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Nat Rev Gastroenterol Hepatol. 2019 Aug 22. doi: 10.1038/s41575-019-0186-y. [Epub ahead of print]
A global view of hepatocellular carcinoma: trends, risk, prevention and management.
Yang JD1,2,3,4, Hainaut P5, Gores GJ1, Amadou A5, Plymoth A6, Roberts LR7.
Author information
1
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
2
Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
3
Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
4
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
5
Tumor Molecular Biology and Biomarkers Group, Institute for Advanced Biosciences, Inserm U 1209 CNRS UMR5309, Université Grenoble Alpes, Grenoble, France.
6
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
7
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. [email protected].
Abstract
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly nonalcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid. All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. HCC surveillance and early detection increase the chance of potentially curative treatment; however, HCC surveillance is substantially underutilized, even in countries with sufficient medical resources. Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumour characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and local expertise. Catheter-based locoregional treatment is used in patients with intermediate-stage cancer. Kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC. Together, rational deployment of prevention, attainment of global goals for viral hepatitis eradication, and improvements in HCC surveillance and therapy hold promise for achieving a substantial reduction in the worldwide HCC burden within the next few decades.
PMID:
31439937
DOI:
10.1038/s41575-019-0186-y |
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