New Advances in Hepatocellular Carcinoma: From the Past to the Future

Dear Colleagues,

Hepatocellular carcinoma is the sixth most common type of cancer worldwide and one of the most frequent causes of cancer-related deaths. The large majority of HCC develops in patients with liver cirrhosis, whose main etiology is either viral infections, alcohol abuse or metabolic disease.

The incidence in these patients has been evaluated to be between 2% and 5% per year. If, on one hand, the antiviral treatments of HBV and HCV are progressively reducing the incidence rate of HCC, on the other hand, there is an increase in the incidence of HCC in patients with nonalcoholic liver disease that represents the hepatic manifestation of the metabolic syndrome. A strict surveillance with periodic ultrasound, with or without alpha-fetoprotein, is recommended in patients with advanced fibrosis and cirrhosis to achieve early diagnosis and, consequently, radical treatment.

The prognostic assessment in patients with HCC is complex, and the survival rate is largely determined not only by tumor characteristics, but also by the presence of cirrhosis and liver functional reserve. Several prognostic systems have been proposed for HCC in an attempt to capture the complex interrelationship between prognostic factors; among them, the most widely used model is the Barcelona Clinic Liver Cancer (BCLC). This model also recommends the first-line therapy for each stage, but frequently, the initial stage changes in patients with HCC after the first line of treatment, leading to the emergency concept of migration stage and downstaging. In clinical practice, doubts also arise in the choice of the type of treatments—in fact, there are multiple therapeutic approaches, such as transplantation, liver resection, thermal ablation, and transcatheter arterial chemoembolization, up to oncological treatments. This results in an increase in complexity which has led to the development of multidisciplinary teams. It is now established that the multidisciplinary evaluation of patients with HCC has an independent factor on survival.

This Special Issue will highlight the current state of the art in HCC from diagnosis to treatment.

Dr. Francesco G. Foschi
Dr. Andrea Casadei Gardini
Dr. Fabio Conti
Guest Editors

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