Improving clinical outcomes of patients with hepatocellular carcinoma: Role of antiviral therapy, conversion therapy, and palliative therapy

Abstract

In this editorial, I comment on three articles published in the recent issue of the World Journal of Gastrointestinal Oncology. Hepatocellular carcinoma (HCC) is an important public health concern, and there are three articles on the theme of HCC in this issue. I focus on the articles by Mu et al, Chu et al, and Ma et al for this editorial. While these articles may be considered as low-quality evidence, and the results cannot be generalized to non-hepatitis-B or C virus patients, the discussion of the results is important. In addition, though all the articles are from China, the relevance of the results is not minuscule. As resection is the main form of curative treatment modality owing to a donor liver shortage, surgeons need to be aware that preoperative long-course antiviral therapy can improve clinical outcomes by reducing postoperative liver dysfunction and recurrence of HCC following resection. Similarly, patients with super-giant HCC (defined as ≥ 15 cm diameter) should also be carefully considered for liver resection, and if it is unresectable upfront, then a combination of liver-directed therapy and systemic therapy may downstage HCC. If, following downstaging, the patient qualifies for liver resection based on locally prevalent resectability criteria, then such therapy is labelled as conversion (from unresectable to resectable) therapy. In unresectable patients treated by a combination of treatment options, serological markers like neutrophil-to-lymphocyte ratio and alpha-fetoprotein are reported to predict treatment responses, thus enabling personalized medicine.

Keywords: Antivirals; Chemoembolization; Conversion therapy; Hepatocellular carcinoma; Lenvatinib; Neutrophil-to-lymphocyte ratio

Core Tip: Hepatocellular carcinoma (HCC) is a common cancer, and the treatment approaches are evolving. The outcomes of liver resection patients can be improved by early diagnosis, robust implementation of screening programs, and pre-operative antiviral therapy for patients who qualify for it. In patients managed with multimodality treatment, downstaging and conversion to surgical resection remain possible. Simple serological markers can be useful for predicting the response to curative or palliative intent treatment of HCC patients.