Hepatocellular carcinoma from the view of gastroenterologist/hepatologist
Authors:
prof. MUDr. Urbánek Petr, CSc.; MUDr. Hříbek Petr
Authors place of work:
Interní klinika 1. LF UK a ÚVN Praha
Published in the journal:
Klin Onkol 2020; 33(Supplementum 3): 34-44
Category:
Review
doi:
https://doi.org/10.14735/amko20203S34
Summary
Hepatocellular carcinoma (HCC) is one of the major complications of chronic liver disease, mostly of liver cirrhosis. Liver diseases from different causes differ in the risks of HCC development. Different mechanisms of carcinogenesis are involved in HCC development in different liver diseases as well. Generally, two main pathways are distinguished: the cause of liver disease itself (e. g. viral infections, accumulation of heavy metals etc.) and chronic liver inflammation and fibrogenesis, including mechanisms of oxidative stress. Rare cases of HCC in liver without underlying cirrhosis are likely the consequences of the mechanisms directly linked with particular etiological factor (e. g. protein X in chronic hepatitis B virus (HBV) infection). The key approach which can lead to significantly better results of any treatment used in HCC cases is HCC screening and surveillance. The appropriate method of HCC surveillance is abdominal ultrasonography in 6-month intervals. There is still one question to be solved: the correct definition of target population which should undergo this method of surveillance. Currently, the target population in the developed world is defined as all patients with liver cirrhosis. Unfortunately, the only method of primary prevention of HCC is available: universal HBV vaccination. Antiviral treatment of hepatitis B or C is considered as a method of secondary prevention. Adjuvant therapy of HCC after its primary therapy (antiviral therapy after HCC resection etc.) and other measures able to reduce HCC recurrence risk are usually mentioned as tertiary prevention approach. The BCLC staging system is the most common system used in Europe for the classification of HCC at the diagnosis. This classification combines the stage of HCC itself with other parameters, such as liver disease severity (Child – Pugh classification), portal hypertension etc. BCLC is a system which guides the physicians to optimal treatment options in every HCC stage. The only potentially curable approaches are surgical resection or liver transplantation. These options may be used in 1/3 of all HCC patients. Unfortunately, the vast majority of HCC patients can be treated only by palliative treatment options with transarterial chemoembolisation being the most common one.
Keywords:
hepatocellular carcinoma – chronic hepatitis B – chronic hepatitis C – non-alcoholic steatohepatitis
Zdroje
1. Global Cancer Observatory. [online]. Available from: https: //gco.iarc.fr/.
2. ÚZIS ČR. Novotvary 2014. [online]. Dostupné z: https: //www.uzis.cz/index-en.php?pg=record&id=7686.
3. Spangenberg HC, Thimme R, Blum HE. Advances in prevention and diagnosis of hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2008; 2 (3): 425–433.
4. Chayanupatkul M, Omino R, Mittal S et al. Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection. J Hepatol 2017; 66 (2): 355–362. doi: 10.1016/j.jhep.2016.09.013.
5. Wu C-Y, Lin J-T, Ho HJ et al. Association of nucleos (t) ide analogue therapy with reduced risk of hepatocellular carcinoma in patients with chronic hepatitis B – a nationwide cohort study. Gastroenterology 2014; 147 (1): 143–151. doi: 10.1053/j.gastro.2014.03.048.
6. Wong GL, Chan HL, Mak CW et al. Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients with liver cirrhosis. Hepatology 2013; 58 (5): 1537–1547. doi: 10.1002/hep.26301.
7. Ahn J, Lim JK, Lee HM et al. Lower observed hepatocellular carcinoma incidence in chronic hepatitis B patients treated with entecavir: results of the ENUMERATE study. Am J Gastroenterol 2016; 111 (9): 1297–1304. doi: 10.1038/ajg.2016.257.
8. Ahmed A, Wong RJ, Harrison SA. Nonalcoholic fatty liver disease review: diagnosis, treatment, and outcomes. Clin Gastroenterol Hepatol 2015; 13 (12): 2062–2070. doi: 10.1016/j.cgh.2015.07.029.
9. Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the US. Hepatology 2014; 59 (6): 2188–2195. doi: 10.1002/hep.26986.
10. White DL, Kanwal F, El-Serag HB. Association between nonalcoholic fatty liver disease and risk for hepatocellular cancer, based on systematic review. Clin Gastroenterol Hepatol 2012; 10 (12): 1342–1359. doi: 10.1016/j.cgh.2012.10.001.
11. Kanwal F, Kramer J, Asch SM et al. Risk of hepatocellular cancer in HCV patients treated with direct-acting antiviral agents. Gastroenterology 2017; 153 (4): 996–1005. doi: 10.1053/j.gastro.2017.06.012.
12. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology 2012; 142 (6): 1264–1273. doi: 10.1053/j.gastro.2011.12.061.
13. Thrift AP, El-Serag HB, Kanwal F. Global epidemiology and burden of HCV infection and HCV- related disease. Nat Rev Gastroenterol Hepatol 2017; 14 (2): 122. doi: 10.1038/nrgastro.2016.176.
14. Tornillo L, Carafa V, Sauter G et al. Chromosomal alterations in hepatocellular nodules by comparative genomic hybridization: high-grade dysplastic nodules represent early stages of hepatocellular carcinoma. Lab Invest 2002; 82 (5): 547–553. doi: 10.1038/labinvest.3780449.
15. Zhang DY, Friedman SL. Fibrosis-dependent mechanisms of hepatocarcinogenesis. Hepatology 2012; 56 (2): 769–775. doi: 10.1002/hep.25670.
16. Jhunjhunwala S, Jiang Z, Stawiski EW et al. Diverse modes of genomic alteration in hepatocellular carcinoma. Genome Biol 2014; 15 (8): 436. doi: 10.1186/s13059-014-0436-9.
17. Levrero M, Zuckman-Rossi J: Mechanisms of HBV-induced hepatocellular carcinoma. J Hepatol 2016, 64 (1_Suppl): S84–S101. doi: 10.1016/j.jhep.2016.02.021.
18. El-Shamy A, Pendleton M, Eng FJ et al. Impact of HCV core gene quasispecies on hepatocellular carcinoma risk among HALT-C trial patients. Sci Rep 2016; 6: 27025. doi: 10.1038/srep27025.
19. Singal A, Volk ML, Waljee A et al. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther 2009; 30 (1): 37–47. doi: 10.1111/j.1365-2036.2009.04014.x.
20. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (3): 1020–1002. doi: 10.1002/hep.24199.
21. Forner A, Vilana R, Ayuso C et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008; 47 (1): 97–104. doi: 10.1002/hep.21966.
22. Mueller C, Waldburger N, Stampfl U et al. Non-invasive diagnosis of hepatocellular carcinoma revisited. Gut 2017; 68 (5): 991–993. doi: 10.1136/gutjnl-2017-314981.
23. Chou R, Cuevas C, Fu R et al. Imaging techniques for the diagnosis of hepatocellular carcinoma. Ann Intern Med 2015; 162 (10): 697–711. doi: 10.7326/M14-2509.
24. Terzi E, Iavarone M, Pompili M et al. Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter retrospective study of 1,006 nodules. J Hepatol 2018; 68 (3): 485–492. doi: 10.1016/j.jhep.2017.11.007.
25. Marrero JA, Fontana RJ, Barrat A et al. Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 2005; 41 (4): 707–716. doi: 10.1002/hep.20636.
26. Llovet JM, Di Bisceglie AM, Bruix J et al. Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 2008; 100 (10): 698–711. doi: 10.1093/jnci/djn134.
27. Takayama T, Makuuchi M, Hirohashi S et al. Early hepatocellular carcinoma as an entity with a high rate of surgical cure. Hepatology 1998; 28 (5): 1241–1246. doi: 10.1002/hep.510280511.
28. Roayaie S, Blume IN, Thung SN et al. A system of classifying microvascular invasion to predict outcome after resection in patients with hepatocellular carcinoma. Gastroenterology 2009; 137 (3): 850–855.
29. Kudo, M. Review of 4th Single Topic Conference on HCC. Hepatocellular carcinoma: international consensus and controversies. Hepatol Res 2007; 37 (Suppl 2): S83–S87. doi: 10.1111/j.1872-034X.2007.00167.x.
30. Raoul JL, Sangro B, Forner A et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev 2011; 37 (3): 212–220. doi: 10.1016/j.ctrv.2010.07.006.
31. Sieghart W, Hucke F, Pinter M et al. The ART of decision making: retreatment with transarterial chemoembolization in patients with hepatocellular carcinoma. Hepatology 2013; 57 (6): 2261–2273. doi: 10.1002/hep.26256.
32. Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30 (1): 52–60. doi: 10.1055/s-0030-1247132.
33. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004; 130 (7): 417–422. doi: 10.1007/s00432-004-0552-0.
34. Sheu JC, Sung JL, Chen DS et al. Growth rate of asymptomatic hepatocellular carcinoma and its clinical implications. Gastroenterology 1985; 89 (2): 259–266. doi: 10.1016/0016-5085 (85) 90324-5.
35. Aghoram R, Cai P, Dickinson JA. Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B. Cochrane Database Syst Rev 2012; (9): CD002799. doi: 10.1002/14651858.CD002799.pub2.
36. Sherman M, Peltekian M, Lee C. Screening for hepatocellular carcinoma in chronic carriers of hepatitis B: incidence and prevalence of hepatocellular carcinoma in a North American urban population. Hepatology 1995; 22 (2): 432–438.
37. Wang J-H, Chang K-C, Kee K-M et al. Hepatocellular carcinoma surveillance at 4- vs. 12-month interval for patients with chronic viral hepatitis – a randomized study in community. Am J Gastroenterol Hepatology 2013; 108 (3): 416–424. doi: 10.1038/ajg.2012.445.
38. European Association for the Study of the Liver. EASL-EORTC Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 2012: 56 (4): 908–943. doi: 10.1016/j.jhep.2011.12.001.
39. Spangenberg HC, Thimme R, Blum HE. Targeted therapy for hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol 2009; 6 (7): 423–432. doi: 10.1038/nrgastro.2009.86.
40. Yeoman AD, Al-Chalabi T, Karani JB et al. Evaluation of risk factors in the development of hepatocellular carcinoma in autoimmune hepatitis: Implications for follow-up and screening. Hepatology 2008; 48 (3): 863–870. doi: 10.1002/hep.22432.
41. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 2018; 69 (1): 182–236. doi: 10.1016/j.jhep.2018.03.019.
42. Cadier B, Bulsei J, Nahon P et al. Early detection and curative treatment of hepatocellular carcinoma: A cost-effectiveness analysis in France and in the United States. Hepatology 2017; 65 (4): 1237–1248. doi: 10.1002/hep.28961.
43. Singal AG, El-Serag HB. Hepatocellular carcinoma from epidemiology to prevention: translating knowledge into practice. Clin Gastroenterol Hepatol 2015; 13 (12): 2140–2151. doi: 10.1016/j.cgh.2015.08.014.
44. Chang MH, Chen CJ, Lai MS et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Me 1997; 336 (26): 1855–1859. doi: 10.1056/NEJM199706263362602.
45. Chang MH, You SL, Chen CJ et al. Taiwan Hepatoma Study Group. Decreased incidence of hepatocellular carcinoma in hepatitis B vaccinees: a 20-year follow-up study. J Natl Cancer Inst 2009; 101 (19): 1348–1355. doi: 10.1093/jnci/djp288.
46. Yang YF, Zhao W, Zhong YD et al. Interferon therapy in chronic hepatitis B reduces progression to cirrhosis and hepatocellular carcinoma: a meta-analysis. J Viral Hepat 2009; 16 (4): 265–271. doi: 10.1111/j.1365-2893.2009.01070.x.
47. Papatheodoridis GV, Chan HL, Hansen BE et al. Risk of hepatocellular carcinoma in chronic hepatitis B: assessment and modification with current antiviral therapy. J Hepatol 2015; 62 (4): 956–967. doi: 10.1016/j.jhep.2015.01.002.
48. Papatheodoridis GV, Idilman R, Dalekos GN et al. The risk of hepatocellular carcinoma decreases after the first 5 years of entecavir or tenofovir in Caucasians with chronic hepatitis B. Hepatology 2017; 66 (5): 1444–1453. doi: 10.1016/j.jhep.2015.01.002.
49. Kim JH, Sinn DH, Kang W et al. Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment. Hepatology 2017; 66 (2): 335–343. doi: 10.1002/hep.28916.
50. Sun P, Dong X, Cheng X et al. Nucleot (s) ide analogues for hepatitis B virus-related hepatocellular carcinoma after curative treatment: a systematic review and meta-analysis. PLoS One 2014; 9 (7): e102761. doi: 10.1371/journal.pone.0102761.
51. Huang G, Lau WY, Wang ZG et al. Antiviral therapy improves postoperative survival in patients with hepatocellular carcinoma: a randomized controlled trial. Ann Surg 2015; 261 (1): 56–66. doi: 10.1097/SLA.0000000000000858.
52. Wang ZY, Tao QF, Wang ZH et al. Antiviral therapy improves post-operative survival outcomes in patients with HBV-related hepatocellular carcinoma of less than 3 cm – a retrospective cohort study. Am J Surg 2019; 219 (4): 717-725. doi: 10.1016/j.amjsurg.2019.05.016.
53. Nahon P, Bourcier V, Layese R et al. ANRS CO12 CirVir Group. Eradication of hepatitis C virus infection in patients with cirrhosis reduces risk of liver and non-liver complications. Gastroenterology 2017; 152 (1): 142–156. doi: 10.1053/j.gastro.2016.09.009.
54. Heckley GA, Jarl J, Asamoah BO et al. How the risk of liver cancer changes after alcohol cessation: a review and meta-analysis of the current literature. BMC Cancer 2011; 11: 446. doi: 10.1186/1471-2407-11-446.
55. La Vecchia C. Alcohol and liver cancer. Eur J Cancer Prev 2007; 16 (6): 495–497. doi: 10.1097/CEJ.0b013e328 0145b5d.
56. Yang Y, Zhang D, Feng N et al. Increased intake of vegetables, but not fruit, reduces risk for hepatocellular carcinoma: a meta-analysis. Gastroenterology 2014; 147 (5): 1031–1042. doi: 10.1053/j.gastro.2014.08.005.
57. Wen CP, Lin J, Yang YC et al. Hepatocellular carcinoma risk prediction model for the general population: the predictive power of transaminases. J Natl Cancer Inst 2012; 104 (20): 1599–1611. doi: 10.1093/jnci/djs372.
Štítky
Paediatric clinical oncology Surgery Clinical oncologyČlánok vyšiel v časopise
Clinical Oncology
2020 Číslo Supplementum 3
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
- Possibilities of Using Metamizole in the Treatment of Acute Primary Headaches
- Current Insights into the Antispasmodic and Analgesic Effects of Metamizole on the Gastrointestinal Tract
Najčítanejšie v tomto čísle
- Hepatocellular carcinoma future treatment options
- Current treatment options for hepatocellular carcinoma
- Hepatocellular carcinoma – imaging methods and imaging guided therapy
- Hepatocellular carcinoma from the view of gastroenterologist/hepatologist