The challenge of prognosis and staging for hepatocellular carcinoma.
Fiche publication
Date publication
janvier 2010
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BRONOWICKI Jean-Pierre
Tous les auteurs :
Marrero JA, Kudo M, Bronowicki JP
Lien Pubmed
Résumé
Hepatocellular carcinoma (HCC) is a heterogeneous condition, with multiple confounding factors making patient assessment extremely complex. Tumor burden, the presence of symptoms, liver function, and comorbidities must all be considered to ensure accurate patient assessment, thereby providing physicians with a common language on which to base treatment decisions and guide research. Although many staging classifications have been developed, there is no consensus on the best classification to use. The Barcelona Clinic Liver Cancer system is a promising candidate for a standard western classification, because it has been externally validated and is endorsed by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. Similarly, the biomarker-combined Japanese Integrated Staging (JIS) score is the most promising candidate for a standard Asia-Pacific classification, because it has been externally validated and shown to be superior to conventional JIS. Because risk factors vary significantly by region, so too does the predictive power of current staging classifications; any standard global staging classification would need to be validated in both western and Asia-Pacific patients. To date, no such globally validated classification exists. Findings from scientific research have improved our understanding of HCC and enabled us to refine current classifications. The role of tumor markers to predict survival was recently reported, and alpha-fetoprotein, lens culinaris agglutinin-reactive alpha-fetoprotein, and des-gamma-carboxyprothrombin have now been incorporated into some classifications. Molecular markers have also been linked with poor outcomes and will likely play a role in future classifications. Although more work is required, it is hoped that these and other ongoing research efforts will eventually enable the development of a global staging classification.
Référence
Oncologist. 2010;15 Suppl 4:23-33.