Epithelial to Mesenchymal Transition Expression Profiles as Predictive Biomarkers of Recurrence Following Resection of HCC: Implications for Current Clinical Use and Future Stratification for Systemic Therapy

Excerpt

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and is responsible for more than 500,000 deaths annually.1 Hepatic resection, liver transplantation, or tumor ablation are the only curative options for HCC. Despite surgical resection being the preferred treatment modality for small, solitary lesions in patients with preserved liver function, postoperative recurrence remains high, and is a major determinant of overall outcome. The overall rate of HCC recurrence is more than 50 % in most published reports with the vast majority of recurrences occurring in the remnant liver. Intrahepatic recurrences are time dependent and thought to occur secondary to either metastasis from the initial resected lesion (within 2 years of resection) or de novo tumors arising from a field defect of the underlying liver parenchyma (beyond 2 years following resection).2 The importance of distinguishing between the two mechanisms is important for future adjuvant systemic therapy trials but can be difficult to discern outside of routine clinicopathological tumor features. Early tumor recurrences are generally seen in tumors with poor pathological features, including poorly differentiated tumors, vascular invasion, and/or multifocality.3 …