The Hepatic oncology team reviews for The Lancet the treatment of Hepatocellular carcinoma

Hepatocellular carcinoma is the sixth most prevalent cancer and the third most frequent cause of cancer-related death. The team led by Dr. Jordi Bruix at Hospital Clínic of Barcelona – IDIBAPS is an international reference for the diagnostic and treatment of this disease. In fact, the classification that stratifies patients according to outcome and simultaneously links it with treatment indication is named after the Barcelona Clínic Liver Cancer (BCLC). The Lancet recently published a Seminar reviewing the latest trends in hepatocellular carcinoma management. The authors of the article are, from first to last, Dr. Alejandro Forner, Dr. Josep M. Llovet, and Dr. Jordi Bruix, all of them members of the Hepatic oncology team at IDIBAPS – Hospital Clínic.  Simultaneously, Dr. Jordi Bruix appeared as senior author in the recently published Saudi Guidelines for the Diagnosi and Management of Hepatocellular Carcinoma. This reinforces the international leadership of this team with direct participation in clinical practice consensus documents for Europe and the United States of America.

According to the Seminar published in The Lancet, patients with cirrhosis are at highest risk of developing this malignant disease, and ultrasonography every 6 months is recommended. Surveillance with ultrasonography allows diagnosis at early stages when the tumour might be curable by resection, liver transplantation, or ablation, and 5-year survival higher than 50% can be achieved. Patients with small solitary tumours and very well preserved liver function are the best candidates for surgical resection. Liver transplantation is most beneficial for individuals who are not good candidates for resection, especially those within Milano criteria (solitary tumour =5 cm and up to three nodules =3 cm). Donor shortage greatly limits its applicability.

Percutaneous ablation is the most frequently used treatment but its effectiveness is limited by tumour size and localization. In asymptomatic patients with multifocal disease without vascular invasion or extrahepatic spread not amenable to curative treatments, chemoembolisation can provide survival benefit. Findings of randomised trials of sorafenib, directed from the IDIBAPS – Hospital Clínic of Barcelona team, have shown survival benefits for individuals with advanced hepatocellular carcinoma, suggesting that molecular-targeted therapies could be effective in this chemoresistant cancer. Research is active in the area of pathogenesis and treatment of hepatocellular carcinoma.