Editor’s note:
Hepatocellular carcinoma (HCC) is the sixth most common malignant tumor worldwide. Although the prognosis for HCC patients is generally poor, if diagnosed early, the 5-year survival rate can exceed 70%. Currently, the diagnosis of HCC without pathological evidence mainly relies on analyzing serum alpha-fetoprotein (AFP) levels and radiological diagnosis. Therefore, exploring early diagnostic biomarkers for HCC is of great clinical significance. In recent years, with advancements in genomics and proteomics, and the rapid development of biomarker detection technologies, numerous new biomarkers have been identified, promising to improve early diagnosis of HCC. At the recently concluded 17th annual meeting of the International Liver Cancer Association (ILCA), Dr. Nathalie Ganne-Carrié from the University Hospital of Paris Seine-Saint-Denis gave a special report on the progress of early diagnostic biomarkers for HCC. We invited Dr. Nathalie Ganne-Carrié for an in-depth interview. Here’s a summary for our readers.
Hepatology Digest: Can you introduce the current application of biomarkers in HCC detection and how can their accuracy be improved?
Dr. Nathalie Ganne-Carrié: Alpha-fetoprotein (AFP) is widely used as a biological marker for HCC screening. According to the latest guidelines of the American Association for the Study of Liver Diseases (AASLD) for liver cancer (2023 edition), regular HCC screening involves abdominal ultrasound and serum AFP testing. Other biomarkers related to HCC, such as Des-gamma Carboxyprothrombin (DCP, also known as PIVKA-II), are specific to HCC like AFP but are not significantly correlated with it. DCP can independently reflect a patient’s HCC status. Particularly for early diagnosis of HCC, DCP plays an important supplementary role for HCC patients with negative AFP results. Thus, combined testing of both can enhance the diagnostic value for HCC. For example, the GALAD model, based on Gender, Age, AFP-L3, AFP, and DCP, has shown promising results in early HCC diagnosis.
However, there’s still a long way to go regarding the application of biomarkers in clinical practice. We’ve achieved encouraging results in the second phase of HCC liquid biopsy research and the third phase of multi-parameter prediction models, such as the aforementioned GALAD model. Now, we must further verify their clinical utility through large-scale clinical trials.
Hepatology Digest: Looking forward, which biomarkers might enhance early detection of HCC? Will this change clinical treatment and prognosis for HCC?
Dr. Nathalie Ganne-Carrié: Personally, I believe that to improve clinical treatment and prognosis for HCC patients, we must shift from traditional HCC diagnostic pathways and stratify patients based on HCC risk. Several methods are already available for HCC risk stratification. For high-risk HCC patients, we need to intensify relevant screenings, possibly using more advanced imaging tools like MRI. For low-risk patients, we can adjust the screening frequency, ensuring no missed diagnosis while also not overburdening them mentally or financially.
Hepatology Digest: Can you summarize the trends in biomarker research and their clinical significance?
Dr. Nathalie Ganne-Carrié : Over the past year, we’ve established many HCC-related biomarkers. Protein-based biomarkers have reached phase three validation, and two significant markers are undergoing prospective studies, i.e., long-term follow-up in phase four and randomized controlled trials in phase five. On the other hand, liquid biopsy technology is still in the second phase of research. It’s a crucial direction for future HCC screening, deserving further in-depth exploration.
In summary, biomarkers are effective means for early HCC detection, significantly enhancing clinical treatment efficacy and patient prognosis. Future HCC clinical diagnosis still needs to be combined with radiological diagnosis. In this sense, biomarkers can also help avoid wastage of medical resources and reduce the medical burden on patients.
TAG: ILCA 2023, Interview, HCC
