Cited by 659Hepatocellular Carcinoma Treatment and PrognosisHepatitis B Virus StudiesLiver Disease Diagnosis and Treatment

Risk factors and prevention of hepatocellular carcinoma in the era of precision medicine

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Fujiwara, Naoto, Friedman, Scott L., Goossens, Nicolas, Hoshida, Yujin·2018·Journal of Hepatology

Abstract

Patients who develop chronic fibrotic liver disease, caused by viral or metabolic aetiologies, are at a high risk of developing hepatocellular carcinoma (HCC). Even after complete HCC tumour resection or ablation, the carcinogenic tissue microenvironment in the remnant liver can give rise to recurrent de novo HCC tumours, which progress into incurable, advanced-stage disease in most patients. Thus, early detection and prevention of HCC development is, in principle, the most impactful strategy to improve patient prognosis. However, a "one-size-fits-all" approach to HCC screening for early tumour detection, as recommended by clinical practice guidelines, is utilised in less than 20% of the target population, and the performance of screening modalities, including ultrasound and alpha-fetoprotein, is suboptimal. Furthermore, optimal screening strategies for emerging at-risk patient populations, such as those with chronic hepatitis C after viral cure, or those with non-cirrhotic, non-alcoholic fatty liver disease remain controversial. New HCC biomarkers and imaging modalities may improve the sensitivity and specificity of HCC detection. Clinical and molecular HCC risk scores will enable precise HCC risk prediction followed by tailoured HCC screening of individual patients, maximising cost-effectiveness and optimising allocation of limited medical resources. Several aetiology-specific and generic HCC chemoprevention strategies are evolving. Epidemiological and experimental studies have identified candidate chemoprevention targets and therapies, including statins, anti-diabetic drugs, and selective molecular targeted agents, although their clinical testing has been limited by the lengthy process of cancer development that requires long-term, costly studies. Individual HCC risk prediction is expected to overcome the challenge by enabling personalised chemoprevention, targeting high-risk patients for precision HCC prevention and substantially improving the dismal prognosis of HCC.

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Crossref · 10.1016/j.jhep.2017.09.016

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  • Observational and case-control studies indicate that, in people with T2D and MASLD-related advanced fibrosis or cirrhosis, metformin may improve transplant-free survival (but not the risk of hepatic decompensation), and reduce the risk of primary liver and extrahepatic cancer.

    “As far as clinical outcomes, there is some indication from observational and case-control studies that, in people with T2D and MASLD-related advanced fi brosis or cirrhosis, metformin may improve transplant-free survival (but not the risk of hepatic decompensation), and reduce the risk of primary liver and extrahepatic cancer.”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [431]

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  1. [237]Burra P Rodriguez-Castro KI Neoplastic disease after liver transplantation: Focus on de novo neoplasms World J Gastroenterol 2015 21 8753 68 26269665 PMC4528018

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Authors
Fujiwara, N., Friedman, S. L., Goossens, N., & Hoshida, Y.
Affiliations
  • Tisch Cancer Institute (US)
  • University Hospital of Geneva (CH)
Corresponding author
Hoshida, Yujin
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2018-03
Volume
68
Issue
3
Pages
526-549
ISSN
0168-8278 (ISSN-L)
OpenAlex
W2763700772
Cited by
659
References
311
Citations by year
2026: 20 · 2025: 44 · 2024: 70 · 2023: 97 · 2022: 133 · 2021: 125 · 2020: 91 · 2019: 51 · 2018: 28
FWCI
6.71
Type
journal article
Language
en
Open access
Locations
  • Journal of Hepatology (acceptedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK56621)
  • Irma T. Hirschl Trust
  • U.S. Department of Defense (W81XWH-16-1-0363, R01 DK099558, W81XWH-16-1-0455)
  • European Commission
  • Uehara Memorial Foundation
Topics
  • Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
  • Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Keywords
hepatocellular carcinoma, HCC risk factors, HCC screening, precision medicine, HCC risk scores, chronic liver disease, chronic hepatitis C, HCC recurrence, alpha-fetoprotein, statins, antidiabetic drugs, targeted therapy
MeSH terms
Carcinoma, Hepatocellular, Humans, Liver Neoplasms, Prognosis, Risk Factors, Precision Medicine

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