Prevention of hepatocellular carcinoma

Abstract

The accuracy and the reliability of well-recognized clinical, virologic, histologic, and molecular risk factors for HCC are still insufficient; thus, accurate risk prediction of developing cancer in individual patients remains an elusive goal. Future directions in chemprevention of HCC will be on the development of molecular risk models and of new chemopreventive agents. The design of targeted molecular therapies may need to be tailored to the specific molecular phenotype of a specific HCC. Studies examining multiple genes and proteins (genomics and proteomics) in the same HCCs will be required to evaluate this possibility thoroughly. In the setting of primary prevention, the epidemiologic data available point to vaccination against HBV as the most efficient primary prevention measure currently available to reduce the HCC incidence and mortality in high-incidence areas. A strategy aiming at preventing chronic liver disease of any etiology (HCV infection, alcohol, obesity, others) may be required to prevent HCC in low- and intermediate-incidence areas, and hence, worldwide. In the setting of secondary chemoprevention, literature data pooling suggest a slight preventive effect of IFN on HCC development in patients with HCV-related cirrhosis. The magnitude of this effect is low, and the observed benefit might be due to spurious associations. The preventive effect is more evident among sustained responders to IFN. There is no sound evidence to support a recommendation for widespread use of IFN to prevent HCC in HBV-related cirrhosis. In the setting of tertiary chemoprevention, the risk of recurrence of HCC is reduced by IFN treatment in selected patients populations. Further large-scale multicenter RCTs may prove useful to evaluate the benefit on overall survival. © 2005 Elsevier Inc. All rights reserved.