Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 18, 2015; 7(20): 2274-2291
Published online Sep 18, 2015. doi: 10.4254/wjh.v7.i20.2274
Hepatocellular carcinoma: From clinical practice to evidence-based treatment protocols
Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic
Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
Danijel Galun, Marinko Zuvela, Miroslav Milicevic, Medical School, University of Belgrade, 11000 Belgrade, Serbia
Author contributions: Galun D and Milicevic M designed research; Galun D, Basaric D and Zuvela M performed research; Bulajic P, Bogdanovic A and Bidzic N analyzed data; Galun D and Milicevic M wrote the paper.
Conflict-of-interest statement: The authors state no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Danijel Galun, Associate Professor, Clinic of Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11000 Belgrade, Serbia.
Telephone: +381-11-3615652 Fax: +381-11-3615655
Received: August 29, 2014
Peer-review started: August 30, 2014
First decision: November 14, 2014
Revised: July 6, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: September 18, 2015

Hepatocellular carcinoma (HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide, HCC is a leading cause of cancer-related deaths, as it is the fifth most common cancer and the third most important cause of cancer related death in men. Among various risk factors the two are prevailing: viral hepatitis, namely chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of obesity and the metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the Barcelona-Clinic Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized -based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the disease (chronic liver disease and the cancer) and due to the large number of potentially efficient therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative (surgical treatment and tumor ablation) or palliative (transarterial therapy, radioembolization and medical treatment, i.e., sorafenib) is mandatory to achieve the best treatment outcome.

Keywords: Hepatocellular carcinoma, Evidence-based, Management, Clinical practice, Treatment allocation

Core tip: In response to the hepatocellular carcinoma (HCC) burden marked differences between countries are reflected in providing disparate quality of healthcare considering screening and surveillance programs; available treatment modalities and drugs; reimbursement of specific treatment options by the state-funded health insurance. Since the number of new HCC cases being diagnosed each year is nearly equal to the number of deaths from this cancer it is clear that the international scientific community and healthcare systems worldwide have no efficient answer to this problem. International consensus on the use of any given staging model is lacking. High-quality trials with better patients’ stratification are mandatory. This review article reflects the perspective of liver surgeons working in a developing country.