Journal of Hepatocellular Carcinoma最新文献

Purpose: To evaluate whether radiomic features from contrast-enhanced computed tomography (CECT) of peritumoral regions can be used to preoperatively predict proliferative hepatocellular carcinoma (PHCC).

Patients and methods: Preoperative CT scans from 486 patients with hepatocellular carcinoma (HCC) were retrospectively analyzed and split into training (n = 252), testing (n = 109), and validation (n = 125) cohorts. Radiomic features were extracted from intra- and peritumoral regions (peri-3 mm, peri-5 mm, and peri-10 mm) on arterial phase (AP) and portal venous phase (PVP) images using PyRadiomics. Features were selected with LASSO regression and 10-fold cross-validation, and a radiomics score (Radscore) was calculated as a weighted sum of selected features. Patients were classified into high- and low-risk groups using the optimal Youden's index cutoff. Recurrence-free survival (RFS) was analyzed with Kaplan-Meier curves, feature contributions were quantified using SHapley Additive exPlanations (SHAP), and model performance was assessed by area under the curve (AUC).

Results: The Naive Bayes model using peri-5 mm features achieved the highest mean AUC (0.739) and accuracy (0.802), with AUCs of 0.839 and 0.639 in internal and external validation. In the test set, combining intra- and peritumoral features improved the AUC to 0.849 (95% CI: 0.773-0.924; sensitivity: 0.974; specificity: 0.606). In the validation set, AP, PVP, and their combined models achieved AUCs of 0.699, 0.672, and 0.695, respectively. SHAP highlighted in the Naive Bayes model that the increased inhomogeneity of the texture grayscale of the peritumoral tissue in the PVP may be associated with more aggressive HCC subtypes. Multivariable analysis identified rim-APHE (OR = 22.667), mosaic architecture (OR = 5.904), and intratumoral hemorrhage (OR = 4.897) as independent risk factors for PHCC (all p < 0.05). PHCC showed significantly worse RFS than non-PHCC (p < 0.0001). Radscore effectively stratified early recurrence risk (p < 0.0001).

Conclusion: Radiomic analysis of intratumoral and peri-5 mm enhancement features enables accurate preoperative PHCC identification and may inform intensified postoperative surveillance and adjuvant therapy.

Purpose: This study aimed to investigate the predictive value of the Tumor Burden Score (TBS) combined with Serum Prealbumin (PALB) and the Neutrophil-to-Lymphocyte Ratio (NLR) for the long-term prognosis of patients with unresectable hepatocellular carcinoma (uHCC) following transcatheter hepatic artery chemoembolization (TACE) therapy, and to elucidate its significance in guiding treatment planning.

Patients and methods: Clinical data from 940 patients with unresectable HCC who underwent TACE treatment at three hospitals in the Jiangsu Province between 2007 and 2018 were retrospectively analyzed. TBS was calculated using the formula: TBS² = (maximum tumor diameter)² + (number of tumors)² (The diameter of the tumor is measured in centimeters). The optimal cutoff values for TBS and NLR were determined using R software. Patients were risk-stratified based on their TBS-PALB-NLR (TPN) score. Independent predictors associated with survival were identified using univariate and multivariate Cox proportional hazards regression analyses.

Results: Independent risk factors identified through univariate Cox analysis included age, cirrhosis, ascites, BCLC stage, vascular invasion, NLR, TBS, PALB, AFP, Bilirubin, AST, and ALT. Multivariate analysis revealed that BCLC stage, NLR, TBS, and PALB were significant independent risk factors affecting overall survival (P < 0.05). The TPN score was established based on TBS, PALB, and NLR, and patients were stratified into low-TPN, intermediate-TPN, and high-TPN groups.

Conclusion: The TPN score is a low-cost, readily available prognostic tool that can effectively risk-stratify patients with uHCC. It may guide personalized adjuvant therapy (eg, systemic therapy for high-risk patients), particularly in resource-limited medical centers.

Background and objective: During the disease course of patients with BCLC B/C hepatocellular carcinoma (HCC) receiving systemic therapy, approximately half of the patients will develop cachexia. Therefore, early identification of which patients are likely to develop cachexia is of crucial significance.This study aims to construct and validate a nomogram for predicting the risk of cachexia in this population based on common clinical parameters.

Patients and methods: This retrospective single - center study involved 906 patients managed at the Fifth Medical Center of Chinese PLA General Hospital from January 2020 to December 2023. Baseline clinical imaging data, biochemical indicators, and relevant clinical data of patients before systemic treatment were collected. All patients were followed up to record treatment regimens and document weight changes for cachexia diagnosis. The data were stratified into a training cohort and a validation cohort. In this study, LASSO regression alongside univariate and multivariate Logistic regression analyses were utilized to ascertain independent risk factors linked to cachexia occurrence, and further to construct and validate a diagnostic nomogram.

Results: This nomogram incorporates predictors such as patient age, maximum size of intrahepatic lesions, extrahepatic metastasis, neutrophil-to-lymphocyte ratio (NLR), and total bile acids, demonstrating good predictive performance. In the training and validation cohorts, its Harrell's concordance index (C-index) reached 0.865 (95% CI: 0.836-0.895) and 0.820 (95% CI: 0.768-0.871), respectively. Calibration curves demonstrated strong consistency between the nomogram's predicted outcomes and the actual measured values, and decision curve analysis (DCA) further substantiated its clinical applicability.

Conclusion: This nomogram shows good predictive performance and can effectively identify high-risk individuals, but it is limited by its single-center retrospective design and requires further verification and optimization through multicenter prospective studies.

Background: The Spiegel lobe, a distinct subdivision of the hepatic caudate lobe, is characterized by its unique anatomical position, with close proximity to major hilar vasculature and extrahepatic structures. Therapeutic intervention for Spiegel lobe lesions remains technically challenging, with no established treatment protocol currently available.

Case presentation: This study reports four cases of recurrent hepatocellular carcinoma (HCC) in the Spiegel lobe treated with conventional transarterial chemoembolization (c-TACE) followed by microwave ablation (MWA) via a transhepatic left lobe approach. Postprocedural imaging assessment confirmed complete response (CR) in all patients according to mRECIST criteria. During a mean follow-up period of 33.75 months (range: 31-37), three patients maintained disease-free status, whereas one patient developed intrahepatic recurrence at 19.2 months. This patient achieved CR after repeat TACE-MWA combined with adjuvant lenvatinib and tislelizumab therapy. The mean overall survival (OS) was 33.75 months (95% CI: 31.2-36.3).

Conclusion: The combination of transcatheter arterial chemoembolization (TACE) and microwave ablation (MWA) for treating recurrent hepatocellular carcinoma (HCC) in the Spiegel lobe was proven feasible in this series of studies, and demonstrated favorable efficacy and safety profiles.

Background: Hepatocellular carcinoma (HCC) is influenced not only by tumor burden but also by liver function and the extent of fibrosis. Although the albumin-bilirubin (ALBI) score and the fibrosis-4 (FIB-4) index are validated independent predictors, their combined prognostic impact has been insufficiently examined.

Methods: We retrospectively analyzed 307 patients with HCC diagnosed between 2002 and 2025. ALBI and FIB-4 scores were calculated at baseline, and a composite score was generated using the β-coefficients obtained from a multivariable Cox regression model, allowing each component to contribute proportionally to its prognostic weight (combined score = 0.503 × ALBI + 0.0576 × FIB-4). Patients were stratified using the median cutoff value (-0.95). Outcomes included overall survival (OS), event-free survival (EFS) for those undergoing locoregional therapies, and progression-free survival (PFS) for patients treated with systemic therapy.

Results: Median OS was 12.1 months. Patients with combined scores ≤-0.95 had superior OS (18.3 vs 6.8 months, p < 0.001), and the score remained an independent predictor of OS (HR 2.01, 95% CI 1.48-2.72, p = 0.001). In the locoregional therapy group, lower scores predicted improved EFS (16.4 vs 5.8 months,: HR:1.86; 95% CI:1.17-2.96; p=0.009). Among systemic therapy patients, the combined score independently predicted PFS (HR 1.70, 95% CI 1.21-2.41, p = 0.021).

Conclusion: The combined ALBI-FIB-4 score is an accessible and reproducible prognostic marker across therapeutic settings in HCC. By integrating measures of hepatic reserve and fibrosis, it provides additional prognostic granularity beyond tumor-centric staging systems. These findings highlight its potential utility in personalized risk stratification and warrant validation in prospective, multi-ethnic cohorts.

Background: Microvascular invasion (MVI) serves as a well-established prognostic factor for tumor recurrence and reduced survival following curative hepatectomy in hepatocellular carcinoma (HCC). This investigation aims to assess the therapeutic value of postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) in HCC patients with MVI and delineate the optimal patient subpopulations for this intervention.

Methods: This retrospective cohort study analyzed patients with MVI in HCC patients who received curative resection from September 2013 to June 2019. After balancing baseline differences between the PA-TACE group and the non-TACE control group using propensity score matching (PSM), the differences in recurrence-free survival (RFS) and overall survival (OS) between the two groups were compared. A multivariate Cox proportional hazards regression model was used to identify independent prognostic factors.

Results: Among 440 evaluable patients, PA-TACE demonstrated statistically significant improvements in both RFS and OS compared to non-TACE management, with consistent results observed in both the entire and propensity score-matched cohorts. Multivariate analysis established PA-TACE as an independent protective predictor for both RFS and OS. Subgroup analyses revealed pronounced clinical benefits in patients exceeding Milan criteria and those presenting with high-risk features including serum AFP ≥400 ng/mL, tumor size ≥5 cm, Edmondson-Steiner grade III/IV differentiation, M2-type MVI, or major hepatectomy. Notably, no survival advantage was observed in patients within Milan criteria or BCLC-A/B stages.

Conclusion: PA-TACE provides substantial survival enhancement in HCC patients with MVI exceeding Milan criteria or with high-risk features, but offers limited benefit for Milan-eligible cases. Patient selection based on tumor biology is critical for optimizing adjuvant therapy.

Purpose: This study aimed to identify independent risk factors for hepatocellular carcinoma (HCC) in patients initially diagnosed with Budd-Chiari syndrome (BCS) and develop a nomogram for HCC risk assessment in these patients.

Patients and methods: Retrospective analysis was conducted on clinical data from 631 newly diagnosed BCS patients (BCS group) and 50 BCS patients complicated with HCC (HCC group) admitted to the Interventional Radiology Department of the Affiliated Hospital of Xuzhou Medical University (Xuzhou, China) between October 2014 and October 2021. General data, clinical symptoms/signs, laboratory tests, imaging features, Child-Pugh classification, and Model for End-Stage Liver Disease score were analyzed. Univariate logistic regression screened risk factors (P<0.05 for multivariate inclusion), and independent risk factors were selected via backward selection (Akaike Information Criterion) to build the nomogram, validated by bootstrap method. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and clinical impact curve evaluated the model.

Results: Independent risk factors in the final model were disease duration [odds ratio (OR)=1.19, 95% CI=1.11-1.28], portal vein diameter (OR=140.29, 95% CI=31.63-622.22), and intrahepatic nodule formation (OR=5.03, 95% CI=2.42-10.44). Bootstrap validation showed the model's ROC area under the curve (AUC)=0.862 (95% CI=0.798-0.926), with cross-validation AUC=0.858 (95% CI=0.663-1.000, good discrimination). Calibration curves (model and internal validation) aligned with ideal status. DCA showed the nomogram had higher net benefit than extreme curves at 2-83% threshold probability. Clinical impact curve indicated threshold probability >60% identified HCC high-risk groups consistent with actual HCC occurrence.

Conclusion: The independent risk factors for HCC in patients initially diagnosed with BCS were disease duration, portal vein diameter and intrahepatic nodule formation. The developed nomogram model exhibited good discrimination, accuracy and clinical applicability for the prediction of HCC risk in patients with BCS. This study, for the first time, established a nomogram for predicting the risk of HCC in patients with BCS in a single-center cohort in China, which can provide a new tool for early screening.

Background: BRAP, a BRCA1-binding protein, exhibits elevated expression across multiple cancers and correlates with poor prognosis in hepatocellular carcinoma (HCC). However, its precise mechanistic roles in HCC tumorigenesis and immune landscape remodeling remain undefined.

Methods: BRAP expression levels and its diagnostic/prognostic value in HCC were analyzed using clinical HCC tissues and public datasets (TCGA and ICGC). CCK-8, colony formation, and EdU assays were employed to evaluate BRAP's impact on HCC cell proliferation; these findings were further validated in vivo using CDX models. RNA-seq and TCGA data analyses were performed to identify BRAP-mediated cellular biological functions and potential underlying mechanisms, with further confirmed via flow cytometry and Western blotting. scRNA-seq data from the GEO and TCGA were used to assess correlations between BRAP expression and immune cell infiltration, as well as immune checkpoint genes (ICGs) expression in HCC. mfIHC, qRT‒PCR, and macrophage-tumor co-cultivation experiments were conducted to validate BRAP's regulatory effects on immunosuppressive cell components in HCC.

Results: BRAP expression is significantly upregulated in HCC tissues and correlates with advanced pathological grades and poor patient prognosis. BRAP knockdown markedly reduced HCC cell proliferation both in vitro and in vivo; this anti-proliferative effect was achieved by inducing cell cycle arrest via suppression of the RAF/MEK/ERK signaling pathway. HCC cells with high BRAP expression exhibited increased infiltration of immunosuppressive cells, upregulated ICGs expression, and promoted M2 macrophage polarization.

Conclusion: BRAP drives HCC progression by promoting proliferation via RAF/MEK/ERK and shaping an immunosuppressive microenvironment. We identify BRAP as a novel prognostic biomarker and promising immunotherapeutic target in HCC.

Background: Patients with hepatocellular carcinoma (HCC) and microvascular invasion (MVI) face high post-resection relapse risk. Whether adjuvant PD-1 alone or with anti-vascular endothelial growth factor (anti-VEGF) improves outcomes remains uncertain.

Methods: Between 1 January 2022 and 1 January 2023, 170 consecutive patients from three Chinese centers were retrospectively reviewed. After resection, 69 received observation, 46 received intravenous sintilimab, and 55 received sintilimab plus either oral lenvatinib or intravenous bevacizumab biosimilar. Recurrence-free survival (RFS) was analyzed with Kaplan-Meier estimates and Cox models.

Results: Median follow-up was 24.7 months. Recurrence or death occurred in 42/69 (60.9%) observation patients, 19/46 (41.3%) sintilimab patients, and 23/55 (41.8%) combination patients. Median RFS was 16.1 months after observation, versus 29.5 months with sintilimab (hazard ratio=0.55, 95% confidence interval=0.32-0.95; P = 0.033) and 30.5 months with sintilimab plus anti-VEGF therapy (hazard ratio=0.55, 95% confidence interval=0.33-0.92; P = 0.023). One- and two-year RFS rates were 58.0% and 40.0% for observation, 73.9% and 66.6% for sintilimab, and 81.8% and 63.0% for combination therapy. Overall survival analysis is immature, median overall survival has not been reached in any group.

Conclusion: Adjuvant sintilimab, with or without anti-VEGF therapy, significantly prolonged RFS compared with surgery alone in patients with MVI-positive HCC. The magnitude of benefit was comparable between monotherapy and combination therapy, indicating that routine addition of anti-VEGF therapy may not be necessary for all patients.

Purpose: The optimal therapeutic strategy of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is debated. This study aimed to compare the survival outcomes of liver resection (LR) versus targeted therapy plus programmed death-1 (PD-1) inhibitors in HCC patients with PVTT.

Patients and methods: The data of 53 patients with HCC and type I-II PVTT was retrospectively assessed. Among them, 23 underwent LR, and 30 received targeted therapy plus PD-1 inhibitors (TT + PD-1). The baseline characteristics, overall survival (OS) and progression-free survival (PFS) of the two groups were compared. Univariable and multivariable Cox regression analysis were performed to identify independent prognostic factors of OS and PFS.

Results: There were no significant differences in baseline characteristics between the LR and TT + PD-1 groups. The LR group showed a significantly superior median OS (27.3 vs 15.3 months; P < 0.001) and PFS (13.8 vs 7.5 months; P = 0.008) compared to the TT + PD-1 group. Multivariable Cox regression analysis identified LR was independently associated with a better OS and PFS.

Conclusion: LR may represent an effective therapeutic option for HCC patients with type I-II PVTT.