Hepatocellular Carcinoma: Paving the Road for Further Developments

The evolution of the field of liver cancer has been enormous in recent decades. There is no need to insist on well-established concepts about diagnosis and treatment, about its real magnitude in terms of global population health, or about how its epidemiology has evolved in separate regions of the world. Furthermore, though years ago the term “liver cancer” would had been seen as synonymous with hepatocellular carcinoma, there is now a wealth of data about the growing incidence of intrahepatic cholangiocarcinoma. This has opened a new area of research to serve specific needs for diagnosis and treatment. As a whole, the willingness to present the current status of knowledge about hepatocellular carcinoma and cholangiocarcinoma is what has primed the development of this new issue of Seminars in Liver Disease. Indeed, this topic has been revisited at regular intervals in this publication. Looking back into past issues it is easy to see how concepts have been developed, refined, and improved in a step-by-step manner.

Bench and clinical research have teamed up to increase our understanding of the disease, and the information gathered has affected all areas of clinical decision making from screening to diagnosis, to prognosis, to the selection of the best treatment option, as well as to the design and analysis of research trials. Until recently, scientific evidence was seldom based on robust randomized clinical trials and large prospective cohort studies; however, now we have powerful data as a result of such investigations. Such established knowledge has defined diagnostic criteria, optimal tools for treatment selection, and ultimately, incorporated or discarded some therapeutic proposals. Failures in the therapeutic realm have not been infrequent, but their analysis has been helpful in the design of studies testing new options. Novel molecular targets are needed to expand the current therapeutic benefits and efforts are ongoing to incorporate immune modulation or reactivation into the treatment armamentarium.

In concert with clinical developments, we have seen a growing array of data centered on molecular profiling, aiming to classify liver cancer according to the molecular mechanism involved in cancer development and progression. Such molecular characterization would be the basis of the so-called molecular medicine that is still awaited in liver cancer. However, key information based on the collection of biological samples (tumor tissue, surrounding liver tissue, peripheral blood, and so on) within prospective investigations with optimal design will provide a new understanding of the disease and its management. Hence, even if reported findings and current proposals do not stand the proof of time, they will represent the needed foundation for the final biology-based model of liver cancer.

In the current issue of Seminars in Liver Disease, we have included a set of reviews prepared by renowned international experts covering all recent developments with an emphasis on areas in need of further research. Hopefully, over the next 3 to 5 years—by the time the next issue devoted to liver cancer is prepared—the field will have evolved in such a remarkable manner that the current topics will be delegated little space, while novelties that may have changed the field in a dramatic and unforeseen manner will occupy most of the pages.