Management of Hepatocellular Carcinoma: The East-West Difference

Abstract: Hepatocellular carcinoma (HCC) is highly prevalent, which contributes to the high disease burden worldwide. It was recognized as the sixth most common cancer and the fourth leading cause of mortality in cancer patients in the Global Cancer Statistics 2018. The management of HCC between eastern and western countries varies from region to region due to the different epidemiology of HCC and the approach of clinicians. Over the past decades, the multidisciplinary team approach has taken a leading role in the therapeutic paradigm of HCC, and the main treatment options include, but are not limited to 1) surgical resection; 2) transarterial chemoembolization (TACE); and 3) systemic therapies. Among these, surgical resection and TACE are applicable in early-intermediate stage HCC with curative intent, while systemic therapies are mostly applied to advanced unresectable HCC. An individualized approach should be encouraged and tailored for each patient, taking into account the different patient population, staging, and treatment responses to achieve the best efficacy. This review discusses current advances and compares the eastern and western treatment options in the management of HCC.