Hepatocellular damage caused by HBV/HCV infection, alcohol abuse, fatty liver and other factors, some lesions form cirrhosis, and the progressive evolution from cirrhosis through regenerative nodules, heterogeneous hyperplastic nodules to early carcinoma is a series of genetic and pathological changes. However, the early diagnosis of hepatocellular carcinoma, especially the differentiation of high-grade heterogeneous hyperplastic nodules from early HCC, is still a challenge that has not been completely solved. It is still difficult to definitively diagnose microscopic nodules <1 cm in diameter by imaging or pathology. Imaging is the most important basis for the clinical diagnosis of HCC and the development of treatment plans. High specific MRI contrast contrast agent gadoxetic acid disodium in liver has high uptake rate and high relaxation rate in liver, which is also helpful to differentiate HCC from focal hyperplastic nodules and hepatic adenoma. A recently completed multicenter phase III clinical trial in China showed that MRI gadoxetic acid disodium enhancement scans significantly improved the sensitivity and diagnostic accuracy of small nodules <1 cm in the liver. Molecular prediction studies of HCC recurrence metastasis and prognosis continue to be explored in depth. The results show that SALLA, an oncogene expressed in human embryonic liver, is absent in normal healthy human liver, but gains re-expression in some HCC patients and in progressive disease, playing a key role in cell survival and tumorigenesis. In experimental studies, knockdown of SALLA gene makes HCC more susceptible to apoptosis and less susceptible to tumor formation. Blocking SALLA expression with therapeutic peptides can block tumorigenesis and kill HCC cells, and SALLA gene can be used as a potential target for HCC targeted therapy, which can help early intervention and improve survival rate. Epithelial cell adhesion molecule-positive (EpCAM+) circulating HCC cells have stem cell-like phenotypic characteristics, which are independent predictors of postoperative recurrence and are closely associated with poor prognosis of HCC. Preoperative EpCAM+ circulating tumor cell counts may serve as a new predictor of prognosis for radical resection of HCC, especially for HCC patients with low AFP levels or low risk of recurrence. Systemic chemotherapy Chemotherapy, as one of the main modalities of oncology treatment, is mainly used for local treatment (hepatic artery chemoembolization and portal vein perfusion chemotherapy) in HCC. Previous clinical data have not confirmed that systemic chemotherapy can improve the overall survival of HCC patients. The results of a multicenter randomized controlled phase III clinical trial in China and Taiwan, as well as in Korea and Thailand, published this year showed that the application of the FOLFOX4 regimen of oxaliplatin combined with fluorouracil/calcium folinate for the treatment of advanced HCC patients who were not suitable for surgery or local treatment prolonged overall survival and significantly improved progression-free survival, remission rate In March 2013, the regimen was approved in China for the treatment of advanced or metastatic HCC that is not amenable to surgical resection or local treatment. Immunotherapy Biological immunotherapy is an important aspect of systemic oncology treatment and has achieved significant efficacy in a variety of tumors, and in recent years, significant progress has been made in immunotherapy of liver cancer. In a recently completed randomized controlled clinical phase II trial of genetically recombinant cowpox virus: IX-594 for immunotherapy of advanced HCC, both groups produced significant efficacy after intratumoral injection of different doses of tumor lysing virus JX-594 at high and low doses for the treatment of hepatocellular carcinoma. The median survival of patients in the two groups was 14.1 and 6.7 months, respectively, with the high-dose group having a significant survival advantage. All patients showed no significant adverse effects except for transient cold-like syndrome, demonstrating an encouraging outlook. preliminary results from a clinical phase II trial of JX-594 sequentially applied with sorafenib in the first-line treatment of advanced HCC showed safe tolerability and a high rate of tumor control. The results showed that PD-1, a cell surface receptor expressed by T lymphocytes and B lymphocytes, can downregulate T lymphocyte function after activation by ligands PD-L1 or PD-L2, and PD-1 binding to tumor B7-Hl can lead to downregulation of T lymphocyte function to destroy tumor cells. Antibodies targeting PD-1 block this downregulation, allowing T lymphocytes to maintain their anti-tumor function and mediating tumor cell death. Clinical phase I trials are currently underway for the treatment of patients with advanced HCC with PD-1 antibodies. Molecularly targeted therapy Molecularly targeted therapy for hepatocellular carcinoma is a hot topic in clinical research for HCC today. Sorafenib is still the only molecularly targeted drug with positive efficacy in unresectable and distant metastatic advanced HCC, and its clinical research on HCC treatment is further advanced: (1) the combination with other antitumor therapeutic drugs, including chemotherapeutic drugs (doxorubicin, fluorouracil, tegafur, capecitabine, oxaliplatin + gemcitabine, oxaliplatin + capecitabine, etc.) or with other molecularly targeted drugs (erlotinib, etc.) for advanced HCC; (2) various combination regimens with local regional therapies such as conventional chemoembolization of hepatic arteries, drug-eluting microsphere embolization or radiotherapy for mid-stage HCC; and (3) adjuvant therapy after radical treatment (hepatectomy or local ablation) to prevent recurrence of HCC. The results of the phase IV clinical study on the safety and long-term efficacy of long-term non-interventional treatment with sorafenib conducted worldwide are under final analysis and some results have been published. Additional clinical studies of molecularly targeted agents for the treatment of HCC are being conducted extensively, including: (1) angiogenesis inhibitors: sunitinib, brivanib, linifanib, lenvatinib, regorafenib, ramucirumab, bevacizumab ( bevacizumab, axitini, cediranib, dovitinib, vandetanib, pazopanib, orantinib, nintedanib, etc.; (2) epidermal growth factor receptor (EGFR), inhibitors: erlotinib, gefitinib (2) epidermal growth factor receptor (EGFR), inhibitors: erlotinib, gefitinib, cetuximab, lapatinib, etc.; (3) mTOR signaling pathway inhibitors: everolimus, temsirolimus, sirolimus, etc. (4) c-Met inhibitors: tivantinib, cabozantinib, golvatinib, foretinib, etc.; (5) MEK inhibitors: selumetinib, BAY86-9766; (6) insulin-like growth factor (IGF) signaling pathway inhibitors: dxutumumab, OSI- 906, etc.; (7) histone deacetylase (HDAC) inhibitors: resminostat, vorinostat, belinostat; (8) other targeted drugs: mapatumumab, tigatuzumab, tremelimrmab, lenalidomide, bortezomib, bavituximab, dasatinib, etc. Among them, phase III clinical trials of sunitinib, linifanib, and bevacizumab + erlotinib for the first-line treatment of advanced HCC did not achieve significant efficacy. The results of the phase III clinical trial of brevafenib announced this year showed that its first-line treatment of advanced HCC was not superior to sorafenib in terms of overall survival; second-line treatment also failed to significantly improve the overall survival of patients with advanced HCC after sorafenib treatment. Recent phase II clinical trials have shown that regorafenib has better safety and antitumor efficacy in second-line treatment of patients with intermediate to advanced HCC whose disease has progressed after first-line treatment with sorafenib; a global multicenter randomized controlled phase III clinical trial of second-line treatment of HCC is currently underway. c-Met inhibitors tivantinib and cabozantinib have been shown to have better safety and antitumor efficacy in second-line treatment of patients with high c-Met expression. Phase III clinical trials have also been conducted for the second-line treatment of HCC. The comprehensive clinical studies of molecularly targeted therapies are expected to bring new hope to patients with liver cancer. Antiviral therapy HBV and HCV infections play an important role in the occurrence and development of HCC, and there is no uniform understanding of the implementation and evaluation of antiviral therapy for hepatocellular carcinoma at home and abroad. Based on the available evidence-based medical clinical data, the Hepatology Group of the Chinese Medical Association Hepatology Branch has proposed the Expert Recommendations on Antiviral Therapy for HBV/HCV-related Hepatocellular Carcinoma, with a view to further improving the standardized treatment of liver cancer in China. Antiviral therapy has received increasing attention in HCC clinical practice, and more clinical data have been accumulated this year to confirm that antiviral therapy (IFNα and nucleoside/nucleoside analogs) can reduce the risk of HBV-related HCC development. Our scholars evaluated the impact of nucleoside/nucleoside analogue therapy on the prognosis of surgical treatment for HBV-related HCC patients through a two-stage longitudinal study including randomized clinical trials. High-load HBV DNA was a predictor of poor overall survival (OS) and relapse-free survival in HCC patients, and antiviral therapy significantly improved the prognosis of patients. Multivariate COX analysis of randomized controlled clinical trials demonstrated that antiviral therapy reduced postoperative recurrence rates and associated mortality in HCC, and significantly improved postoperative liver function in patients. Further studies confirmed that surgical treatment may also lead to HBV reactivation in HCC patients with low viral load (HBV DNA < 2000 IU/ml), with significantly lower overall and disease-free survival rates than in patients without HBV reactivation. The incidence of HBV reactivation after radiofrequency ablation (RFA) treatment was significantly lower than in patients undergoing hepatectomy. Prophylactic antiviral therapy was effective in reducing the incidence of HBV reactivation in patients with hepatectomized HCC. Intrahepatic cholangiocarcinoma Intrahepatic cholangiocarcinoma is a less common type of PLC with an increasing incidence year by year. Its etiology, pathogenesis, diagnosis and treatment are different from those of HCC, and there is no clear consensus opinion at home and abroad. The International Society of Hepatocellular Carcinoma launched the first recommendation of clinical guidelines for the diagnosis and treatment of intrahepatic cholangiocarcinoma at its annual meeting in September this year, which is of guiding significance to standardize the clinical treatment of intrahepatic cholangiocarcinoma (to be published). Based on the clinical data of intrahepatic cholangiocarcinoma patients undergoing liver resection, our scholars established a prognostic line chart. Multivariate analysis showed that CEA and CA19-9 levels, tumor diameter and number, vascular invasion, lymph node metastasis, direct tumor invasion and extrahepatic metastasis were all independent factors related to survival in patients with intrahepatic cholangiocarcinoma. The prospective prediction of survival probability fits well with actual observation and is better than the currently available staging system. Comprehensive multidisciplinary treatment Primary liver cancer is treated in a variety of ways, involving multiple treatments and different specialties. Integrated treatment of liver cancer by multidisciplinary teams is an important way to further improve the efficacy, and this model has attracted great attention and become the trend of Tao today. It can be expected that strengthening communication and collaboration among related disciplines, conducting multicenter randomized controlled studies, rationalizing the application of various treatment methods, formulating the best individualized comprehensive treatment plan, and avoiding inappropriate or overtreatment will continuously improve the final outcome of clinical outcomes and benefit more patients with liver cancer.