The observation that patients who received a sub-median dose of drug may have an advantage in terms of overall survival and time to progression compared to those this website who received a dose over-the median deserves further comments. It is possible that a higher dose of chemotherapy would result in an additional damage to a liver function already heavily compromised due to the underlying disease, rather than an advantage, measurable with a tumor shrinkage. Another crucial point of discussion in HCC is the use of a staging system which effectively reproducible. In our study none of the staging systems commonly used in clinical practice has proven to be able to classify patients from a prognostic point of view,

with the exception of the Okuda system, which proved able to influence the overall survival (p = 0.046).

Unlike most other malignancies, for which the staging systems are well codified and universally accepted the staging systems proposed for HCC are not universally adopted and shared. One of the reasons that makes it difficult to obtain reliable results, is related to the fact that in most cases, the tumor occurs in patients with liver cirrhosis. Therefore tumor stage, liver function and clinical characteristics may differently concur to define subgroups of HCC in different patients. In this perspective, the results of our analysis proved to agree with the majority of studies in the literature. PAK6 Conclusion The clinical BGJ398 in vitro management of HCC is becoming increasingly complex as therapeutic options are expanding. The patient has, in most cases, two diseases, cancer and the underlying liver disease that often heavily influenced, by mechanisms not yet completely clear, the response to cancer therapy and prognosis. So it is clear how crucial is a multi-specialist management of patients with HCC. In this

framework, loco-regional treatment still plays an important role and appears to be an essential point of comparison even, and maybe even more, in the era of biological therapies. References 1. Parkin DM, Bray F, Ferlay J, et al.: Global cancer statistics, 2002. Ca Cancer J Clin 2005, 55: 74–108.PubMedCrossRef 2. Montalto G, Cervello M, Giannitrapani L, et al.: Epidemiology, risk factors and natural history of hepatocellular carcinoma. Ann N Y Acad Sci 2002, 963: 13–20.PubMedCrossRef 3. Llovet JM: Update treatment approach to hepatocellular carcinoma. J Gastroenterol 2005, 40: 225–235.PubMedCrossRef 4. Lencioni R, Allagaier HP, Cioni D, et al.: Small hepatocellular carcinoma in cirrhosis: randomized controlled trial of radiofrequency thermal ablation versus percutaneous ethanol injection. Radiology 2003, 228: 235–240.PubMedCrossRef 5. Lin S, Lin C, Lin C, et al.: Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma of 4 cm or less. Gastroenterology 2004, 127: 1714–1723.PubMedCrossRef 6.