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Clinical and molecular classification of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a major health problem worldwide, accounting for more than 626,000 new cases per year. The incidence of HCC is increasing in the United States and Europe, and it is currently the third cause of cancer-related death globally, behind only lung and colon cancers. Chronic hepatitis B virus infection is the main risk factor in Asia and Africa, and hepatitis C virus infection is the main risk factor in western countries and Japan. Cancer classification seeks to establish prognosis and to select the adequate treatment for the best candidates. In addition, it aids researchers in the exchange of information and the design of clinical trials, to permit criteria to be compared. Clinical classifications have been proposed for most cancers. However, few include molecular data. Such is the case for breast cancer, where Her2/nu status discriminates subgroups of patients with different outcome and treatment response. Similarly, EGFR mutation status in non–small cell lung cancer identifies a subgroup of patients whose disease will respond to tyrosine kinase inhibitors. Clinical classification of HCC is currently available, but no molecular data have been incorporated so far. Specific knowledge of the molecular classification of HCC is preliminary, and further studies are required. Molecular data can be useful to further discriminate the best candidates for liver transplantation.