Work

Should hepatic dysplastic nodules and regenerative nodules be regarded as premalignant lesions and treated?

Year: 2016

Type: article

Abstract: LZ is funded by 2015 Innovation and Creation Fund of Shandong Academy of Medical Science. Potential conflict of interest: Dr. Wong is on the speakers' bureau for Bayer. To the Editor: The American Association for the Study of Liver Diseases (AASLD) practice guidelines on management of hepatocellular carcinoma (HCC) was last updated in 20111; another update is anticipated soon. For high‐grade dysplastic nodules (HGDNs), low‐grade dysplastic nodules (LGDNs), or large regenerative nodules (LRNs), it suggests “enhanced follow‐up.” No treatment would be provided until the diagnosis of HCC established during the follow‐up. However, is follow‐up always the best choice? Perhaps we can attempt to compare this to colorectal adenoma by focusing on their clinical behavior and malignant potential. In the National Comprehensive Cancer Network (NCCN) guideline, adenomatous polyps are accepted precursors to colorectal cancer (CRC) and removed to prevent cancer.2 A recent cohort study estimated that the average annual transition rate from advanced adenoma to CRC in men was 3.1%,3 so the 5‐year‐transition rate was around 15%. In HCC, several studies have revealed a relatively high transition rate of hepatic nodular lesions to HCC. In 154 patients with chronic hepatitis and cirrhosis, Kobayashi et al. reported the annual transition rate of 20% for patients with HGDN and 10% for patients with LGDN. The 5‐year cumulative transition rate from HGDN and LGDN was 80.8% and 30.2%, respectively. Even regenerative nodules without dysplasia evolved into HCC in 12.4%.4 More recently, Sato et al. studied 68 LRNs and 20 dysplastic nodules (DNs) from 1,500 consecutive nodular lesions; the 50‐month transition rate was 13.6% in LRNs and 40% in DNs.5 Earlier studies support these findings. Thus, DNs, especially HGDNs, have the high potential of malignant transition, and LRNs in patients with chronic hepatitis and cirrhosis can be considered as pre‐HCC lesion. In AASLD guidelines, the continuum between HGDN and early HCC obscures the diagnosis, whereas the smaller lesions would be more likely to receive curative treatment. Thus, we further raise the enquiry of whether LRNs and DNs should undergo active treatment, perhaps with minimally invasive ablation therapies. Preventing the transition to HCC by actively treating DNs and LRNs, such as removing colonic adenomas, may not only improve overall outcome, but also potentially decrease the need for liver transplantation in patients who can live with well‐compensated cirrhosis. Certainly, this provocative concept would need to be studied in a prospective, randomized controlled trial with long‐term follow‐up.

Source: Hepatology

DOI: 10.1002/hep.28444

Authors: Lei Zhao, Linda L. Wong, Xuetao Shi, Junfang Ji

Institutions: Shandong Tumor Hospital, University of Hawaii Cancer Center, Zhejiang University

Language: English

Topic: Hepatocellular Carcinoma Treatment and Prognosis

Subfield: Hepatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $2,900