Journal of Liver Cancer

Review Articles

Early Detection of HCC: What is the Best Strategy?: Do Young Kim; Journal of the Korean Liver Cancer Study Group. 2012;12(2):113-119. Published online September 30, 2012

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Abstract PDF: HCC is an appropriate cancer to apply surveillance program for early cancer detection. Currently, liver ultrasonography (US) combined with serum biomarker, alpha‐fetoprotein (AFP), measurement every 6 months is the standard method of HCC surveillance. Although US is the most widely used tool, its sensitivity in early HCC (within Milan criteria) detection during surveillance is only 63%. AFP is the representative biomarker for both HCC surveillance and diagnosis. The unsatisfactory performance of AFP as a surveillance tool requires discovery of novel biomarker or combination with other serum markers. Desgamma‐ carboxy prothrombin (DCP) and AFP‐L3 are candidate biomarkers which are complementary to AFP. AFP‐L3 is an emerging biomarker for diagnosis of HCC, but it needs to be validated as a surveillance tool. Regarding surveillance interval, 6 months or less seems to be superior to more longer interval in terms of early HCC detection and survival improvement. The strategies of HCC surveillance are different in countries according to health care system including available resources and health insurance coverage. Many studies demonstrated that rate of early cancer detection and application of curative therapies was increased, along with survival benefit, by HCC surveillance which is now the standard care, not just a recommendation. Improved ultrasound technology and biomarker discovery such as a specific microRNA are necessary to make more progress in HCC surveillance.

Surgical treatment of combined hepatocellular and cholangiocarcinoma: Chul Soo Ahn; Journal of the Korean Liver Cancer Study Group. 2007;7(1):22-27. Published online June 30, 2007

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Abstract PDF: Combined hepatocellular and cholangiocarcinoma (HCC-CC) is an uncommon form of primary liver cancer (PLC) with features of hepatocellular and biliary epithelial differentiation. According to publishing records HCC-CC accounts for 0.4% to 14.2% of all PLC cases. Large number of HCC-CC is associated with chronic viral hepatitis or cirrhosis, especially in asian countries. The tumor markers of HCC-CC (AFP, CA19-9) shows the intermediate level between hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). The clinical features of HCC-CC resembled with HCC but its post operative result and metastatic pattens are similar to that of CC. Surgical results of this tumor can yield results that are intermediate between HCC and CC in characteristics. But complete resection is the only effective therapy and can result in long term survival. And there are hot debates for the additional hilar lymph node dissection. The survival rate of HCC-CC is higher than CC but lower than HCC. The recurrence after resection has been frequently reported. Most of them are intrahepatic recurrences as HCCs but extrahepatic recurrences are much more frequent like CC. The CC component of HCC-CC seem to determine the prognosis. So more effective approaches for treating recurrent disease, such as local ablation therapy and or combination systemic chemotherapy and neoadjuvant chemoradiation, should be applied for long term and better results.

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