Pub Date : 2022-02-11DOI: 10.20517/2394-5079.2021.123
Chimaobi Anugwom, T. Leventhal, J. Debes
Treatment modalities for hepatocellular carcinoma (HCC) vary from surgical techniques and interventional radiologic strategies to systemic therapy. For the latter, the use of immune checkpoint inhibitors (ICIs) has gained popularity due to successful trials showing increased survival. In patients who have undergone liver transplantation, recurrence of HCC poses a significant challenge. There is indeed considerable debate on the efficacy and safety of ICI use in liver transplant recipients due to competing immune interests in maintaining a healthy graft and combating the tumor. Recent reports and case series have highlighted a role for the type of immune therapy, timing of therapy, tissue expression of PD-1 and modulation of immunosuppression, in the understanding of the efficacy and risks of ICIs for HCC in liver transplant. In this article, we appraise the available literature on the usage of ICIs for HCC in liver transplant recipients and provide perspectives on immune concerns as well as potential recommendations to consider during the management of such complex cases.
{"title":"Understanding immune perspectives and options for the use of checkpoint immunotherapy in HCC post liver transplant","authors":"Chimaobi Anugwom, T. Leventhal, J. Debes","doi":"10.20517/2394-5079.2021.123","DOIUrl":"https://doi.org/10.20517/2394-5079.2021.123","url":null,"abstract":"Treatment modalities for hepatocellular carcinoma (HCC) vary from surgical techniques and interventional radiologic strategies to systemic therapy. For the latter, the use of immune checkpoint inhibitors (ICIs) has gained popularity due to successful trials showing increased survival. In patients who have undergone liver transplantation, recurrence of HCC poses a significant challenge. There is indeed considerable debate on the efficacy and safety of ICI use in liver transplant recipients due to competing immune interests in maintaining a healthy graft and combating the tumor. Recent reports and case series have highlighted a role for the type of immune therapy, timing of therapy, tissue expression of PD-1 and modulation of immunosuppression, in the understanding of the efficacy and risks of ICIs for HCC in liver transplant. In this article, we appraise the available literature on the usage of ICIs for HCC in liver transplant recipients and provide perspectives on immune concerns as well as potential recommendations to consider during the management of such complex cases.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45337906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2021.136
Elvire Desjonqueres, E. Gigante
The epidemiological features of hepatocellular carcinoma have changed significantly in the last decades. While for a long-time viral hepatitis and alcohol consumption have been the leading risk factors, the current spread of obesity and type 2 diabetes has contributed to the emergence of non-alcoholic fatty liver disease (NAFLD) worldwide, which has become the leading chronic liver disease as well as one of the main etiologies of hepatocellular carcinoma (HCC), especially in western countries. In this review, we resume the latest data about the epidemiology of metabolic liver disease and HCC arising from NAFLD and discuss the main clinical and molecular features leading to the progression of liver disease and the development of HCC in NAFLD. The emerging concept of metabolic associated fatty liver disease and its association with the development of HCC are also introduced.
{"title":"Hepatocellular carcinoma on the background of nonalcoholic fatty liver disease: epidemiological update","authors":"Elvire Desjonqueres, E. Gigante","doi":"10.20517/2394-5079.2021.136","DOIUrl":"https://doi.org/10.20517/2394-5079.2021.136","url":null,"abstract":"The epidemiological features of hepatocellular carcinoma have changed significantly in the last decades. While for a long-time viral hepatitis and alcohol consumption have been the leading risk factors, the current spread of obesity and type 2 diabetes has contributed to the emergence of non-alcoholic fatty liver disease (NAFLD) worldwide, which has become the leading chronic liver disease as well as one of the main etiologies of hepatocellular carcinoma (HCC), especially in western countries. In this review, we resume the latest data about the epidemiology of metabolic liver disease and HCC arising from NAFLD and discuss the main clinical and molecular features leading to the progression of liver disease and the development of HCC in NAFLD. The emerging concept of metabolic associated fatty liver disease and its association with the development of HCC are also introduced.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.43
Mei-Mei Li, Yi He, Jie-Kai Liang, X. Guan, N. Ma, Ming Liu
Hepatocellular carcinoma (HCC) is a highly heterogeneous malignancy. In the clinic, therapeutic resistance is largely attributed to tumor heterogeneity. Growing evidence indicates that cancer stem cells (CSCs) are the major source of tumor heterogeneity. Hence, uncovering the resistance mechanisms associated with CSC properties is essential for developing effective therapeutics. CSCs resemble embryonic stem cells. Embryonic development-related genes and signaling pathways are usually abnormally active and function as oncofetal drivers in HCC. Multiple strategies have been applied to identify oncofetal drivers. The mechanisms of CSC resistance could also provide reliable biomarkers to predict treatment failure. Precisely targeting these specific CSC properties may be effective in preventing or annihilating therapy resistance. This review provides an overview of drug resistance mechanisms associated with CSC traits and summarize therapeutic strategies against drug resistance.
{"title":"Cancer stem cell-mediated therapeutic resistance in hepatocellular carcinoma","authors":"Mei-Mei Li, Yi He, Jie-Kai Liang, X. Guan, N. Ma, Ming Liu","doi":"10.20517/2394-5079.2022.43","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.43","url":null,"abstract":"Hepatocellular carcinoma (HCC) is a highly heterogeneous malignancy. In the clinic, therapeutic resistance is largely attributed to tumor heterogeneity. Growing evidence indicates that cancer stem cells (CSCs) are the major source of tumor heterogeneity. Hence, uncovering the resistance mechanisms associated with CSC properties is essential for developing effective therapeutics. CSCs resemble embryonic stem cells. Embryonic development-related genes and signaling pathways are usually abnormally active and function as oncofetal drivers in HCC. Multiple strategies have been applied to identify oncofetal drivers. The mechanisms of CSC resistance could also provide reliable biomarkers to predict treatment failure. Precisely targeting these specific CSC properties may be effective in preventing or annihilating therapy resistance. This review provides an overview of drug resistance mechanisms associated with CSC traits and summarize therapeutic strategies against drug resistance.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.46
R. Piciotti, M. Longo, Adele Agresta, E. Paolini, A. Cespiati, M. Meroni, P. Dongiovanni
Nonalcoholic fatty liver disease (NAFLD) is the major contributor to the global burden of chronic liver diseases and ranges from simple and reversible steatosis to nonalcoholic steatohepatitis (NASH), which may progress into cirrhosis and hepatocellular carcinoma (HCC). HCC represents the most common liver cancer, and it is a leading cause of death worldwide with an increasing trend for the future. Due to late diagnosis, non-responsiveness to systemic therapy, and high cancer heterogeneity, the treatment of this malignancy is challenging. To date, liver biopsy and ultrasound (US) are the gold standard procedures for HCC diagnosis and surveillance, although they are not suitable for mass screening. Therefore, it is impelling to find new, less invasive diagnostic strategies able to detect HCC at an early stage as well as monitor tumor progression and recurrence. Common and rare inherited variations that boost the switching from NASH to liver cancer may help to predict tumor onset. Furthermore, epigenetic changes which reflect intertumoral heterogeneity occur early in tumorigenesis and are highly stable under pathologic conditions. The severity of hepatic injuries can be detected through the analysis of cell circulating tumor DNAs (ctDNAs), microRNAs (miRNAs), and noncoding RNAs (ncRNAs), which are involved in several pathological processes that feature cancer, including cell growth, survival, and differentiation, thus representing appealing biomarkers for HCC. Therefore, this review discusses the current options for HCC surveillance, focusing on the role of genetic and epigenetic biomarkers as new strategies to refine HCC management.
{"title":"Old-fashioned and newly discovered biomarkers: the future of NAFLD-related HCC screening and monitoring","authors":"R. Piciotti, M. Longo, Adele Agresta, E. Paolini, A. Cespiati, M. Meroni, P. Dongiovanni","doi":"10.20517/2394-5079.2022.46","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.46","url":null,"abstract":"Nonalcoholic fatty liver disease (NAFLD) is the major contributor to the global burden of chronic liver diseases and ranges from simple and reversible steatosis to nonalcoholic steatohepatitis (NASH), which may progress into cirrhosis and hepatocellular carcinoma (HCC). HCC represents the most common liver cancer, and it is a leading cause of death worldwide with an increasing trend for the future. Due to late diagnosis, non-responsiveness to systemic therapy, and high cancer heterogeneity, the treatment of this malignancy is challenging. To date, liver biopsy and ultrasound (US) are the gold standard procedures for HCC diagnosis and surveillance, although they are not suitable for mass screening. Therefore, it is impelling to find new, less invasive diagnostic strategies able to detect HCC at an early stage as well as monitor tumor progression and recurrence. Common and rare inherited variations that boost the switching from NASH to liver cancer may help to predict tumor onset. Furthermore, epigenetic changes which reflect intertumoral heterogeneity occur early in tumorigenesis and are highly stable under pathologic conditions. The severity of hepatic injuries can be detected through the analysis of cell circulating tumor DNAs (ctDNAs), microRNAs (miRNAs), and noncoding RNAs (ncRNAs), which are involved in several pathological processes that feature cancer, including cell growth, survival, and differentiation, thus representing appealing biomarkers for HCC. Therefore, this review discusses the current options for HCC surveillance, focusing on the role of genetic and epigenetic biomarkers as new strategies to refine HCC management.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2021.139
Hannah Lee, D. McClish, Binu V. John, Sarah Winks, Ryan D Clayton, S. Albhaisi, Allawy Allawy, S. Patel, E. Fields, S. Matherly, B. Strife, C. Bhati, Amit Sharma, R. Sterling
Background: Discordance in hepatocellular carcinoma (HCC) staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death. Our aim was to evaluate variables that predicted concordance/discordance in the era of new generation locoregional therapies (LRT) and improved radiologic technology in diagnosis. Methods: A single-center retrospective study was performed on patients who received a liver transplant for HCC between 2008-2019. Pre- and post-LT variables, including type of LRT, downstaging (DS), transplant time period, and radiologic response to LRT, were analyzed for concordance/discordance. Kaplan-Meier analysis was used to assess post-LT survival. Results: Of 146 patients transplanted within Milan Criteria (MC), discordance rates (understaged) were 45%. Discordance was associated with ≥ 3 HCC lesions at diagnosis but not newer generation LRT (transarterial radioembolization/ stereotactic body radiation therapy), traditional LRT or combination. No differences in discordance were seen between transplant periods (2008-2013 vs. 2014-2019), but those within MC in the earlier period had higher concordance rates. A trend was observed between DS and discordance. Conclusion: HCC stage discordance remains common and poorly predictable. Discordance was associated with three or more HCC lesions at the time of diagnosis. Patients within MC transplanted between 2008-2013 was associated with concordance, while a trend was noted between DS and discordance. No other pre- or post- LT variables predicted discordance/ concordance. Discordance was associated with decreased survival.
{"title":"Liver cancer understaging in liver transplantation in the current era of radiologic imaging and newer generation locoregional therapies","authors":"Hannah Lee, D. McClish, Binu V. John, Sarah Winks, Ryan D Clayton, S. Albhaisi, Allawy Allawy, S. Patel, E. Fields, S. Matherly, B. Strife, C. Bhati, Amit Sharma, R. Sterling","doi":"10.20517/2394-5079.2021.139","DOIUrl":"https://doi.org/10.20517/2394-5079.2021.139","url":null,"abstract":"Background: Discordance in hepatocellular carcinoma (HCC) staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death. Our aim was to evaluate variables that predicted concordance/discordance in the era of new generation locoregional therapies (LRT) and improved radiologic technology in diagnosis. Methods: A single-center retrospective study was performed on patients who received a liver transplant for HCC between 2008-2019. Pre- and post-LT variables, including type of LRT, downstaging (DS), transplant time period, and radiologic response to LRT, were analyzed for concordance/discordance. Kaplan-Meier analysis was used to assess post-LT survival. Results: Of 146 patients transplanted within Milan Criteria (MC), discordance rates (understaged) were 45%. Discordance was associated with ≥ 3 HCC lesions at diagnosis but not newer generation LRT (transarterial radioembolization/ stereotactic body radiation therapy), traditional LRT or combination. No differences in discordance were seen between transplant periods (2008-2013 vs. 2014-2019), but those within MC in the earlier period had higher concordance rates. A trend was observed between DS and discordance. Conclusion: HCC stage discordance remains common and poorly predictable. Discordance was associated with three or more HCC lesions at the time of diagnosis. Patients within MC transplanted between 2008-2013 was associated with concordance, while a trend was noted between DS and discordance. No other pre- or post- LT variables predicted discordance/ concordance. Discordance was associated with decreased survival.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.02
K. Igarashi, K. Mishima, T. Ozaki, G. Wakabayashi
Anatomical resection (AR) has been reported to achieve better long-term outcomes than non-anatomical resection for the treatment of hepatocellular carcinoma (HCC). The surgical feasibility and oncological significance of laparoscopic AR (LAR), especially “subsegment resection”, “cone unit resection”, and repeat LAR for HCC, remain unproven. We present a 67-year-old patient with alcoholic liver cirrhosis and HCC who underwent full LAR three times, focusing on the technical aspects of the Glissonean approach. Repeating LAR for recurrent HCC could be a safe and feasible procedure. However, HCC recurred in the neighboring segment twice, even though pathological vascular invasion and marginal remnants were not confirmed. We should investigate the oncological significance and advancements in subsegmentectomy and cone unit resection, in the future.
{"title":"Repeat laparoscopic anatomical liver resection in a hepatocellular carcinoma patient: a case report","authors":"K. Igarashi, K. Mishima, T. Ozaki, G. Wakabayashi","doi":"10.20517/2394-5079.2022.02","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.02","url":null,"abstract":"Anatomical resection (AR) has been reported to achieve better long-term outcomes than non-anatomical resection for the treatment of hepatocellular carcinoma (HCC). The surgical feasibility and oncological significance of laparoscopic AR (LAR), especially “subsegment resection”, “cone unit resection”, and repeat LAR for HCC, remain unproven. We present a 67-year-old patient with alcoholic liver cirrhosis and HCC who underwent full LAR three times, focusing on the technical aspects of the Glissonean approach. Repeating LAR for recurrent HCC could be a safe and feasible procedure. However, HCC recurred in the neighboring segment twice, even though pathological vascular invasion and marginal remnants were not confirmed. We should investigate the oncological significance and advancements in subsegmentectomy and cone unit resection, in the future.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.18
M. Renzulli, M. Gentilini, G. Marasco, N. Brandi, A. Granito, S. Lo Monaco, A. Ierardi, A. De Cinque, F. Tovoli, L. Bartalena, Daniele Spinelli, F. Piscaglia, R. Golfieri
Aim: The present study evaluated the duration of chemoembolization in patients with hepatocellular carcinoma, analyzing possible factors affecting the procedural time. Methods: In total, 175 patients who underwent chemoembolization have been prospectively enrolled. The procedural length was considered the time between the insertion and the removal of the angiographic sheath. The features related to the tumor burden and angiographic procedures, which could be related to the procedural time, were recorded. Results: The chemoembolization time resulted in a mean of 58.1 min. The longer procedural time was associated with a number of nodules treated per patient ≥ 2 (P < 0.001), a number of segments with nodules ≥ 2 (P < 0.001), the presence of more than 1 nodule in the same segment (P < 0.001), the location of the tumor in the left lobe (P = 0.001), the exclusion from the Milan criteria (P < 0.001), and a number of segments treated ≥ 2 (P < 0.001). Only the number of nodules treated per patient resulted significantly in multivariate analysis (OR 2.927, 95%CI: 2.015-4.251, P < 0.001). Conclusion: The factors related to longer procedural time are the number of nodules treated ≥ 2, the number of segments with nodules ≥ 2, the involvement of the left lobe, the tumor burden outside the Milan criteria, and the number of segments treated ≥ 2. All these characteristics, known in the pre-procedural phase, represent useful tools for a correct planning of the angiographic room’s workflow during the pandemic era as well as in the future to reduce downtime and increase productivity.
{"title":"The duration of the conventional chemoembolization for hepatocellular carcinoma: factors affecting the procedural time","authors":"M. Renzulli, M. Gentilini, G. Marasco, N. Brandi, A. Granito, S. Lo Monaco, A. Ierardi, A. De Cinque, F. Tovoli, L. Bartalena, Daniele Spinelli, F. Piscaglia, R. Golfieri","doi":"10.20517/2394-5079.2022.18","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.18","url":null,"abstract":"Aim: The present study evaluated the duration of chemoembolization in patients with hepatocellular carcinoma, analyzing possible factors affecting the procedural time. Methods: In total, 175 patients who underwent chemoembolization have been prospectively enrolled. The procedural length was considered the time between the insertion and the removal of the angiographic sheath. The features related to the tumor burden and angiographic procedures, which could be related to the procedural time, were recorded. Results: The chemoembolization time resulted in a mean of 58.1 min. The longer procedural time was associated with a number of nodules treated per patient ≥ 2 (P < 0.001), a number of segments with nodules ≥ 2 (P < 0.001), the presence of more than 1 nodule in the same segment (P < 0.001), the location of the tumor in the left lobe (P = 0.001), the exclusion from the Milan criteria (P < 0.001), and a number of segments treated ≥ 2 (P < 0.001). Only the number of nodules treated per patient resulted significantly in multivariate analysis (OR 2.927, 95%CI: 2.015-4.251, P < 0.001). Conclusion: The factors related to longer procedural time are the number of nodules treated ≥ 2, the number of segments with nodules ≥ 2, the involvement of the left lobe, the tumor burden outside the Milan criteria, and the number of segments treated ≥ 2. All these characteristics, known in the pre-procedural phase, represent useful tools for a correct planning of the angiographic room’s workflow during the pandemic era as well as in the future to reduce downtime and increase productivity.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2021.125
J. Mok
Aim: To describe the current practise of living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC), including the patient selection criteria, surgical techniques, management of small-for-size syndrome, postoperative complications, and the results of our units, in the Liver Transplant Centre of Queen Mary Hospital, Hong Kong, one of the high-volume centres for LDLT in Asia. Methods: Our centre practises careful selection for HCC patients using the University of California, San Francisco (UCSF) criteria, supplemented by alpha-fetoprotein level and the model for end-stage liver disease score. Slight flexibility is offered to enthusiastic donors and recipients in LDLT while balancing the risks and benefits. We pioneered in using the extended right lobe graft and the novel hepatic venoplasty technique, which lessen the risk of hyperperfusion and small-for-size syndrome with improved overall recipient survival. Data were collected prospectively and presented as the mean values and ranges, or the number of patients in proportion of total patient population. Results: Of our patients, 74.9% met the UCSF criteria, and 64.5% met the Milan criteria. A 5-year overall and disease-free survival rate of 78.9% and 76.3% were achieved. Conclusion: LDLT is an ideal treatment for HCC in Hong Kong with regard to the critical organ shortage and high demand for transplantation. The current surgical techniques and post-transplant surveillance contribute to the positive outcome.
{"title":"Experience of living donor liver transplantation for hepatocellular carcinoma in the University of Hong Kong Hospital","authors":"J. Mok","doi":"10.20517/2394-5079.2021.125","DOIUrl":"https://doi.org/10.20517/2394-5079.2021.125","url":null,"abstract":"Aim: To describe the current practise of living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC), including the patient selection criteria, surgical techniques, management of small-for-size syndrome, postoperative complications, and the results of our units, in the Liver Transplant Centre of Queen Mary Hospital, Hong Kong, one of the high-volume centres for LDLT in Asia. Methods: Our centre practises careful selection for HCC patients using the University of California, San Francisco (UCSF) criteria, supplemented by alpha-fetoprotein level and the model for end-stage liver disease score. Slight flexibility is offered to enthusiastic donors and recipients in LDLT while balancing the risks and benefits. We pioneered in using the extended right lobe graft and the novel hepatic venoplasty technique, which lessen the risk of hyperperfusion and small-for-size syndrome with improved overall recipient survival. Data were collected prospectively and presented as the mean values and ranges, or the number of patients in proportion of total patient population. Results: Of our patients, 74.9% met the UCSF criteria, and 64.5% met the Milan criteria. A 5-year overall and disease-free survival rate of 78.9% and 76.3% were achieved. Conclusion: LDLT is an ideal treatment for HCC in Hong Kong with regard to the critical organ shortage and high demand for transplantation. The current surgical techniques and post-transplant surveillance contribute to the positive outcome.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.42
P. Radu, J. Dufour
Over the last decade, we have been facing a new aetiology responsible for the development of HCC - the non-alcoholic fatty liver disease (NAFLD). The prevalence of HCC development in this group is higher than that observed in the general population and in non-cirrhotic subjects with other causes of liver disease. Conventional ultrasound (US) is the first-line tool for HCC surveillance, but, in this population, it has a decreased diagnostic accuracy due to several particular features, including obesity and steatosis. Contrast-enhanced ultrasound (CEUS) appeared as a new branch of US due to its ability to depict the vascular architecture of all types of focal lesions (FLs). Nevertheless, CEUS has several limitations besides those inherited from US, which renders this method unreliable as the first-line HCC diagnostic tool and for HCC staging. Artificial intelligence eliminates operator limitations, which has led to an increased sensitivity and specificity of US. However, this approach is still in its early stages and more data are needed. Consequently, the purpose of the current study is to highlight the strengths and limits of US, along with its alternatives to HCC screening in NAFLD population.
{"title":"Sonography in surveillance for HCC in NAFLD patients","authors":"P. Radu, J. Dufour","doi":"10.20517/2394-5079.2022.42","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.42","url":null,"abstract":"Over the last decade, we have been facing a new aetiology responsible for the development of HCC - the non-alcoholic fatty liver disease (NAFLD). The prevalence of HCC development in this group is higher than that observed in the general population and in non-cirrhotic subjects with other causes of liver disease. Conventional ultrasound (US) is the first-line tool for HCC surveillance, but, in this population, it has a decreased diagnostic accuracy due to several particular features, including obesity and steatosis. Contrast-enhanced ultrasound (CEUS) appeared as a new branch of US due to its ability to depict the vascular architecture of all types of focal lesions (FLs). Nevertheless, CEUS has several limitations besides those inherited from US, which renders this method unreliable as the first-line HCC diagnostic tool and for HCC staging. Artificial intelligence eliminates operator limitations, which has led to an increased sensitivity and specificity of US. However, this approach is still in its early stages and more data are needed. Consequently, the purpose of the current study is to highlight the strengths and limits of US, along with its alternatives to HCC screening in NAFLD population.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"209 0 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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