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Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,236
Online ISSN 1827-1669
Gianni TESTINO 1, 2, Silvia LEONE 3, Valentino PATUSSI 2, 4, Emanuele SCAFATO 2, 5, Paolo BORRO 1, 2
1 Centro Alcologico Regionale-Regione Liguria, IRCCS AOU San Martino-IST, Genova, Italy; 2 World Health Organization Collaborating Centre for Research and Health Promotion on Alcohol and Alcoholrelated Health Problems, Europe Region, Istituto Superiore di Sanita’’, Roma, Italy; 3 School of Toxicology, University of Genoa, Italy; 4 Centro Alcologico Regionale Toscano, AOU Careggi, Firenze, Italy; 5 National Institute of Health, Roma, Italy
Hepatocellular carcinoma (HCC) ranks third for causes of cancer deaths globally. The most frequent causes are the hepatitis C virus (HCV), a combination of alcohol/HCV and metabolic syndrome (MS). The introduction of new pharmaceutical drugs that inhibit protease will bring a relative increase in the number of cases of HCC that are linked to the consumption of alcohol and MS. The latest development in the diagnostic sector is the total recognition of the CEUS diagnostic algorithm. In the treatment sector we are moving on from the Barcelona criteria. With nodules that are up to 3 cm in size, and with favorable anatomical and clinical conditions, the first treatment choice is percutaneous ablation. The first choice for nodules that are 3-5 cm in size is still hepatic resection (HR). For cases that fall completely within the Milan criteria with portal hypertension and compromised liver function the first treatment choice, in the total absence of any contraindications, is certainly LT. Intermediate forms of HCC are the most complicated as the stratification of patients is particularly relevant. TACE certainly no longer represents the only choice. HR is preferable where possible. According to the individual case and during down-staging, LT may be proposed. In some cases both locoregional ablative approaches and sorafenib can be used. In advanced cases with preserved function the best treatment is still sorafenib. The treatment of HCC is complex because of the extreme anatomic-clinical variability of the cases. The key to success for a personalized choice is the creation of a true multi-disciplinary group in which the various players have the opportunity to express their own opinion as best they can. This is an indispensible prerequisite for a successful synthesis.