HCC, which accounts for most of the liver cancer, a globally common disease that ranks fourth in cancer-related deaths (1). Risk factors for HCC include viral hepatitis, alcoholic hepatitis, nonalcoholic steatohepatitis, and exposure to aflatoxin (2). These risk factors vary from region to region due to uneven distribution of hepatitis virus, religion, economic problems, environment and hygiene (3). These HCC risk factors are theoretically preventable but practically difficult. Therefore, the number of HCC patients depends on the amount of risk factors in each region. Regional genetic differences in HCC also affect therapeutic efficacy. It is unclear whether this genetic difference is due to etiology, environment, or race. Surveillance by setting high-risk group is effective for early detection of HCC. However, due to social issues including the economy, medical resources also have a serious regional disparity. In areas with inadequate medical resources, HCC cases are on the rise and are detected in advanced stages. The treatment guidelines for HCC dictate the recommended treatment by a staging system consisting of liver function factors and tumor factors. HCC treatment guidelines have also been taken regional characteristics into consideration (4-7). Treatment methods also have regional characteristics. Even the standard treatment, including surgical resections, local ablation, and TACE, recommended in the guidelines vary in frequency and timing of selection by region (3). In addition, the diversity of treatment modalities by region is even greater. Large regional differences in HCC itself, background, and management are thought to have a major impact on the therapeutic effects and adverse events of systemic therapy. This article discusses regional differences in the therapeutic efficacy of systemic therapy.
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