<p>Intermediate stage hepatocellular carcinoma: a summary review</p>

Abstract

It is well known that intermediate stage hepatocellular carcinoma (HCC) encompasses the widest class of patients with this disease. The main characteristic of this special sub-group of patients is that it is extensively heterogenous. This substantial heterogeneity is due to the wide range of liver functions of such patients and variable tumor numbers and sizes. Real world clinical data show huge support for transarterial chemo-embolization (TACE) as a therapeutic modality for intermediate stage HCC, applied in 50%–60% of those class of patients. There are special considerations in various international guidelines regarding treatment allocation in intermediate stage HCC. There is an epidemiological difference in HCC in eastern and western cohorts, and various guidelines have been proposed. In patients with HCC, it has frequently been reported that there is poor correlation between the clinical benefit and real gain in patient condition and the conventional way of tumor response assessment after locoregional treatments. This is due to the evaluation criteria in addition to the scoring systems used for treatment allocation in those patients. It became clear that intermediate stage HCC patients receiving TACE need a proper prognostic score that offers valid clinical prediction and supports proper decision-making. Also, it is the proper time to study more treatment options beyond TACE, such as multimodal regimens for this class of patients. In this review, we tried to provide a summary of the challenges and future directions in managing patients with intermediate stage HCC.

Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review

“…Linear predictive models generated from large data sets were shown to be able to prognosticate for HCC patients[ 7 , 8 ]. Indeed, simpler prognostic ways are required given the complexity of the intermediate stage of HCC[ 9 ]. The emerging literature describes two new markers in HCC prognosis, the Neutrophil to Lymphocyte Ratio (NLR) and the Albumin Bilirubin (ALBI) grade.…”

<p>Drug-eluting Bead-Transcatheter Arterial Chemoembolization for Advanced Hepatocellular Carcinoma Refractory to Conventional Lipiodol-based Transcatheter Arterial Chemoembolization</p>

“…Transcatheter arterial chemoembolization (TACE) is a standard treatment for patients with multiple HCC with Barcelona Clinic Liver Cancer study group (BCLC)-B stage. 2,3 TACE showed survival benefits for unresectable HCC in randomized controlled trials 4,5 and prospective large cohort studies. 6,7 In TACE procedures, HCC nodules are embolized through feeding hepatic artery with embolic agents and anticancer agents, inducing antitumor effects by anticancer effects and ischemic effects.…”

Transarterial Chemoembolization Combined With Hepatectomy for the Treatment of Intermediate-Stage Hepatocellular Carcinoma

“…Advances in diagnostic imaging and widespread application of screening programs in high-risk populations have allowed detection of HCC at earlier stages, but some patients with HCC still continue to present in intermediate or even advanced stages. According to the Barcelona Clinic Liver Cancer (BCLC) algorithm for the treatment of HCC, intermediate-stage HCC (stage B) is defined as extensive multifocal disease without vascular invasion in patients with preserved liver function and the absence of cancer-related symptoms (2).…”