Journal of Hepatocellular Carcinoma最新文献

Objective: This study aimed to identify independent predictors of early recurrence (ER) and to establish a clinically applicable, individualized nomogram for patients with solitary hepatocellular carcinoma (HCC) who underwent postoperative adjuvant transarterial chemoembolization (PA-TACE).

Methods: A total of 165 patients with solitary HCC treated with PA-TACE between January 2018 and December 2022 were retrospectively analyzed. Among these patients, 71 experienced ER, while 94 remained recurrence-free for over 24 months. Independent prognostic variables were identified through univariate and multivariate Cox regression analyses. These factors were integrated into a nomogram model, and its performance was evaluated using internal validation and calibration curves.

Results: Multivariate analysis revealed that AFP-L3% >10% (p = 0.009), presence of satellite lesions (p = 0.026), GLR >20 (p = 0.020), microvascular invasion (MVI) (p = 0.008), and Ki-67 expression >50% (p < 0.001) were independently associated with ER. These five variables were used to establish the nomogram, which had a C-index of 0.763 (95% CI: 0.736-0.870).

Conclusion: A nomogram incorporating AFP-L3, satellite lesions, GLR, MVI, and Ki-67 for predicting ER in patients with solitary HCC following PA-TACE was developed and validated. This model exhibits high predictive accuracy and provides a valuable tool for identifying patients who may benefit from PA-TACE.

Purpose: The aim of this study was to evaluate the potential of partial transcatheter arterial embolization (pTAE)-hepatic artery infusion chemotherapy (HAIC) in combination with tyrosine kinase inhibitors (TKIs) and anti-PD-1 antibodies for downstaging and subsequent resection in patients with initially unresectable hepatocellular carcinoma (HCC).

Methods: Patients with unresectable HCC who underwent initial treatment with a combination of pTAE, HAIC, TKIs, and an anti-PD-1 antibody were studied. The tumour response and potential for resection were assessed through imaging every month (±1 week) using RECIST v1.1.

Results: Among 17 patients (27.4%) who achieved R0 resection, the median time from quadruple therapy initiation to surgery was 89 days (range: 69-255). The cohort comprised 13 males and 4 females, with a median age of 51 years (range: 18-70). Twelve patients had BCLC stage C disease, including 11 with major vascular invasion (Vp2, Vp3, Vv2, Vv3, Vv1) and 3 with concurrent portal and hepatic venous invasion (Vp2/Vv2, Vp3/Vv2, Vp3/Vv3). Five patients had BCLC stage B HCC. The median diameter of the largest liver nodule was 11.5 cm (range: 3.9-18.8), with 10 patients presenting multiple lesions. Preoperatively, 17 patients underwent 43 cycles of pTAE-HAIC (median: 2, range: 1-5). Based on RECIST v1.1, 13 patients achieved partial response (PR), and 4 had stable disease (SD). With a median follow-up of 17.8 months (range: 12.2-38.3), the 12-month overall survival post-hepatectomy was 100%, and the median progression-free survival (PFS) was 14.5 months (range: 1.5-31.8). Tumor recurrence within 12 months occurred in 5 patients, with 4 achieving disease control after additional treatment.

Conclusion: Quadruple therapy, consisting of pTAE-HAIC combined with TKIs and anti-PD-1 antibodies, represents a feasible conversion strategy for patients with unresectable HCC to achieve successful resection and potential long-term survival.

Background: For hepatocellular carcinoma (HCC), adjuvant transarterial chemoembolization (TACE) shows an advantageous response and prognosis in recurrent patients after resection. In consideration of similar pathogenesis and clinicopathological characteristics, studies should be conducted to ascertain whether hepatitis B virus (HBV)-associated intrahepatic cholangiocarcinoma (ICC) can be successfully treated by the methods used to treat HCC. The role of adjuvant TACE following liver resection for HBV-associated ICC remains controversial. This study aims to evaluate the efficacy of adjuvant TACE on recurrence and survival after liver resection, both before and after propensity score weighting (PSW) analysis.

Materials and methods: A total of 356 patients were categorized into two groups: i) 77 patients who received adjuvant TACE, and ii) 279 patients who underwent R0 resection alone. Staging was conducted according to the 8th edition of the American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) staging system. Univariate and multivariate analyses were utilized to assess independent prognostic factors. Recurrence-free survival (RFS) and overall survival (OS) rates were compared using the Kaplan-Meier method.

Results: Among the 356 enrolled patients, 77 received adjuvant TACE. The median follow-up period was 45.3 months. Adjuvant TACE did not significantly affect OS (P=0.629) before or after PSW. Subgroup analyses indicated that TACE was not associated with OS across different TNM stages. After propensity score weighting, Cox regression model indicated significantly increased recurrence risk with TACE (HR=1.53, 95% CI: 1.02-2.28; P=0.0071). Stage-specific risks were visually summarized in Supplementary Figure 1. Additionally, TACE did not significantly impact RFS in TNM stage I (P=0.1720) and stage II (P=0.7905) subgroups. Conversely, TACE was positively associated with increased recurrence risk in TNM stage III (P=0.0014) and stage IV (P=0.0051) patients.

Conclusion: These findings suggest that adjuvant TACE following radical surgery does not prolong OS for patients with HBV-associated ICC. Furthermore, adjuvant TACE was associated with increased recurrence risk in TNM Stage III and IV subgroups, though this observation requires further validation due to sample size limitations in advanced stages.

Objective: This study aimed to compare the efficacy and safety of transarterial chemoembolization followed by radiofrequency ablation (cTACE-RFA) versus RFA alone in patients with early-stage hepatocellular carcinoma (HCC) within the Milan criteria.

Methods: A retrospective analysis included 343 patients with Milan criteria-compliant HCC. After 1:1 propensity score matching (PSM), 93 patients underwent cTACE-RFA, and 93 received RFA alone. Primary endpoints were overall survival (OS) and local progression-free survival (LPFS).

Results: The TACE-RFA group demonstrated significantly superior 1-, 3-, and 5-year LPFS rates (84.9%, 58.1%, 36.6%) compared to the RFA group (75.3%, 44.1%, 16.1%; HR=0.54, 95% CI: 0.37-0.79, P=0.001). However, no significant 1-, 3-, and 5-year OS difference (HR = 1.06, 95% CI: 0.61-1.83, p = 0.843) was observed between cTACE-RFA (95.7%, 80.6%, 59.1%) and RFA alone group (96.8%, 78.5%, 61.3%). Subgroup analyses revealed significant OS improvements with cTACE-RFA in tumor with high-risk locations (HR = 0.38; 95% CI: 0.17-0.85, p = 0.018) and diameter 3-5 cm: (HR = 0.28; 95% CI: 0.12-0.64, p = 0.003). cTACE-RFA group also was observed significant LPFS improvements for tumors in high-risk locations (HR=0.48, 95% CI: 0.30-0.77, p=0.002) or 3-5 cm in size (HR=0.25, 95% CI: 0.15-0.41, p<0.001). Complication rates were comparable, with no procedure-related mortality and similar severe adverse event incidences (P=0.516).

Conclusion: cTACE-RFA significantly prolongs LPFS compared to RFA alone in early HCC, particularly for tumors >3 cm or in high-risk locations, without increasing major complications.

Purpose: To compare the efficacy and safety of postoperative adjuvant therapy with transarterial chemoembolization (TACE) plus tyrosine kinase inhibitor (TKI) (TPT) versus TACE alone in hepatocellular carcinoma (HCC) patients at high risks of recurrence after radical hepatectomy.

Patients and methods: We retrospectively analyzed 264 HCC patients who underwent radical hepatectomy (R0 resection) between August 2016 and August 2023. To mitigate selection bias, propensity score matching (PSM) was employed. The primary endpoints were recurrence-free survival (RFS) and overall survival (OS), analyzed using Kaplan-Meier curves and Log rank tests. Treatment-related adverse events (TRAEs) were graded according to CTCAE v4.0. Prognostic factors were evaluated via Cox proportional hazards regression.

Results: Before PSM, the cohort comprised 141 patients receiving TPT and 123 patients treated with TACE alone. After PSM, 81 well-balanced patients were selected per group (all p > 0.05). The TPT group exhibited significantly prolonged median recurrence-free survival (mRFS: 37.1 vs 27.7 months; p < 0.05) and median overall survival (mOS: 41.3 vs 38.3 months; p < 0.05) compared to the TACE alone group. The 1-, 2-, and 3-year RFS rates in the TPT group were 95.1%, 67.9%, and 48.1%, respectively, significantly higher than those in the TACE alone group (76.5%, 55.6%, and 40.7%; all p < 0.05). Similarly, the corresponding OS rates were 95.1%, 75.3%, and 54.3% (TPT) versus 81.5%, 66.7%, and 53.1% (TACE alone; all p < 0.05). Multivariable Cox regression analyses confirmed TPT as an independent protective factor for both RFS and OS. No significant increase in treatment-related adverse events (TRAEs) was observed with the TPT regimen compared to TACE alone. The overall TRAE rate was 51.8% in the TPT group, with grade ≥3 events occurring in 14.8% of patients, indicating an acceptable safety profile.

Background: Postoperative recurrence after curative resection is a major concern in the management of hepatocellular carcinoma (HCC). This study aimed to develop a radiomics-based model for predicting recurrence-free survival (RFS) after curative resection.

Methods: We retrospectively included 184 patients with early-stage HCC who underwent curative resection. The patients were randomized into training and validation sets in a 7:3 ratio. Radiomics features of the tumors on CT images were extracted to construct the Rad-score. We incorporated the Rad-score, clinical characteristics and biochemical parameters into univariate and multivariate analyses to construct a COX proportional hazards model. A radiomics-based nomogram model for predicting recurrence risk was developed by integrating multiple factors that affect recurrence. Calibration curve was used to assess the predictive performance of the model.

Results: Rad-score was constructed using 15 radiomic features. The results of multivariate analyses showed that Rad-score, lactate dehydrogenase (LDH) and alpha-fetoprotein (AFP) were independent predictors of RFS. They categorized patients into different recurrence risk groups, and RFS was significantly prolonged in patients in the low-risk group in the training (p<0.001) and validation sets (p<0.001). The Rad-score based composite prediction model showed good predictive performance with AUC of 0.765 and 0.920 for predicting 3 years RFS in the training and validation sets, respectively. The calibration curves indicated that the nomogram model had a favorable predictive performance.

Conclusion: This postoperative predictive model allows for better screening of patients at a high risk of recurrence and is a valuable instrument to guide clinicians in clinical treatment decisions.

Purpose: To investigate the application of imaging biomarkers, including R2*, Fat Fraction (FF) and apparent diffusion coefficient (ADC) values, obtained through Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation for Imaging Quantification (IDEAL-IQ) and DWI techniques, in differentiating P53-mutated and non-mutated HCC.

Patients and methods: This retrospective study included patients with pathologically confirmed HCC between January 2019 and July 2024. HCC were divided into P53-mutated group and non-mutated group by immunostaining. Preoperative R2*, FF, and ADC values derived from IDEAL-IQ and DWI were compared between the two groups, as well as different histological grades. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of each MRI parameter for detecting P53 mutations in HCC, with area under the curve (AUC) compared by Delong's test.

Results: Compared to the non-mutated group, the P53-mutated group (n = 31) showed significantly higher R2* values (34.821 ± 9.980 vs 23.713 ± 5.586, P < 0.001) and lower ADC values (0.760 ± 0.142 vs 0.855 ± 0.130, P = 0.002), while FF values showed no significant difference (P = 0.646). R2*, ADC, and the combined model (R2* + ADC) revealed AUCs of 0.849, 0.726, and 0.856, respectively, with the combined model demonstrating the highest sensitivity and specificity. Additionally, high-grade HCC showed significantly lower ADC values compared to lower-grade tumors (P < 0.001).

Conclusion: R2* and ADC exhibited significant features in P53-mutated HCC, suggesting their potential as non-invasive biomarkers for predicting P53 mutation status and guiding clinical management. The combined use of R2* and ADC may further enhance diagnostic accuracy.

Objective: This study aimed to develop and validate a triphasic CT-based radiomics model for the synchronous prediction of multiple critical pathological markers in hepatocellular carcinoma (HCC).

Materials and methods: This retrospective study analyzed 174 patients with 187 hepatocellular carcinoma (HCC) lesions. Radiomic features (n = 2264) were extracted from arterial phase (AP), venous phase (VP), and delayed phase (DP) CT images. Key features were selected using minimum redundancy maximum relevance (mRMR), SelectKBest, and least absolute shrinkage and selection operator (LASSO) algorithms. Logistic regression and support vector machine (SVM) classifiers were employed to develop individual phase-specific models and a triphasic fusion model. Model performance was evaluated through the area under the curve (AUC), sensitivity, specificity, decision curve analysis, and other metrics.

Results: The triphasic fusion model demonstrated superior performance. In the testing 1 dataset, the triphasic fusion model achieved AUCs of 0.890 (95% CI: 0.741-1), 0.895 (95% CI: 0.781-1) and 0.829 (95% CI: 0.675-0.984) for Edmondson-Steiner (Ed) grading, Microvascular invasion (MVI) grading, and Satellite nodule (SN) grading, respectively. In the testing 2 (validation) dataset, the triphasic fusion model achieved AUCs of 0.836 (95% CI: 0.739-0.934), 0.871 (95% CI: 0.748-0.993) and 0.810 (95% CI: 0.656-0.963) for Ed, MVI, and SN grading, respectively. The performance of the fusion model was better than that of the single-phase models.

Conclusion: The triphasic CT radiomics model provides a noninvasive tool for preoperative prediction of HCC pathological grading (Ed, MVI, SN), enhancing diagnostic accuracy for clinical decision-making and prognostic evaluation.

Background & aims: Despite the significant hepatocellular carcinoma (HCC) patient population, gaps exist in understanding their survivorship journey.

Methods: Patients diagnosed with HCC at all stages were recruited at Sun Yat-sen University Cancer Center from August 1, 2023, to December 30, 2023. The comprehensive score for financial toxicity (COST) was used to assess financial toxicity, the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) was used to assess quality of life (QOL), and the Social Support Rating Scale (SSRS) was used to assess social support. Separate multiple linear regression models were performed to assess the association among social support, FT, and QOL.

Results: Of the 250 approached HCC patients, 239 completed the survey and were included in this study. Most respondents were male (192 [80.3%]), of Han nationality (235 [98.3%]), and married (214 [89.5%]). Higher social support (β, 0.13; 95% CI, 0.01 ~ 0.26; P = 0.048) was independently associated with lower FT (higher COST score). Lower FT (β, 0.74; 95% CI, 0.49 ~ 0.99; P < 0.001) and social support (β, 1.47; 95% CI, 0.73 ~ 2.21; P < 0.001) were independently associated with higher QOL. Social support not only directly affected the QOL (b = 0.62, P<0.001, 95% CI [0.33-0.90]) but also indirectly affected the QOL through FT (b = 0.14, 95% CI [0.03-0.28]).

Conclusion: The findings of this survey study suggest that social support was associated with higher QOL and lower FT in HCC patients. Future investigations focusing on targeted social support interventions may enhance QOL and reduce FT in HCC patients.

Purpose: Surgical resection is the primary curative treatment for hepatocellular carcinoma (HCC), while high recurrence rates can limit the prognosis, emphasizing the need for reliable biomarkers. GALNT14-rs9679162 is associated with postoperative prognosis and therapeutic responses. However, relying on one single nucleotide polymorphism (SNP) greatly limits its predictive power. This study aims to identify an SNP panel to improve prognosis prediction and explore its role in modulating tumor-infiltrating immune cells (TIICs).

Patients and methods: We included 345 HCC patients underwent surgical resection: 15 in the exploration cohort and 330 in the validation cohort. Genome-wide association study (GWAS) and PCR-based genotyping identified SNPs in linkage disequilibrium (LD) with rs9679162. The link between GALNT14 expression and TIICs was analyzed. Prognostic evaluation was performed using Kaplan-Meier survival analysis and Cox proportional hazards models, with statistical significance set at P < 0.05.

Results: GWAS identified 39 SNP loci linked to rs9679162 and associated with postoperative prognosis. In the validation cohort, 10 SNPs were selected and categorized into four groups. Eight SNPs showed strong LD with rs9679162 and were significantly associated with recurrence-free survival and metastasis-free survival. The predictive performance of the combined SNP groups surpassed that of rs9679162 alone, with the most effective stratification achieved by combining groups-2+3. Additionally, GALNT14 expression, linked to the identified genotypes, correlated with M2-macrophage abundance within TIICs.

Conclusion: An SNP panel in LD with rs9679162, particularly from group-2 (rs62140629, rs4952033, rs56284247) and group-3 (rs9679162, rs6752303), serves as a prognostic marker for HCC. GALNT14 expression was associated with M2-macrophages, suggesting an immune-regulatory mechanism.