Journal of Liver Cancer

Original Article

Pain, analgesic use and misconceptions in patients with hepatocellular carcinoma: a cross-sectional survey: Jina Park, Jiwon Yang, Sung Won Chung, Won-Mook Choi, Ju Hyun Shim, Danbi Lee, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Jonggi Choi; Received January 15, 2026 Accepted March 19, 2026 Published online April 29, 2026; DOI: https://doi.org/10.17998/jlc.2026.03.19 [Epub ahead of print]

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Abstract PDF Supplementary Material: Backgrounds/Aims
Cancer-related pain remains undertreated despite established guidelines. In hepatocellular carcinoma (HCC), underlying chronic liver disease may amplify concerns regarding analgesic safety. We aimed to evaluate pain prevalence, analgesic use, pain-related perceptions, and educational needs among patients with HCC.
Methods
We conducted a cross-sectional survey of 200 adult patients with HCC receiving systemic therapy at a tertiary referral center. A 30-item questionnaire assessed pain presence and intensity using a numeric rating scale (NRS), analgesic use patterns, liver-related safety concerns, opioid-related stigma, and educational needs. Clinical characteristics, including tumor burden and liver function, were analyzed in relation to pain and perception domains.
Results
Fifty-five patients (27.5%) reported current pain (mean NRS, 3.6±2.5; mean worst pain 5.2±2.8). Among them, 31 patients (56.3%) were using analgesics; however, 51.6% reported using them only when pain became unbearable. Misconceptions regarding analgesic safety were prevalent: 70.0% believed long-term analgesic use damages the liver, 56.0% believed analgesics are unsafe with impaired liver function, 46.5% associated opioids with addiction, and 30.0% hesitated due to the term “narcotic.” These beliefs were not associated with Child-Pugh class or serum albumin level. Extrahepatic metastasis was associated with higher liver-related concern scores and a trend toward increased pain prevalence. Patients with elementary school education or less had poorer pain scale knowledge and no prior counseling.
Conclusions
Pain undertreatment and safety-related misconceptions are common in HCC and appear independent of objective liver function. Structured, proactive education, particularly for patients with untreated pain and low educational attainment, may improve pain control in this population.

Review Article

Second-line antidiabetic drugs: friend or foe of the liver: Jiwon Yang, Gunho Kim, Ju Hyun Shim, Jihyun An; J Liver Cancer. 2025;25(2):187-203. Published online June 26, 2025; DOI: https://doi.org/10.17998/jlc.2025.06.25

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Abstract PDF Supplementary Material

Diabetes mellitus is a cardiometabolic risk factor associated with the development of various comorbidities and malignancies. It has a bidirectional relationship with chronic liver disease, promoting hepatic inflammation and fibrosis, which can ultimately progress to advanced liver diseases such as cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Therefore, the importance of antidiabetic treatment has been increasingly emphasized as a strategy for preventing liver-related diseases in diabetic patients. Metformin, a first-line antidiabetic agent, has been shown to be effective in improving hepatic steatosis and preventing progression to advanced liver disease. Recently updated international guidelines recommend the use of metformin as a chemopreventive agent for HCC in diabetic patients, albeit with a weak recommendation. Meanwhile, as metformin alone is often insufficient for blood glucose control and concurrent metabolic comorbidities are increasingly prevalent, new second-line antidiabetic agents have been developed: glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, and dipeptidyl peptidase-4 inhibitors. These novel antidiabetic agents have demonstrated cardiovascular benefits, and protective effects on liver-related outcomes and mortality in previous studies. However, due to the limited number of studies and the variability in study populations, their effects remain inconsistent across different studies. Furthermore, there are no established therapeutic guidelines for diabetic patients with liver disease. Therefore, this review aims to examine the association between the use of novel second-line antidiabetic agents and the risk of liver-related outcomes and mortality in this population.

Citations

Citations to this article as recorded by

Insulin Resistance and Hepatocellular Carcinoma Development in Chronic Hepatitis B Patients Under Antiviral Therapy
Dong Hyun Sinn, Kyung-Ah Kim, Jung Il Lee, Geum-Youn Gwak
Journal of Korean Medical Science.2026;[Epub] CrossRef
Exploring the Epidemiologic Burden, Pathogenetic Features, and Clinical Outcomes of Primary Liver Cancer in Patients with Type 2 Diabetes Mellitus (T2DM) and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Scoping Review
Mario Romeo, Fiammetta Di Nardo, Carmine Napolitano, Claudio Basile, Carlo Palma, Paolo Vaia, Marcello Dallio, Alessandro Federico
Diabetology.2025; 6(8): 79. CrossRef

Original Article

Outcomes of liver resection and transarterial chemoembolization in patients with multinodular BCLC-A hepatocellular carcinoma: Jiwon Yang, Won-Mook Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Deok-Bog Moon, Dong-Hwan Jung, Jonggi Choi; J Liver Cancer. 2024;24(2):178-191. Published online April 3, 2024; DOI: https://doi.org/10.17998/jlc.2024.03.25

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150 Downloads
8 Citations

Abstract PDF Supplementary Material

Backgrounds/Aims
This study aimed to compare the outcomes of liver resection (LR) and transarterial chemoembolization (TACE) in patients with multinodular hepatocellular carcinoma (HCC) within the Milan criteria who were not eligible for liver transplantation.
Methods
We retrospectively analyzed 483 patients with multinodular HCC within the Milan criteria, who underwent either LR or TACE as an initial therapy between 2013 and 2022. The overall survival (OS) in the entire population and recurrence-free survival (RFS) in patients who underwent LR and TACE and achieved a complete response were analyzed. Propensity score (PS) matching analysis was also used for a fair comparison of outcomes between the two groups.
Results
Among the 483 patients, 107 (22.2%) and 376 (77.8%) underwent LR and TACE, respectively. The median size of the largest tumor was 2.0 cm, and 72.3% of the patients had two HCC lesions. The median OS and RFS were significantly longer in the LR group than in the TACE group (P<0.01 for both). In the multivariate analysis, TACE (adjusted hazard ratio [aHR], 1.81 and aHR, 2.41) and large tumor size (aHR, 1.43 and aHR, 1.44) were significantly associated with worse OS and RFS, respectively. The PS-matched analysis also demonstrated that the LR group had significantly longer OS and RFS than the TACE group (PS<0.05).
Conclusions
In this study, LR showed better OS and RFS than TACE in patients with multinodular Barcelona Clinic Liver Cancer stage A HCC. Therefore, LR can be considered an effective treatment option for these patients.

Citations

Citations to this article as recorded by

Survival Prediction and Treatment Decisions in Hepatocellular Carcinoma: A Deep Learning-Based Radiomics Approach
Xiaoqin Wei, Jun Xiao, Ying Liu, Chaofeng Yang, Ziren Luo, Mingyue Tang, Xiaowen Chen
British Journal of Hospital Medicine.2026;[Epub] CrossRef
Liver resection versus radiofrequency ablation or transarterial chemoembolization for early multinodular BCLC-A hepatocellular carcinoma: a systematic review and meta-analysis
Maria F. F. Viana, Arthur A. Braga, Lucas B. Carvalho, Danilo C. M. S. Vasconcellos, Bianca C. M. R. Alexandrino, Felipe J. F. Coimbra
Journal of Liver Cancer.2026; 26(1): 157. CrossRef
Low Tumor Burden Predicts Benefit from Transarterial Treatment in Hepatocellular Carcinoma with Extrahepatic Metastasis: A Nationwide Cohort Study
Jaejun Lee, Hyun Yang, Keungmo Yang, Ji Won Han, Pil Soo Sung, Jeong Won Jang, Si Hyun Bae
Liver Cancer.2026; : 1. CrossRef
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Seung Yeon Lim, Gi Hong Choi, Jin Hong Lim, Ho-Seong Han, Yoo-Seok Yoon, Hae Won Lee, Boram Lee, Yeshong Park, MeeYoung Kang, Jinju Kim, Hyelim Joo, Jai Young Cho
Cancers.2025; 17(5): 757. CrossRef
Comparison of initial treatments for resectable hepatocellular carcinoma within Milan criteria: an observational study based on a nationwide survey
Sang Jin Kim, Woo Kyoung Jeong, Hyung-Joon Han, Gyu-Seong Choi, Kyun-Hwan Kim, Jongman Kim
Annals of Surgical Treatment and Research.2025; 108(5): 279. CrossRef
Comparative analysis of the immediate results of surgical treatment in patients with early (BCLC A) and intermediate (BCLC B) stage hepatocellular carcinoma
B. I. Sakibov, D. V. Podluzhnyi, Yu. I. Patyutko, E. A. Moroz, O. A. Egenov, N. E. Kudashkin
Surgery and Oncology.2025; 15(2): 52. CrossRef
Artificial intelligence for multi-time-point arterial phase contrast-enhanced MRI profiling to predict prognosis after transarterial chemoembolization in hepatocellular carcinoma
Lanlin Yao, Hamzah Adwan, Simon Bernatz, Hao Li, Thomas J. Vogl
La radiologia medica.2025; 130(10): 1517. CrossRef
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