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Management strategies for hepatocellular carcinoma: old certainties and new realities

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Abstract

Hepatocellular carcinoma (HCC) is a highly prevalent disease ranking among the ten most common cancers worldwide with increasing trend of incidence in most developed countries. The great healthcare costs and economic burden of HCC dictate proper preventive interventions as well as surveillance and screening programs to decrease disease incidence and allow early diagnosis. HCC treatment outcomes are affected by several variables, including liver function, patient’s performance status, and tumor stage. In line with the Barcelona Clinic Liver Cancer (BCLC) staging curative treatments, such as surgery or radio-frequency ablation, are indicated in early-stage HCC (BCLC-A), and the noncurative treatments are indicated in intermediate and advanced stages of HCC (BCLC-B, C). Transarterial chemoembolization (TACE) represents the treatment of choice for intermediate-stage HCC with Child–Pugh A cirrhosis, and the long-term survival after liver transplantation is inferior to that of early-stage HCCs. In advanced-stage HCC or when complete necrosis is not achieved or early recurrence after TACE develops, individualized treatments such as systemic treatment or combined radiation therapy are indicated. The increasing knowledge of the genomic landscape of HCC and the development of molecular-targeted therapies is heading toward expanding the armamentarium for HCC management.

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Acknowledgments

We apologize for not citing all the relevant articles due to space limitations. This work was funded by the “5 × 1000” voluntary contribution, by a grant (to G.M.) from the Italian Ministry of Health (RC1201ME04, RC1203ME46, RC1302ME31, and RC1403ME50) through Department of Medical Sciences, Division of Internal Medicine and Chronobiology Unit, IRCCS Scientific Institute and Regional General Hospital “Casa Sollievo della Sofferenza,” Opera di Padre Pio da Pietrelcina, San Giovanni Rotondo (FG), Italy, by Wellcome Trust (to J.A.O.) and by the Associazione Italiana per la Ricerca sul Cancro (AIRC) program MyFAG-13419 (to M.V.).

Conflict of interest

The authors declare no conflict of interests in relationship to the present article.

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Authors and Affiliations

  1. Department of Medical Sciences, Division of Internal Medicine and Chronobiology Unit, IRCCS Scientific Institute and Regional General Hospital “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, FG, Italy

    Gianluigi Mazzoccoli

  2. Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy

    Roberto Tarquini, Alice Valoriani & Fabio Marra

  3. Inter-company Department for Continuity Assistance, School of Medicine, University of Florence, Florence, Italy

    Roberto Tarquini & Alice Valoriani

  4. San Giuseppe Hospital, Empoli, Italy

    Roberto Tarquini & Alice Valoriani

  5. University College London (UCL) – Institute for Liver and Digestive Health, Division of Medicine, Royal Free Hospital, London, UK

    Jude Oben & Manlio Vinciguerra

  6. Istituto EuroMEditerraneo di Scienza e Tecnologia (IEMEST), Palermo, Italy

    Manlio Vinciguerra

  7. School of Science and Technology, Nottingham Trent University, Nottingham, UK

    Manlio Vinciguerra

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  6. Fabio Marra
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Correspondence to Gianluigi Mazzoccoli.

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Mazzoccoli, G., Tarquini, R., Valoriani, A. et al. Management strategies for hepatocellular carcinoma: old certainties and new realities. Clin Exp Med 16, 243–256 (2016). https://doi.org/10.1007/s10238-015-0368-z

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  • DOI: https://doi.org/10.1007/s10238-015-0368-z

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