Hepatocellular carcinoma - prognostic criteria of individualized treatment

Though the sixth most frequent malignancy, hepatocellular carcinoma (HCC) is the third most common cause of death amongst solid tumours. Only surgery in the early stages may provide the cure; however, HCC still has a high recurrence rate. Non-surgical treatment lacks comparable efficacy. It was not sooner than in 2017 that the therapy galore started to extend. Thus prognostic factors driving the therapy have been gaining importance.

All relevant literature was checked for aetiology, epidemiology, dia-gnostic means, and individualised treatment of HCC. Cytochrome P-450 expression data from 22 patients operated in the University Hospital Brno in the period 2017-2020 were included.

Screening the population at risk (presence of cirrhosis) with the transabdominal ultrasound lies at the centre of the dia-gnostic algorithm. Making the dia-gnosis does not require a bio-psy in most cases. Only a few parameters are thus known before the treatment - a size and number of lesions, and AFP level. These drive the indication to surgery. Relapses after surgery and response to palliative treatment depend on the expression of MET and AXL that directly affect anti-VEGF therapy. High AFP predicts a good response to regorafenib but early relapse after surgery. The pattern of P450 expression was found linked with tumour differentiation. The differentiation correlates with the size and number of lesions. We also found a link between the P450 expression and some mi-RNAs possibly detectable using liquid bio-psy techniques.

The share of deaths from HCC overweighs its incidence. The risk population to screen is well-defined (cirrhosis). The BCLC staging system probably gives the best complication/efficacy results. This system does not require any bio-psy and does not comprise all predictive factors important in the expanding targeted molecular therapy. According to our results, small molecules to treat HCC should work better in poorly differentiated tumours. Surgery is more effective in those well-differentiated. It isnt easy to get all relevant information before therapy. Some factors need macrobio-psy (surgical). The pretreatment workup will probably require a mandatory bio-psy in BCLC B and C stages to get the information. This opens up a way for the liquid bio-psy that could use some specific mi RNAs.