HBV-related HCC, clinical issues and therapy

Every year, more than 600 thousand persons will develop hepatocellular carcinoma (HCC) worldwide. Sixty percent of all HCCs in Asia and Africa are related to chronic infection with the hepatitis B virus (HBV) compared to only 20% of HCC cases in Europe, Japan and USA. Surveillance of chronically infected patients improves treatment of HCC, since it helps detecting tumors amenable to radical therapies. In cirrhotic patients, HCC can be confidently diagnosed by contrast imaging techniques, albeit the accuracy of radiological diagnosis is largely influenced by tumor size. Hepatic resection and liver transplantation are the first therapeutic options for patients within Milan criteria. The long-term outcome of resection, however, is affected by high risk of tumor recurrence, whereas liver transplantation has a negligible risk of both HBV and HCC recurrence-related anticipated mortality. The clinical benefits of loco-regional ablative techniques are evidence based for patients with less than 3 cm tumors only, whereas the standard of care for intermediate tumors, chemoembolization, needs to be validated in view of new technical improvements. Tertiary prevention of HCC in patients with established HBV infection is doubtful, mainly due to methodological weaknesses of studies based on interferon and nucleos(t)ide analogues therapy.