Editorial: Liver Cancer Awareness Month 2024: Current Progress and Future Prospects on Advances in Primary Liver Cancer Investigation and Treatment

FRANCISCO TUSTUMI^1,2*Rodrigo Xavier Das Neves³Marina Alessandra Pereira⁴WELLINGTON ANDRAUS⁵Fabricio Ferreira Coelho⁵

• ¹University of São Paulo, São Paulo, Brazil
• ²Sociedade Beneficente Israelita Brasileira Albert Einstein, São Paulo, Brazil
• ³National Cancer Institute Center for Cancer Research, Bethesda, United States
• ⁴Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
• ⁵Universidade de Sao Paulo, São Paulo, Brazil

Liver cancer ranks among the most lethal cancers globally, and projections indicate that its burden may rise by more than 50% over the next two decades [1]. In this context, Liver Cancer Awareness Month, observed every October, provides a vital platform to discuss the disease's global impact and to highlight recent advances in prevention, detection, and therapeutic innovation.The most frequent primary liver cancers are hepatocellular carcinoma (HCC) and cholangiocarcinoma [2,3]. Despite improvements in surgical techniques and systemic therapies, survival rates remain low, particularly for those diagnosed at advanced stages. The need for early detection, risk stratification, and tailored therapeutic strategies has driven increased research into molecular biomarkers, immunotherapy, targeted therapies, and imaging-based innovations. These advances align with the primary goal of shifting from a one-size-fits-all approach to precision medicine, where tumor biology, host factors, and microenvironmental signatures increasingly guide treatment selection [4]. This editorial builds upon our prior initiative, which highlighted the progress in pathogenesis, diagnostic advances, and technological innovation [5]. The current Research Topic on Liver Cancer Awareness Month 2024 extends this vision, featuring 25 articles that address emerging biomarkers, diagnostic strategies, and novel treatment modalities poised to individualize patient care. Together, these contributions reflect where the field is heading: towards biologically informed, patient-centered, and precision-driven approaches to combat liver cancer (Figure 1). The progressive shift toward precision medicine in liver cancer has been largely fueled by the discovery, validation, and clinical application of biomarkers-molecular or imaging signatures that refine diagnosis, risk stratification, and therapeutic tailoring. Traditional modalities such as imaging and histopathology remain indispensable, but they are increasingly complemented by biomarker-based approaches that allow earlier detection and more nuanced prognostic assessment, both in early and advanced disease.Biomarkers are increasingly recognized as fundamental tools for improving the diagnosis of primary liver cancer, especially in the early stages when clinical and imaging findings alone may be insufficient. Although modern imaging modalities already provide moderate sensitivity, their specificity remains suboptimal in certain scenarios, which is critical when deciding on showing that circRNAs and mRNAs-such as hsa_circ_000224 and KIAA0101 mRNA-outperform traditional biomarkers in distinguishing HCC from both healthy controls and patients with chronic liver disease. Together, these studies reinforce the potential of biomarker-based strategies to expand diagnostic precision, promote earlier intervention, and ultimately improve patient outcomes.Beyond their diagnostic applications, biomarkers are increasingly central to risk stratification and prognostic assessment in liver cancer. Simple serum-based indices, such as the ALBI score, are routinely used in clinical practice to predict outcomes in HCC [6,7]. They remain attractive for clinical practice due to their accessibility and cost-effectiveness. Fang Taken together, these studies show that response evaluation in HCC is increasingly multidimensional: radiological signatures, immune profiling, procedural refinements, and recurrence-risk stratification all converge to inform treatment continuation, escalation, or change.Precision medicine, therefore, lies not only in choosing the right therapy but also in continuously measuring and refining its effectiveness in the individual patient.