Journal of Liver Cancer

Review Articles

Immune-related adverse events in hepatocellular carcinoma: organ-specific patterns and management approaches: Sul Ki Choi, Seonjeong Woo, Hong Jae Chon; J Liver Cancer. 2026;26(1):65-82. Published online December 29, 2025; DOI: https://doi.org/10.17998/jlc.2025.12.21

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Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide. The recent introduction of immune checkpoint inhibitors (ICIs) has transformed the therapeutic landscape for advanced HCC. Combination regimens such as atezolizumab plus bevacizumab, durvalumab plus tremelimumab, and nivolumab plus ipilimumab have demonstrated significant survival improvements over conventional tyrosine kinase inhibitors and have become the new standard of care. However, ICIs can trigger immune-related adverse events (irAEs) through overactivation of the immune system, affecting multiple organs including the skin, gastrointestinal tract, liver, endocrine system, lungs, and heart. Patients with HCC frequently have underlying liver diseases such as chronic hepatitis or cirrhosis, placing them at higher risk of hepatic irAEs compared to that with other cancer types, which can markedly influence prognosis. The pathophysiology of irAEs is driven by a series of interconnected immune mechanisms, including excessive T-cell activation, disruption of immune tolerance, cytokine dysregulation, complement-mediated injury, and innate immune activation. Clinical decisions regarding the continuation, interruption, or discontinuation of ICIs, as well as the administration of corticosteroids or immunosuppressants, should be guided by the severity of toxicity. Organ-specific management strategies and multidisciplinary collaboration are essential, particularly for severe presentations. This review summarizes the incidence, mechanisms, and management strategies for ICI-related irAEs in advanced HCC, and provides practical insights for clinical decision-making.

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Response: Reassessing the Use of Nivolumab Plus Ipilimumab After Atezolizumab Plus Bevacizumab in Advanced HCC
Jung Sun Kim, Thomas Yau, Hong Jae Chon
Liver International.2026;[Epub] CrossRef

Management of hepatocellular carcinoma in elderly and adolescent/young adult populations: Han Ah Lee; J Liver Cancer. 2025;25(1):52-66. Published online March 20, 2025; DOI: https://doi.org/10.17998/jlc.2025.02.28

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Abstract PDF

Hepatocellular carcinoma (HCC) presents unique challenges in both the elderly and adolescent/young adult (AYA) populations, requiring distinct management approaches. Recent epidemiological data show an increasing incidence of HCC in both age groups, with elderly cases rising significantly and AYA cases showing trends in specific regions. The clinical characteristics and treatment considerations vary substantially among these populations. Elderly patients with HCC typically present with hepatitis C virus infection, metabolic dysfunction-associated steatotic liver disease, well-differentiated tumors, and multiple comorbidities. In contrast, AYA patients with HCC often present with more aggressive tumor characteristics and predominantly with hepatitis B virus-related diseases. Treatment decisions for elderly patients with HCC require careful consideration of physiological reserves, comprehensive geriatric assessments, and potential complications. Recent studies have demonstrated that elderly patients can achieve outcomes comparable to younger patients across various treatment modalities when properly selected. While surgical outcomes are comparable to those of younger patients with proper selection, less-invasive options such as radiofrequency ablation or transarterial therapies may be more appropriate for some elderly patients. The treatment approach for AYA HCC emphasizes curative intent while considering long-term effects. AYA patients require specialized attention to their psychosocial needs, fertility preservation, and long-term health maintenance. Although data on AYA patients remain limited, they are known to have relatively favorable prognoses despite exhibiting more aggressive tumor characteristics. Management of HCC in both the elderly and AYA populations requires individualized approaches that consider age-specific factors. Both groups benefit from multidisciplinary team involvement and careful consideration of quality of life.

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Synergistic anticancer activity of frankincense aqueous extract with sorafenib in HepG2 cells and its UHPLC–QTOF–MS/MS-based metabolomic profiling
Wesam Ragab, Kamel Mahmoud, Seham Salah El-Din El-Hawary, Osama M. Gomaa, Rasha M. Allam, Abeer S. Moawad, Rabab Mohammed
Scientific Reports.2026;[Epub] CrossRef
Repurposing GLP-1 Receptor Agonists: A Perspective on Epigenetic Strategies to Combat Fibrosis and Hepatocellular Carcinoma in the Aged Liver
Silvia Hanna, Jason Sethiadi, Qazi Ali, Saloni Sinha
Cancers.2025; 17(16): 2600. CrossRef

Original Article

The efficacy of treatment for hepatocellular carcinoma in elderly patients: Han Ah Lee, Sangheun Lee, Hae Lim Lee, Jeong Eun Song, Dong Hyeon Lee, Sojung Han, Ju Hyun Shim, Bo Hyun Kim, Jong Young Choi, Hyunchul Rhim, Do Young Kim; J Liver Cancer. 2023;23(2):362-376. Published online September 14, 2023; DOI: https://doi.org/10.17998/jlc.2023.08.03

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Abstract PDF Supplementary Material

Background/Aim
Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established.
Methods
Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC.
Results
Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05).
Conclusions
Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.

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Effect of Direct‐Acting Antivirals on Prognosis in Older Patients With Hepatitis C Virus‐Related Hepatocellular Carcinoma After Curative Therapy: A Retrospective Study by the Red Cross Liver Study Group in Japan
Hironori Ochi, Masayuki Kurosaki, Takaaki Tanaka, Takehiro Akahane, Hiroyuki Marusawa, Haruhiko Kobashi, Hideki Fujii, Atsuhiro Morita, Yasushi Uchida, Kazuhiko Okada, Naohito Urawa, Nami Mori, Keiji Tsuji, Eisuke Okamoto, Chikara Ogawa, Masahiko Kondo, M
Hepatology Research.2026; 56(5): 744. CrossRef
An Image-Guided Combination Strategy: Immediate Hepatic Arterial Infusion of Nivolumab Following Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma
Sujing Zhang, Zheng Zheng, Changwang Zhang, Xueqian Liu, Xinlei Shi, Wenhua Ma
Cancers.2026; 18(6): 978. CrossRef
Contemporary Approaches to the Care of Older Adults with Gastrointestinal Cancers
Dina Ioffe, Efrat Dotan
Advances in Oncology.2026; 6(1): 223. CrossRef
Management of hepatocellular carcinoma in elderly and adolescent/young adult populations
Han Ah Lee
Journal of Liver Cancer.2025; 25(1): 52. CrossRef
Immunological Landscape and Molecular Therapeutic Targets of the Tumor Microenvironment in Hepatocellular Carcinoma
Yusra Zarlashat, Abdul Ghaffar, Flora Guerra, Anna Picca
International Journal of Molecular Sciences.2025; 26(16): 7836. CrossRef
The delayed cancer treatment and economic inequality in Korea: results of common cancers by the time-to-surgery
Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Kyu-Tae Han
Epidemiology and Health.2025; 47: e2025056. CrossRef
Radiotherapy for Liver-Confined Hepatocellular Carcinoma in Elderly Patients with Comorbidity
Sun Hyun Bae, Young Seok Kim, Sang Gyune Kim, Jeong-Ju Yoo, Jae Myeong Lee, Sanghyeok Lim, Jae Hong Jung, Chan Kyu Kim
Cancers.2025; 18(1): 91. CrossRef
Efficacy and Safety of Surgical Resection in Elderly Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Jin-Soo Lee, Dong Ah Park, Seungeun Ryoo, Jungeun Park, Gi Hong Choi, Jeong-Ju Yoo
Gut and Liver.2024; 18(4): 695. CrossRef
Achieving Sufficient Therapeutic Outcomes of Surgery in Elderly Hepatocellular Carcinoma Patients through Appropriate Selection
Han Ah Lee
Gut and Liver.2024; 18(4): 556. CrossRef

Case Reports

Hepatocellular Carcinoma Arising from Hepatocellular Adenoma in an Elderly Male Patient: Manuel Lim, Jong Man Kim, Ji Eun Kwon, Eun Sung Jeong, Jaehun Yang, Okjoo Lee, Kyeong Deok Kim, Sang Jin Kim, Jinsoo Rhu, Gyu-Seong Choi, Jae-Won Joh; J Liver Cancer. 2021;21(1):87-91. Published online March 31, 2021; DOI: https://doi.org/10.17998/jlc.21.1.87

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2 Citations

Abstract PDF

Hepatocellular adenoma is a benign tumor of the liver occurring predominantly in young women taking oral contraceptives. The malignant transformation of hepatocellular adenoma into hepatocellular carcinoma has rarely been reported. Herein, we report the case of an elderly male patient with hepatocellular carcinoma that developed from hepatocellular adenoma. The patient’s high risk for surgery and conflicting biopsy and imaging results made it difficult to determine the treatment direction. Eventually, the mass was completely removed by laparoscopic left hemi-hepatectomy without complications.

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A Multicenter Study on Hepatocellular Adenomas in Korea: Clinicopathological and Imaging Features With an Emphasis on β‐Catenin Mutated Subtype
Subin Heo, Bohyun Kim, So Yeon Kim, Hyo Jeong Kang, In Hye Song, Sung Hak Lee, Jimi Huh, Seokhwi Kim, Seunghee Baek, Seung Soo Lee, Sang Hyun Choi, Jong Keon Jang, Seong Ho Park
Liver International.2025;[Epub] CrossRef
Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Jeong-Ju Yoo, Sujin Koo, Gi Hong Choi, Min Woo Lee, Seungeun Ryoo, Jungeun Park, Dong Ah Park
Current Oncology.2024; 31(1): 324. CrossRef

The Natural Course of Hepatocellular Carcinoma in a Super-Elderly Patient: Park, Yoo Min , Choi, In Zoo , Shim, Jae Jun , Kim, Byung Ho; J Liver Cancer. 2018;18(2):146-150. Published online September 30, 2018; DOI: https://doi.org/10.17998/jlc.18.2.146

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39 Downloads

Abstract PDF: As the mean life expectancy increases, the incidence of hepatocellular carcinoma (HCC) in superelderly patients (>85 years old) is expected to increase in Korea. However, their clinical features, treatments, and treatment outcomes are unclear. Herein, we present a case of a large single HCC and its natural course in an 86-year-old man who refused any treatment following histologic diagnosis.

Review Article

Treatment and Surveillance of Hepatocellular Carcinoma in Elderly Patients: Rho, Seoung Yoon , Lee, Hyun Woong , Kim, Kyung Sik; J Liver Cancer. 2018;18(2):103-114. Published online September 30, 2018; DOI: https://doi.org/10.17998/jlc.18.2.103

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83 Downloads

Abstract PDF: Hepatocellular carcinoma (HCC) is the third most common cancer in the digestive system based on survey of domestic cancer incidence, and the ratio of elderly aged 65 or older is expected to rise steadily, leading to a higher incidence of total hepatocellular carcinoma. The most important thing in treating these older patients with HCC is to assess the benefits and risks of the treatment in advance. In other words, the benefit of treatment should be greater than the reduction of survival period or maladjustment due to treatment. Based on these perspectives, we examined how the detailed treatment of hepatocellular carcinoma differs from that of general treatment in elderly patients. In conclusion, older age was not a definite prognostic factor of survival risk-benefit comparison in the most treatment modalities. However it should be carefully considered and approached about possible complications in treating HCC in elderly patients.

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