New Paradigm: Adaptive Approach

Excerpt

Hepatocellular carcinoma (HCC) is a major health problem worldwide which continues to increase. HCC is one of the leading causes of cancer-related death and is currently the main event leading to death in patients with cirrhosis. HBV and HCV infections are major risk factors of HCC [1]. Non-alcoholic steatohepatitis has recently emerged a relevant risk factor. The molecular pathogenesis is extremely complex and heterogeneous. Our understanding of the molecular pathogenesis of HCC has improved significantly in the last decade. Certainly, cumulative data from high-throughput analysis of large number of samples have provided an accurate landscape of HCC genetic alterations [2]. But, to date, the molecular information has not impacted on treatment decision. Liver transplantation for HCC is the best treatment option for patients with early-stage tumors and account for approximately 20–40% of all liver transplantations performed at most centers worldwide [2]. The Milan criteria are the most common criteria to select patients with HCC for transplantation but they can be seen as too restrictive [3]. Several proposals have been made for a moderate expansion of criteria, which result in good outcomes but with an increase in the risk of tumor recurrence. A flexible approach aimed at merging tumor stage and results of treatment is going to be adopted in a large European region [1]. …