Early detection and curative treatment of early-stage hepatocellular carcinoma

The method for early detection of hepatocellular carcinoma (HCC) has been well-established in Japan by means of regularly screening patients at risk for developing HCC by using imaging and tumor markers. An important issue is the accurate characterization of nodular lesions found in cirrhotic livers. This problem has been addressed by development of imaging modalities such as ultrasonography angiography with intra-arterial injection of CO2, computed tomography during hepatic arteriography, and computed tomography during arterial portography. It is most important to differentiate the typical hemodynamic patterns of low-grade dysplastic nodule including arterial hypovascularity with preserved portal perfusion from those of HCC characterized by arterial hypervascularity with decreased portal perfusion. At present, these findings are easily obtained by contrast-enhanced phase-invasion harmonic imaging, which is a noninvasive ultrasound technology. Radiofrequency ablation is an efficient technique to curatively treat early-stage HCC. The 5-year survival rate of RFA at our institution is 76%. Although local recurrence rate after curative RFA is as low as 6.2%, the intrahepatic distant metastasis is as high as 85% at 5 years. The prevention of intrahepatic distant recurrence by maintenance interferon therapy is thus very important. The 5-year survival rate and first, second, and third recurrence rates after curative RFA in patients who had maintenance interferon therapy were much better than those in patients who did not receive interferon therapy after curative RFA. In conclusion, recent progress in screening, diagnostic, and therapeutic strategy for early-stage HCC has improved the prognosis of patients with HCC. Furthermore, advances of prognostic staging system, such as Japan Integrated Staging score, facilitate the management of HCC.