Abstract Body

In 2015 there have been 854,000 incident cases of liver cancer and 810,000 related deaths globally contributing to > 20 million disability-adjusted life-years (DALYs).Incident liver cancer increased by 75% between 1990-2015 : 47% explained by changing population age structures, 35% by population growth and 8% to changing age-specific incidence rates. Infection with the hepatitis B virus accounted for 33% liver cancer deaths, alcohol for 30%, hepatitis C (HCV) for 21%, and other causes for 16%,the latter including metabolic syndrome . HCC is on the raise in northern and central Europe, N America and English speaking Asia, mainly due to epidemics of viral hepatitis, alcohol abuse and metabolic syndrome. HCC is declining in several traditionally high risk countries of the Mediterranean Europe, Japan and Hong Kong following effective measures of sanitation, including vaccination. In HIV population HCC stands as a growing cause of end stage HCV infection and related mortality. Surveillance of patients with chronic liver disease allows for increased detection of small, potentially curable tumors via such radical therapies as liver transplantation, hepatic resection and local ablative therapies that in accurately selected populations result in survival rates up to 75% at 5 year. Survival benefits, were further extended following successful control/cure of viral hepatitis. Since the Milan criteria(MC) for liver transplantation(up to one 5 cm tumor or 3 nodules each 3 cm) are too restrictive and the prognosis is dismal for patients beyond MC treated with local ablative techniques, loosed criteria of listing are increasingly being adopted in patients beyond MC who are successfully downstaged with local ablative techniques. Patients with an intermediate burden of HCC not bridged to transplantation, can still have limited survival benefits from local tumor ablation through repeat courses of chemo embolization (TACE) whereas both patients failing TACE and those with advanced HCC may respond to first and second lines of systemic therapy with targeted agents sorafenib, regorafenib, lenvantinib and cabozantinib. In these patients, 2 RCT failed to show superiority of radio embolization with yttrium versus sorafenib immune therapy with PD1 check point inhibitors has been registered in the USA to treat experienced patients with advanced HCC.