◎Health and Medical Network
Because early-stage liver disease usually lacks obvious symptoms, some patients do not receive examinations until they develop discomfort, and they are already in the mid-to-late stage when diagnosed. Hong Zhaohong, director of the Department of Gastroenterology and Hepatobiliary Medicine at Kaohsiung Chang Gung Memorial Hospital, said that in the past, the treatment goals for patients with intermediate and advanced liver cancer were mostly to prolong life and control the disease. However, with the continued development of targeted drugs, immunotherapy and local therapies, the treatment goal is not only to prolong survival. Some patients who respond well to treatment may also use "Conversion curative therapy" to further strive for eradication treatment opportunities such as ablation, surgery or liver transplantation after the tumor shrinks.
More than 40% of patients in Taiwan are diagnosed in the mid-to-late stage. It is often too late to check again if there are symptoms.
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Director Hong Zhaohong pointed out that according to the Barcelona clinical liver cancer staging (BCLC stage), liver cancer can be divided into very early stage (BCLC stage 0), early stage (BCLC stage A), intermediate stage (BCLC stage B), late stage (BCLC stage C) and terminal stage (BCLC stage D). Patients in the very early and early stages can usually receive treatments such as ablation, surgery, and liver transplantation. According to clinical statistics, the 5-year survival rate is approximately more than 50%. In the past, patients in the middle stage were mostly treated with hepatic artery embolization (TACE), while patients in the advanced stage were mainly treated with systemic drugs, including targeted drugs and immunotherapy.
Clinical statistics also mention that in Taiwan, very early and early-stage liver cancer detected through liver B and C screening accounts for more than 40% of first-time diagnosed patients, but there are still about 40% to 50% of patients who have entered the mid-to-late stage when diagnosed. Dr. Hong said that the liver is known as the "silent organ". If patients wait until symptoms appear before seeking medical treatment, the disease is often not in the early stage. He also called on patients with hepatitis B, hepatitis C, chronic hepatitis and cirrhosis to be followed up regularly according to risk. Patients with cirrhosis are usually checked every 3 to 6 months, while patients with chronic hepatitis are followed up about every 6 to 12 months.
From prolonging survival to conversion curative therapy, eradication opportunities can be reassessed after tumor shrinkage
For patients who are unfortunately diagnosed with liver cancer and are already in the mid-to-late stage, Director Hong Zhaohong said that with the development of targeted and immunotherapy, some mid-to-late stage patients may shrink in size after receiving immunotherapy, immunotherapy combined with anti-angiogenic targeted drug therapy, or other systemic treatments, and lesions that originally invaded blood vessels or were unresectable may also be controlled. The survival period is also different from traditional treatments. In addition to controlling the tumor, doctors will also try to maintain the patient's liver function and physical condition as much as possible, leaving room for subsequent "Conversion curative therapy".
Director Hong Zhaohong said that the so-called "Conversion curative therapy" allows patients who were originally not suitable for ablation, surgery, or liver transplantation to be downgraded after treatment to regain the opportunity for eradication therapy. However, whether they can undergo further surgery must still be evaluated by an interdisciplinary team based on the extent of the tumor, liver function, and overall physical condition.
About 30% of patients experience different tumor reactions, and complete remission does not mean cure
Director Hong Zhaohong pointed out that after patients with intermediate and advanced liver cancer receive immunotherapy or immunotherapy combined with anti-angiogenesis target therapy, clinical statistics indicate that about 30% of patients will experience varying degrees of tumor response, of which about 10% may achieve a "complete response." Complete remission may be the complete disappearance of lesions on imaging examinations, and no active tumor tissue is found after a period of time. However, complete remission does not mean a guarantee of cure, and patients must continue to follow up in the outpatient department for recurrence.
Advanced liver cancer combined with lung metastasis underwent living donor liver transplantation after 3 years of treatment
Director Hong Zhaohong shared that a patient in his 60s was diagnosed with advanced liver cancer at the end of 2020. The tumor was close to 10 centimeters and had invaded the hepatic portal vein. However, due to cirrhosis and small liver size, he could not undergo direct surgical resection. So he received radiotherapy first, and then received immunotherapy combined with anti-angiogenesis targeted therapy. Follow-up imaging examinations showed that the size of the primary tumor was different from before treatment. Although distant metastasis occurred again during the treatment, it was successfully removed with surgery.
After receiving treatment for about 3 years, the patient's condition gradually stabilized. Immunotherapy was stopped and observed for about 1 year. After evaluation by the surgical team, he received a living donor liver transplant in December 2023. As of July 2026, it has been more than 2 and a half years since the liver transplant, and the follow-up condition is still being followed up in the outpatient clinic. However, Director Hong Zhaohong emphasized that the case cannot be applied to all patients who have developed distant metastasis, but it also reflects that some patients who have responded well to treatment may indeed have the opportunity to seek eradication treatment again.
Immunotherapy may still cause serious side effects. A complete evaluation is required before treatment.
Immunotherapy or immunotherapy combined with anti-angiogenic targeted therapy is usually administered every 3 to 4 weeks. Some patients can maintain daily activities during treatment, but they may still experience side effects such as immune pneumonia, hepatitis, or thyroid and adrenal dysfunction. A few patients may have severe reactions, and must be identified by the medical team early and the use of steroid drugs or other immunosuppressive therapies to control symptoms may be considered.
For this reason, Director Hong Zhaohong reminded that patients must evaluate the functions of multiple organs such as the liver, kidneys, gastrointestinal tract, thyroid, and adrenal glands before receiving treatment. If they already have more severe esophageal varices, gastric ulcers, or autoimmune diseases, they must be further treated and other treatment strategies considered. He also emphasized that although the treatment options for intermediate and advanced liver cancer have increased compared with the past, they still need to be planned according to individual conditions, and it is not appropriate to estimate the efficacy based on a single case.
Dr. Hong Zhaohong said that the liver is known as the "silent organ". If patients wait until symptoms appear before seeking medical treatment, the disease is often not in the early stages. He also called on patients with hepatitis B, hepatitis C, chronic hepatitis and cirrhosis to be tracked regularly according to risk. (Taken from the post)
This article is reproduced with permission from the Health Medical Network/Reported by reporters Lin Zecheng and Pan Yuqiao. Late-stage liver cancer is no longer just about prolonging life. Doctors: Some patients can use 1 therapy to reduce the period of treatment and strive for follow-up treatment.
