastroenterology/Hepatology, Liver Cancer (HCC)-Study Group, Medical University, Vienna, Austria.
Wolfgang
W
Sieghart
Department of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
Sven
S
Van Poucke
Department of Surgery, Wexner Medical Center at The Ohio State University, OH, USA.
Timothy M
TM
Pawlik
D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy; D019468:Disease Management; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D018579:Patient Selection
Ablation; Evidence based treatment; Liver resection; Liver transplantation; Personalized approach; Very early hepatocellular carcinoma