Global Epidemiology, Prevention, and Management of Hepatocellular Carcinoma

Abstract

The incidence rate of hepatocellular carcinoma (HCC) is rising. It is one of the most common cancers worldwide and accounts for substantial morbidity and mortality. Chronic hepatitis B virus (HBV) infection, chronic hepatitis C virus (HCV) infection, and nonalcoholic fatty liver disease (NAFLD) are the most important etiologies of HCC, and effective screening and management strategies are crucial to reduce the HCC risk. For HBV, which accounts for the majority of HCC cases, most infections were acquired via perinatal and early horizontal transmission. Universal vaccination of newborns has led to a decline in HCC incidence compared with the pre-vaccination era. Effective antiviral therapies with nucleos(t)ide analogues or pegylated interferon reduced the incidence of HCC. For HCV, the emergence of effective direct-acting antiviral (DAA) agents has substantially improved cure rates; therefore all patients with HCV should be considered for DAA treatment. The most important obstacle in eliminating HCV is access to therapy. For NAFLD, the global incidence is increasing rapidly, thus its impact on HCC incidence may be explosive. Progression to HCC in NAFLD happens particularly in those with nonalcoholic steatohepatitis (NASH) and exacerbated by metabolic syndrome, or PNPLA3 gene polymorphism. Lifestyle changes are imperative while drug therapy has yet to demonstrate substantive protective effects on HCC prevention. For management of HCC, early diagnosis via imaging surveillance among persons with HCC risk factors remains the most important strategy to identify early-stage disease appropriate for resection or transplantation.

Role of the Gut–Liver Axis in Liver Inflammation, Fibrosis, and Cancer: A Special Focus on the Gut Microbiota Relationship

“…Recently, the development of therapies and methods for controlling hepatitis B virus and hepatitis C virus infections has led to a reduction in the mortality rate of viral HCC worldwide . On the other hand, the incidence of NASH, the aggressive inflammatory form of nonalcoholic fatty liver disease (NAFLD) without viral etiology, and NASH‐associated cirrhosis and HCC is rapidly increasing . Moreover, molecular‐based therapies for NASH have been developed, and these therapies could also help us understand the progression mechanisms of NASH and NASH‐associated HCC.…”

Precision pathology analysis of the development and progression of hepatocellular carcinoma: Implication for precision diagnosis of hepatocellular carcinoma

“…At the same time, the incidence of virus‐related liver disease has been decreasing thanks to vaccination against hepatitis B virus (HBV) and direct‐acting antiviral therapies for HCV. As a result, the etiology of HCC has been changing: although the proportion of HCCs caused by chronic viral hepatitis is still higher than that caused by NAFLD, chronic viral hepatitis is becoming less common as a cause of HCC, whereas NAFLD is becoming more common, especially in the developed countries . Consequently, the assessment of liver fibrosis is increasingly important for patients with NAFLD.…”

“…As a result, the etiology of HCC has been changing: although the proportion of HCCs caused by chronic viral hepatitis is still higher than that caused by NAFLD, chronic viral hepatitis is becoming less common as a cause of HCC, whereas NAFLD is becoming more common, especially in the developed countries. 21 Consequently, the assessment of liver fibrosis is increasingly important for patients with NAFLD. Evaluation of the fibrosis stage is also important in NAFLD because most HCC cases in NAFLD occur in patients who also have cirrhosis.…”

Interaction between the tumor microenvironment and resection margin in different gross types of hepatocellular carcinoma

“…The occurrence of viral hepatitis, cirrhosis, and HCC will continue to decrease with the evolution of antiviral agents. However, the incidence of alcohol and nonalcoholic steatohepatitis is increasing, and many patients show poor residual liver function after diagnosis with HCC …”

“…However, the incidence of alcohol and nonalcoholic steatohepatitis is increasing, and many patients show poor residual liver function after diagnosis with HCC. 3 Poor residual liver function is the main negative side effect of liver resection. One randomized control study reported that a wide resection margin is an important prognostic factor.…”