Although hepatocellular carcinoma (HCC) is associated with a poor prognosis, management of early-stage HCC is often successful with highly efficacious treatment modalities such as liver transplantation, surgical resection, and radiofrequency ablation. However, unfavorable clinical outcomes have been observed under certain circumstances, even after efficient treatment. Factors that predict unsuitable results after treatment include tumor markers, inflammatory markers, imaging findings reflecting tumor biology, specific outcome indicators for each treatment modality, liver functional reserve, and the technical feasibility of the treatment modalities. Various strategies may overcome these challenges, including the application of reinforced treatment indication criteria with predictive markers reflecting tumor biology, compensation for technical issues with up-to-date technologies, modification of treatment modalities, downstaging with locoregional therapies (such as transarterial chemotherapy or radiotherapy), and recently introduced combination immunotherapies. In this review, we discuss the challenges to achieving optimal outcomes in the management of early-stage HCC and suggest strategies to overcome these obstacles.
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Acute pulmonary infarction by tumoral thromboemboli is an extremely rare fatal complication
as the first clinical manifestation of hepatocellular carcinoma (HCC) patient with tumoral thrombi
in the inferior vena cava. The treatment method has not been established and shown to very
poor prognosis despite of trying various modalities such as anticoagulation, radiotherapy and
thromboembolectomy. Here, we describe a 74-year-old man who was diagnosed with HCC that
presented as pulmonary thromboembolism and subsequent pulmonary infarction as the first
manifestation.