Centers with more therapeutic modalities are associated with improved outcomes for patients with hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and is the third most common cause of cancer death worldwide. Management of HCC has many different treatment modalities (1). While surgery and transplantation are potential curative options, the majority of patients are not candidates for these therapies (2). For patients with unresectable disease, locoregional therapies include ablation, arterially directed therapies such as transarterial chemoembolization (TACE) or radioembolization, or stereotactic body radiation therapy (SBRT). Systemic therapy options include newer kinase inhibitors, such as, sorafenib, which has provided marginal increases in life span for advanced HCC patients (3). Chemotherapy options such as gemcitabine and oxaliplatin have demonstrated efficacy with overall disease control rates of 66% and 8.5% of the patients were subsequently eligible for curative-intent therapies after downstaging (4). More recently, immunotherapy using checkpoint blockade has demonstrated promise for the management of advanced HCC (5)