[Different strategies for treatment of hepatocellular carcinoma in the west and in the east].

In most of the cases, hepatocellular carcinoma (HCC) develops in the setting of cirrhosis associated with hepatitis B or C infection. Thus, cirrhotic patients constitute the population at risk for HCC. This has prompted the screening of cirrhotic patients for HCC and this policy has facilitated the detection of HCC at an early and/or asymptomatic phase when potentially effective treatments are available. However, it must be stressed that the prognosis of the patients with HCC is determined not only by the stage of the HCC, but also by the functional status of the underlying liver. In such a situation in Japan, systematic subsegmentectomy using intraoperative ultrasound, trancathether arterial embolization (TAE), and percutaneous ethanol injection (PEI) were developed to treat HCC patients with cirrhosis. On the other hand in the West, liver transplantation is the therapeutic modality for small HCC with cirrhosis while small HCCs are treated mainly by PEI. However, the lack of controlled trials for the most therapeutic options in our country precludes knowing if their antitumoral effect is associated with an improved survival. In summary, the treatment of patients with HCC remains a clinical challenge with several areas to be investigated through carefully designed prospective randomized controlled trials. Ideally, this clinical research will provide us with solid therapeutic options that unequivocally improve the survival of the patients with HCC. Application of living-related liver transplantation for carefully selected adult patients with small HCC will be necessary in Japan.