Hepatocellular Carcinoma
The number of papers published in the topic of hepatocellular carcinoma (HCC) increased remarkably from last year. The prevalence of chronic hepatitis C infection has increased the incidence of HCC. However, studies confirm that obesity and nonalcoholic fatty liver disease are important factors for the development of HCC in the United States. Alpha-fetoprotein is the most widely used tumor marker, but has poor diagnostic accuracy and ethnic variability. Using proteonomic genome analysis, new candidate tumor markers have been identified but await validation. Dynamic gadolinium magnetic resonance imaging seems to be more sensitive than spiral computed tomography scan for the identification of HCC, and seems to be modality of choice in most centers. Transplantation offers the best long-term option for patients with HCC, but in a certain group of patients without portal hypertension and well-preserved liver function, surgical resection is an acceptable option. A large study from Europe confirms the utility of resection in some patients with early HCC. However, most patients are not candidates for curative intervention. A meta-analysis and a randomized, controlled trial showed that chemoembolization offers a survival advantage in selected patients (Child class A and B) with nonresectable HCC. Finally, chemoprevention in patients with chronic hepatitis C infection with interferon is a promising strategy to prevent HCC.
Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide. Its incidence rate, however, has been increasing over the last two decades of the 20th century. In the United States, the reported incidence has increased to 4.7/100,000. In both cases, the male population, both black and white, is primarily affected. However, the incidence of HCC in eastern Asia and middle Africa is more than five times that of North America. Furthermore, from 1981 to 1985 the peak incidence of HCC occurred in patients 80 to 84 years of age, whereas from 1991 to 1995 the peak was noted in persons 74 to 79 years of age. This shift in incidence toward younger persons seen over the last two decades coincides with the prevalence of the hepatitis C infection.
Abstract and Epidemiology
Abstract
The number of papers published in the topic of hepatocellular carcinoma (HCC) increased remarkably from last year. The prevalence of chronic hepatitis C infection has increased the incidence of HCC. However, studies confirm that obesity and nonalcoholic fatty liver disease are important factors for the development of HCC in the United States. Alpha-fetoprotein is the most widely used tumor marker, but has poor diagnostic accuracy and ethnic variability. Using proteonomic genome analysis, new candidate tumor markers have been identified but await validation. Dynamic gadolinium magnetic resonance imaging seems to be more sensitive than spiral computed tomography scan for the identification of HCC, and seems to be modality of choice in most centers. Transplantation offers the best long-term option for patients with HCC, but in a certain group of patients without portal hypertension and well-preserved liver function, surgical resection is an acceptable option. A large study from Europe confirms the utility of resection in some patients with early HCC. However, most patients are not candidates for curative intervention. A meta-analysis and a randomized, controlled trial showed that chemoembolization offers a survival advantage in selected patients (Child class A and B) with nonresectable HCC. Finally, chemoprevention in patients with chronic hepatitis C infection with interferon is a promising strategy to prevent HCC.
Epidemiology
Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide. Its incidence rate, however, has been increasing over the last two decades of the 20th century. In the United States, the reported incidence has increased to 4.7/100,000. In both cases, the male population, both black and white, is primarily affected. However, the incidence of HCC in eastern Asia and middle Africa is more than five times that of North America. Furthermore, from 1981 to 1985 the peak incidence of HCC occurred in patients 80 to 84 years of age, whereas from 1991 to 1995 the peak was noted in persons 74 to 79 years of age. This shift in incidence toward younger persons seen over the last two decades coincides with the prevalence of the hepatitis C infection.
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