Treatment of early hepatocellular carcinoma: How to predict and prevent recurrence.

Abstract

Early and very early stage hepatocellular cancers (HCC) when staged clinically, if they are coincident with histological early HCC, have the best outcome in terms of recurrence rates and survival after potential curative therapy. This is because predictors of HCC recurrence such as microscopic vascular invasion and satellite metastases, are rarely present in histological early HCC. Other predictors of HCC recurrence are size of the principal lesion, numbers of lesions, histological grade, several gene signature patterns that are promising for future clinical practice, and other less constantly predictive features such as high alpha-fetoprotein and transaminase concentrations, and cellular aneuploidia. Adjuvant and neo-adjuvant therapies have been proposed to reduce the risk of HCC recurrence after potentially curative treatments. These preventative therapies are focused on extra-tumoural therapies, such as retinoids or interferon, possibly effective in preventing late recurrence by influencing the premalignant field in cirrhosis, and on tumour related therapies, by utilising several procedures able to downstage tumours, such as neo-adjuvant and "bridge to transplant" therapies, which influence mainly early recurrence. Both strategies have been combined for example with using sorafenib which may treat both the patient's premalignant liver and malignant liver cells themselves.

• Authors: Lorenzo Andreana, Andrew K Burroughs
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 42 Suppl 3 Pg. S249-57 (Jul 2010) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 20547311 (Publication Type: Journal Article)
• Copyright: Copyright 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Angiogenesis Inhibitors
• Antineoplastic Agents

Topics

• Ablation Techniques
• Angiogenesis Inhibitors (therapeutic use)
• Antineoplastic Agents (therapeutic use)
• Carcinoma, Hepatocellular (drug therapy, pathology, surgery)
• Chemoprevention
• Humans
• Liver Cirrhosis (surgery)
• Liver Neoplasms (drug therapy, pathology, surgery)
• Liver Transplantation
• Neoadjuvant Therapy
• Neoplasm Recurrence, Local (prevention & control)
• Neoplasm Staging