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Zhang et al. Hepatoma Res 2019;5:27 I http://dx.doi.org/10.20517/2394-5079.2019.13 Page 11 of 18

Figure 2. Clinical implication of conventional cancer therapy and LCSC-targeting therapy. Conventional chemotherapy and radiotherapy
are frequently used to treat liver cancer, effectively targeting the non-stem liver cancer cells (NSLCCs) but not liver cancer stem
cells (LCSCs). The LCSC residual can be re-activated to enrich the LCSC subpopulation and eventually trigger cancer recurrence and
metastasis with a more aggressive phenotype. With the help of varied LCSC surface markers that can specifically and effectively identify
LCSC heterogeneity, LCSC-targeting therapy is believed to be capable of eradicating the CSC subpopulation in liver cancer. Integration of
LCSC-targeting therapy and conventional chemo-/radiotherapy might lead to complete cancer elimination without further development
and invasion. LCSC-targeting therapy has generated many promising results in pre-clinical trials and there are intensive efforts from
researchers and clinicians for further research.

eliminate CSCs remains relatively high so far. It is worth considering that such treatment failure might
be resulted from inefficiency of drug delivery instead of inefficiency of the drugs. Promoting the efficacy
of drug delivery and developing alternative approaches to target CSCs represent one of the most foremost
fields to be explored. In addition, early diagnosis of cancer by using CSC markers remains as an important
ramification that can prevent development, metastasis and resistance. Hence, there is an emergency for
greater concentration on identification of CSC markers that can specifically and effectively represent tumor
grades and disease stages. Integrating the development of early diagnosis techniques with a comprehensive
understanding of CSC surface markers that drive a benign stage to a malignant stage can enable patient-
specific and efficient early intervention and offer a balanced approach to regulating cancer development and
invasion.

DECLARATIONS
Authors’ contributions
Designed the structure and outline of the manuscript, instructed writing the intellectual part, and approved
final publication: Guan XY
Reviewed the literatures and wrote the draft: Zhang JL
Revised the manuscript and drew the pictures: Gong LQ
Review and minorly revised the manuscript: Yan Q, Zhou NN, Lee VHF

Availability of data and materials
Not applicable.

Financial support and sponsorship
This study was supported by a grant of the Basic Research (Discipline Layout) of Shenzhen Science and
Technology Project (No. JCYJ20180508153249223).