Hepatocellular carcinoma: Surgical perspectives beyond the barcelona clinic liver cancer recommendations

Abstract

The barcelona clinic liver cancer (BCLC) staging system has been approved as guidance for hepatocellular carcinoma (HCC) treatment guidelines by the main Western clinical liver associations. According to the BCLC classification, only patients with a small single HCC nodule without signs of portal hypertension or hyperbilirubinemia should undergo liver resection. In contrast, patients with intermediate-advanced HCC should be scheduled for palliative therapies, even if the lesion is resectable. Recent studies report good short-term and long-term outcomes in patients with intermediate-advanced HCC treated by liver resection. Therefore, this classification has been criticised because it excludes many patients who could benefit from curative resection. The aim of this review was to evaluate the role of surgery beyond the BCLC recommendations. Safe liver resection can be performed in patients with portal hypertension and well-compensated liver function with a 5-year survival rate of 50%. Surgery also offers good long-term result in selected patients with multiple or large HCCs with a reported 5-year survival rate of over 50% and 40%, respectively. Although macrovascular invasion is associated with a poor prognosis, liver resection provides better long-term results than palliative therapies or best supportive care. Recently, researchers have identified several genes whose altered expression influences the prognosis of patients with HCC. These genes may be useful for classifying the biological behaviour of different tumours. A revision of the BCLC classification should be introduced to provide the best treatment strategy and to ensure the best prognosis in patients with HCC.

MicroRNA-33a downregulation is associated with tumorigenesis and poor prognosis in patients with hepatocellular carcinoma

“…A principal reason for the high mortality of this disease is the failure of early diagnosis for patients with HCC and the lack of effective therapies for patients with HCC in advanced stages. Despite a number of advances made in therapeutic strategies and surgery, the overall prognosis for patients with HCC remains poor due to the high rate of metastasis and recurrence (4)(5)(6). Hence, the characterization of the molecular mechanisms in HCC is urgently required to allow the development of novel treatment methods for patients with HCC.…”

Silencing of survivin by YM155 induces apoptosis and growth arrest in hepatocellular carcinoma cells

“…Hepatocellular carcinoma (HCC) is responsible for numerous clinical therapeutic problems and is ranked as the third leading cause of cancer-associated mortality worldwide (1). As only patients with early-stage HCC are able to achieve optimal survival by radical hepatectomy or liver transplantation, the majority of patients are beyond curative intervention upon HCC diagnosis (1,2).…”

“…As only patients with early-stage HCC are able to achieve optimal survival by radical hepatectomy or liver transplantation, the majority of patients are beyond curative intervention upon HCC diagnosis (1,2). Notably, existing alternative strategies, including chemotherapy and immunotherapy, have seldom elicited satisfactory responses in HCC (2,3).…”

Hepatocellular carcinoma: Surgeon's view on latest findings and future perspectives

“…Up to now, resection as most favorable treatment option is only recommended for the very early stage (0) of HCC in patients with normal portal venous pressure and normal serum bilirubin. However, as reviewed in detail by Guglielmi et al [147] , the rigid Slotta JE et al . HCC: Current management and perspectives EASL-EORTC limits for liver resection can be expanded to more advanced tumor stages.…”