Hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) represents approximately 90% of all cases of primary liver cancer, which is the second leading cause of cancer related deaths globally and has an incidence of 850,000 new cases per year. The main risk factors for developing HCC are wellknown and include infection with hepatitis B and C viruses, alcohol intake and ingestion of the fungal metabolite aflatoxin B1. Nonetheless, knowledge is emerging regarding additional risk factors such as non-alcoholic steatohepatitis. Advances in the understanding of the molecular pathogenesis of HCC led to identification of critical driver mutations, however the most prevalent of these are not yet druggable targets. The molecular classification of HCC is not established, and the Barcelona-Clinic-Liver Cancer Classification is the main clinical algorithm for the stratification of patients according to prognosis and treatment allocation. Surveillance programmes enable detection of early-stage tumours that are amenable to curative therapies-resection, liver transplantation or local ablation. At more-developed stages, only chemoembolization (for intermediate HCC) and sorafenib (for advanced HCC) have shown survival benefits. There are major unmet needs in HCC management that might be addressed through discovery of new therapies and their combinations for use in the adjuvant setting and for intermediate and advanced stage disease, biomarkers for therapy stratification, patient-tailored strategies targeting driver mutations and/or activating signalling cascades and validated measurements of quality of life. Recent failures in testing systemic drugs for intermediate and advanced stages have pointed towards a refinement in trial design and defining novel approaches.

Computational intelligence identifies alkaline phosphatase (ALP), alpha-fetoprotein (AFP), and hemoglobin levels as most predictive survival factors for hepatocellular carcinoma

“…The study of El-Fattah et al 101 instead, stated that age, race, tumor size, AFP level, the American Joint Committee on Cancer (AJCC) stage, and the year of diagnosis were the most relevant factors for survival in the medical records of HCC-diagnosed patients. Falkson et al 102 identified impaired performance status, male sex, older age, and disease symptoms (jaundice and reduced appetite) as factors most mortality-related. The research study of Vauthey et al 103 identified cirrhosis and vascular invasion as clinical aspects more correlated to mortality.…”

Evolving thresholds for liver transplantation in hepatocellular carcinoma: A Western experience

“…HCC most commonly occurs in a background of chronic liver disease with or without cirrhosis . Prognosis is not only dependent on tumor burden, but on underlying liver function and patient performance status . Surgical resection is the standard of care for patients without underlying liver disease and with preserved liver function who develop HCC.…”

Clinicopathologic Features and Prognosis of Young Patients With Hepatocellular Carcinoma in a Large German Cohort

“…Therefore, most collectives we know about describe HBV-positive patients. Survival of these young patients varies between different publications, ranging from worse [4][5][6][7] to better prognosis 8 compared with older patients. Some reports, however, did not find a different outcome between the different age groups.…”