Diagnostic and Therapeutic Approaches in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and a major contributor to global cancer mortality. Surveillance in at-risk populations integrates semi-annual abdominal ultrasound with serum biomarkers, notably alpha-fetoprotein, to detect early lesions. Equivocal findings are further characterised by contrast-enhanced computed tomography or magnetic resonance imaging using standardised classification schemes. When imaging remains inconclusive, percutaneous core or fine-needle biopsy yields histopathological confirmation, enables immunophenotypic assessment and supports molecular profiling for personalised therapy. Curative modalities include surgical resection and liver transplantation, while locoregional treatments—radiofrequency or microwave ablation, trans-arterial chemoembolisation and radioembolisation—address intermediate-stage disease or act as bridges to surgery. Systemic therapy has expanded from multikinase inhibitors to include immune checkpoint inhibitors and targeted antibodies, often deployed in combination. Recent advances in understanding tumour heterogeneity and the microenvironment have fostered the development of predictive nomograms to balance procedural risks, such as tract seeding, with therapeutic benefit. A multidisciplinary approach remains pivotal for optimising outcomes and improving quality of life for patients worldwide.

Research from Nature Portfolio

Recent studies have revealed substantial variability in the quality of image-guided core biopsies intended for genomic, proteomic and metabolomic analyses. Even with uniform coaxial sampling protocols, tumour fraction within biopsy cores ranged widely, rendering up to 59 percent of specimens inadequate for downstream profiling. These findings have prompted the establishment of rigorous quality-control benchmarks and refinement of sampling techniques to ensure sufficient malignant cell content. Such measures are essential for the reliable integration of molecular data into clinical trial design and for tailoring immunotherapy regimens based on individual tumour biology.

Diagnostic and Therapeutic Approaches in Hepatocellular Carcinoma publication trend

The graph below shows the total number of articles in diagnostic and therapeutic approaches in hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Alpha-fetoprotein (AFP): A glycoprotein secreted by hepatocytes, elevated in many HCC cases, used as a serum biomarker.

Coaxial biopsy: A percutaneous sampling technique employing an introducer sheath that permits multiple core specimens through a single tract.

Nomogram: A graphical predictive model that assigns a numerical risk score based on multiple clinical and pathological variables.

Tumour fraction: The proportion of malignant cells within a biopsy specimen, critical for molecular analyses.

Immune checkpoint inhibitor: A class of systemic therapy targeting regulatory proteins to enhance anti-tumour immune responses.

Locoregional therapy: Procedures that directly target the tumour in the liver, including ablation and chemoembolisation.

Tract seeding: The implantation of tumour cells along the needle path following percutaneous procedures.

References

1. An Investigative Analysis of Therapeutic Strategies in Hepatocellular Carcinoma: A Raetrospective Examination of 23 Biopsy-Confirmed Cases Emphasizing the Significance of Histopathological Insights. Cancers (2024).
2. Biopsy for advanced hepatocellular carcinoma: results of a multicentre UK audit. British Journal of Cancer (2021).
3. Development and validation of a clinicopathological‐based nomogram to predict seeding risk after percutaneous thermal ablation of primary liver carcinoma. Cancer Medicine (2020).
4. Variability in biopsy quality informs translational research applications in hepatocellular carcinoma. Scientific Reports (2021).