Contribution of biomarkers and imaging in the management of hepatocellular carcinoma - 08/07/11

Doi : 10.1016/S2210-7401(11)70004-3

Laetitia Fartoux ^a,^⁎ , Thomas Decaens ^b,^c,^d
^a Hôpital Saint-Antoine, Department of Hepatology, 184, rue du Faubourg Saint-Antoine 75571 Paris Cedex 12, Paris, France
^b Groupe hospitalier Henri-Mondor, Department of Hepatology, 51 avenue du Maréchal de Lattre de, 94010 Créteil Cedex, France
^c INSERM U955, 51 avenue du Maréchal de Lattre de, 94010 Créteil Cedex, France
^d Université Paris Est Créteil, Faculté de Médecine, 8, avenue du Général Sarrail 94010 Créteil Cedex, France

Corresponding author.

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Summary

Hepatocellular carcinoma (HCC) is the most frequent malignant tumour of the liver. HCC prognosis is dependent on the determination of the tumour stage by conventional imaging and early screening. However, patient survival can vary with the same tumour stage. Biomarkers thus have a role in providing an earlier diagnosis, better prognosis classification before treatment and classification prognosis during treatment.

In this review article, we will provide a successive, detailed description of the serum, pathological, molecular and imaging markers of HCC.

Key Points

•	The identification of serum, histological, molecular, or imaging markers is essential for optimising the current management of HCC.
•	Recent litterature data suggest that a pretherapeutic value of AFP > 1000ng/ml or increasing kinetic AFP (> 15μg/month) should prompt reconsideration of the initially proposed treatment.
•	Currently, the best immuno-histochemical markers for HCC prognosis are probably CK19 and EpCAM.
•	Molecular markers can be used for different reasons in HCC, but the 3 most common are: a) to search for new HCC diagnostic markers in order to provide an earlier diagnosis and a higher proportion of curative treatment; b) to learn of pretreatment status, to classify the cancer and better tailor treatment and post-treatment monitoring, and 3) to better identify patients with highly efficient treatment (mainly for targeted therapy) and to stop in case of inefficiency.
•	The RECIST (Recist Evaluation Criteria in Solid Tumors) criteria are not relevant to the assessment of therapeutic response to new treatments, expecially targeted therapies which increase the survival of HCC patients without size reduction.
•	The modified RECIST criteria (mRECIST) have been recently proposed to identify the best radiological response criteria that can be correlated with overall survival. These criteria are based on the concept of viable tumor showing arterial uptake on contrast-enhanced radiologic Imaging.
•	The contribution of FDG-PET to the diagnosis of HCC nodules remains limited because of low sensitivity (60%).
•	¹⁸F-Fluorocholine (FCH), a PET tracer of lipid metabolism, is significantly more sensitive than ¹⁸F-FDG at detecting HCC, particularly in well-differentiated forms
•	The positive FDG-PET is associated with a poor HCC prognosis: 1) The intensity of tumor uptake in FDG-PET was higher in poorly-differentiated tumors compared to those that was were well- or moderately differentiated; 2) the FDG-PET is associated with the HCC recurrence after surgical resection and liver transplantation.