A global view of hepatocellular carcinoma: trends, risk, prevention and management

Abstract

Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly nonalcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid. All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. HCC surveillance and early detection increase the chance of potentially curative treatment; however, HCC surveillance is substantially underutilized, even in countries with sufficient medical resources. Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumour characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and local expertise. Catheter-based locoregional treatment is used in patients with intermediate-stage cancer. Kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC. Together, rational deployment of prevention, attainment of global goals for viral hepatitis eradication, and improvements in HCC surveillance and therapy hold promise for achieving a substantial reduction in the worldwide HCC burden within the next few decades.Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. This Review summarizes the epidemiology, risk factors (including viral hepatitis and NAFLD), molecular profiles and treatment of HCC, providing insights into how the global burden of HCC can be reduced.Key pointsHepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide; >80% of HCC cases occur in low-resource and middle-resource countries, particularly in Eastern Asia and sub-Saharan Africa, where medical and social care resources are often constrained.Prevention and treatment of viral hepatitis and mitigation of exposure to aflatoxin and aristolochic acid, the main risk factors in high-incidence regions, are critical for decreasing the global burden of HCC.HCC surveillance enables early detection and increases the chance of potentially curative treatment; therefore, broad implementation of HCC surveillance in high-risk patients is essential to reduce the high mortality from HCC.Early-stage HCC is amenable to potentially curative treatment, which includes local ablation, surgical resection and liver transplantation.Catheter-based locoregional treatment is indicated in patients with intermediate-stage disease; kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC.Global reduction of HCC burden can be achieved by universal HBV vaccination, control of chronic viral hepatitis, avoiding environmental and lifestyle risk factors, and improving early detection and management.