National University Health System, Department of Pharmacology , Singapore.
Introduction: Hepatocellular carcinoma (HCC) is a lethal liver malignancy with an exceptionally high incidence in Asia and Africa. The number of new cases in America and Europe is rapidly increasing, making HCC a worldwide health problem. Patients with early HCC can be treated by potentially curative interventions such as tumor resection, liver transplantation, and radiofrequency ablation, but unfortunately a considerable portion of them would develop tumor recurrence, which in many cases cannot be detected early. As such, it remains imperative to develop accurate, noninvasive blood tests, which can be applied in most clinical laboratories, for the measurement of treatment responses and the surveillance for tumor recurrence. Areas covered: This review article focuses on the recent discoveries of circulating proteins, DNA, microRNAs, cancer cells, and regulatory T cells as serological prognostic biomarkers for patients with HCC. These biomarkers not only have prognostic implications, but also hold promises to help physicians stratify patients for different interventions. Expert opinions: Biomarkers will certainly serve as accurate tools in disease prognostication, changing the ways physicians stratify patients for specific therapy and monitor patients' responses toward treatment.