Journal of Hepatocellular Carcinoma最新文献

Background: To evaluate the relationship between soluble CD36 (sCD36) and type 2 diabetes mellitus complicated by hepatocellular carcinoma (T2DM-HCC), and to explore its potential clinical prognostic value.

Methods: A prospective study was conducted enrolling newly diagnosed T2DM-HCC patients from two medical centers, along with control groups including healthy individuals (HC), T2DM patients, and HCC patients. Clinical, biochemical, and pathological data were collected. Serum sCD36 levels were measured by ELISA. Univariate and multivariate analyses were used to identify recurrence risk factors, and ROC analysis was performed to evaluate diagnostic performance.

Results: Among 258 participants, the T2DM-HCC group exhibited the highest sCD36 levels, impaired liver function, lower platelets, and mild chronic inflammation. In this group, sCD36 levels positively correlated with tumor stage, size, and proliferation. In univariable analysis, it was associated with postoperative recurrence (OR = 2.57, 95% CI: 0.68-9.67). The predictive ability of sCD36 for recurrence (AUC = 0.86) was comparable to AFP (AUC = 0.89), while their combination showed the highest accuracy (AUC = 0.94).

Conclusion: sCD36 is associated with tumor progression in T2DM-HCC patients and serves as an independent risk factor for recurrence. To the best of our knowledge, this is the first study to identify sCD36 as a critical clinical biomarker for disease progression in T2DM-HCC, with strong potential for clinical application.

Trial registration: This study was registered in September 2024 with the Chinese Clinical Trial Registry (ChiCTR), registration number: ChiCTR2400089651.

Objective: This study retrospectively analyzed clinical data from adolescent primary liver cancer (PLC) cases over the past decade, summarizing clinical characteristics, diagnostic approaches, and prognostic outcomes to provide guidance for prevention, early diagnosis, and timely treatment of adolescent PLC.

Methods: Clinical data of 497 cases of adolescent PLC patients were collected from January 1, 2014, to December 31, 2024. The baseline demographic data, general condition, imaging, laboratory findings, and pathological features of these patients were described, and the diagnostic and therapeutic processes were analyzed, univariate and multivariate Cox regression analyses were conducted to identify significant prognostic factors.

Results: The age of onset for patients was 13.75 (10.25-19.00) years, with 311 males (62.58%) and 186 females (37.42%), yielding a male-to-female ratio of 1.67:1. Elevated ALT and GGT levels were observed in most patients, while all patients exhibited elevated ChE. Among all patients included in this study, 320 cases (64.39%) were infected with HBV, 469 cases (94.36%) were diagnosed with hepatocellular carcinoma (HCC), 14 cases (2.82%) with intrahepatic cholangiocarcinoma, and 14 cases (2.82%) with mixed hepatocellular-intrahepatic cholangiocarcinoma. The follow-up results showed the 1-year, 2-year, and 3-year survival rates in adolescent PLC patients were 45.27%, 20.32%, and 8.45%, respectively. The univariate Cox regression analysis revealed that adolescent PLC patients who accompanied with portal vein tumor thrombus, ascites, advanced CNLC stage, abnormalities in AFP, ALT, AST, AST/ALT ratio, GGT, ALP and TBIL, high ECOG score and non-surgical treatment had shorter OS (P < 0.05). Multivariate Cox regression analysis showed that portal vein tumor thrombus, advanced CNLC stage, abnormalities in AFP, GGT, and non-surgical treatment were independent prognostic factors influencing the OS of adolescent PLC patients (P < 0.05).

Conclusion: Clinical manifestations and symptoms of adolescent PLC patients lack specificity, and portal vein tumor thrombus, advanced CNLC stage, abnormalities in AFP, GGT, and non-surgical treatment were independent prognostic factors influencing OS in adolescent PLC.

Purpose: Systemic inflammatory response is reported to occupy a crucial role in the progression of hepatocellular carcinoma (HCC). The prognostic significance of SII and PNI in HCC has been explored, but the prognostic significance of aggregate index of systemic inflammation (AISI) in HCC is still unknown. This study was designed to determine the prognostic significance of AISI in HCC and explain the potential underlying mechanisms via gut microbiota and fecal metabolomic profiling.

Patients and methods: A cohort of 109 cases of HCC individuals during January 2023 to August 2024 was included into this clinical research, and the clinical information and fresh fecal samples were collected. The fecal samples were collected for 16S rRNA sequence and metabolomics analysis.

Results: Survival analysis revealed that HCC patients in low AISI group tend to experience relatively longer survival time compared with those in high AISI group. Then, we employed ROC analysis to measure the predictive performance of AISI for the survival outcome, and ROC curve showed that levels of AISI had good predictive performance for the survival status with an AUC of 0.771 (95%CI: 0.671-0.871). 16S rRNA sequencing results revealed that levels of Parabacteroides were up-regulated in the low AISI group, and levels of Fusicatenibacter were up-regulated in the high AISI group. Metabolic analysis demonstrated that cavipetin A, pemptoporphyrin, and 8-Oxo-dGMP with high VIP value were the most distinct fecal metabolites.

Conclusion: AISI is a potential prognostic biomarker in individuals with HCC. A low level of AISI was correlated with high abundance of Parabacteroides and some metabolites, indicating that AISI might affect the prognosis of HCC individuals via the regulations of gut microbes and metabolites.

Hepatocellular carcinoma (HCC) is the most common liver cancer and has a high incidence in China, largely due to the high prevalence of hepatitis B virus (HBV) infection. HBV‑related HCC often presents with aggressive characteristics but preserved liver function. Resection and ablation are approaches to achieve potentially curative outcomes. However, the recurrence rate is high, with up to 70% within five years. Curative surgery or ablation is used more broadly in China than in Western countries, so identifying patients at high risk of recurrence is essential: risk stratification can inform postoperative management, including surveillance intensity and avoidance of over- or under-treatment. Baseline characteristics provide a simple method of prediction, the impacts of which differ in early and late recurrence. To our knowledge, this is the first narrative review to comprehensively understand the identification, prevalence, and impact of risk factors for both early and late HCC recurrence in Chinese patients following curative‑intent resection or ablation. The review suggests that the most impactful risk factors for early recurrence are aggressive tumor features including tumor size, number and vascular invasion. For late recurrence, key risk factors are patient characteristics such as sex, viral infections and liver cirrhosis. As these risk factors are interrelated, several integrated predictive models like nomograms and artificial intelligence (AI) applications have been proposed, which may enhance risk stratification and inform personalized management strategies. These models should be further validated in large prospective studies to achieve clinical application.

Background: Very early recurrence (VER), defined as recurrence within one year after curative resection of hepatocellular carcinoma (HCC), significantly impacts long-term survival. This study aimed to develop and validate the ANT Score, a novel prognostic model integrating nutrition, inflammation, and tumor burden to refine VER prediction.

Methods: A retrospective cohort of HCC patients undergoing curative liver resection was analyzed. Key predictors were identified using least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression, forming the ANT Score. Model performance was evaluated through receiver operating characteristic (ROC) curve analysis, DeLong's test, calibration curves, and decision curve analysis (DCA). The prognostic value of capsule integrity was also assessed.

Results: Among 459 included patients, 118 (25.7%) experienced VER. Patients were randomly assigned to training (70%) and test (30%) cohorts. The ANT Score, comprising albumin-to-alkaline phosphatase ratio (AAPR), neutrophil-to-albumin ratio (NPAR), and tumor burden score (TBS), demonstrated superior predictive performance (area under the curve [AUC] = 0.751, 95% confidence interval: 0.669-0.832, P < 0.05) compared to conventional markers. Capsule incompleteness was an independent risk factor but did not significantly enhance predictive accuracy (AUC = 0.76 vs 0.751, P > 0.05, DeLong test). The ANT Score-based nomogram exhibited excellent calibration and clinical utility in DCA.

Conclusion: The ANT Score is an independent and superior predictor of VER after curative HCC resection. The ANT Score-based nomogram showed promising predictive value, offering a practical tool for individualized risk assessment. External validation and prospective studies are warranted to further assess its clinical applicability.

Background: With the increasing prevalence of obesity and type 2 diabetes, the number of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) coexisting with hepatic steatosis is steadily rising. However, the impact of hepatic steatosis on tumor recurrence following radical resection remains unclear.

Methods: We retrospectively analyzed a cohort of 733 HBV-infected patients diagnosed with HCC who underwent curative liver resection. Propensity score matching (PSM) was performed at a 1:2 ratio using 12 covariates to reduce selection bias and explore the association between preoperative hepatic steatosis and recurrence-free survival (RFS). Furthermore, we constructed a postoperative recurrence prediction model based on hepatic steatosis and other clinicopathological factors using 101 combinations of machine learning algorithms. The optimal model was identified through comprehensive evaluation and validation.

Results: After PSM, survival analysis revealed that patients without hepatic steatosis had significantly better RFS compared to those with steatosis. Multivariate Cox regression analysis confirmed that preoperative hepatic steatosis was an independent risk factor for recurrence following radical resection ( P = 0.006, HR:1.564, 95% CI:1.137-2.150). A recurrence prediction model was developed using hepatic steatosis and additional clinicopathological features through machine learning. Among the 101 models tested, the Random Survival Forest (RSF) model exhibited the best predictive performance, achieving a C-index of 0.719 in the training cohort. The model demonstrated high predictive accuracy for 1-, 2-, and 3-year recurrence, with AUC of 0.782, 0.856, and 0.898, respectively. Compared to conventional staging systems such as BCLC and CNLC, our model achieved superior performance, and decision curve analysis (DCA) demonstrated favorable clinical utility.

Conclusion: Preoperative hepatic steatosis is an independent predictor of recurrence after radical resection in patients with HBV-related HCC. The RSF-based machine learning model incorporating hepatic steatosis and other clinicopathological factors effectively predicts postoperative recurrence risk and may facilitate personalized clinical decision-making in this patient population.

Objective: Targeted and immunotherapy offer new treatment options for patients with advanced hepatocellular carcinoma (HCC); however, the proportion of patients who benefit from these therapies remains limited. Moreover, these treatments can involve complications and add financial burdens to patients, underscoring the need to identify those who are likely to benefit. As an advanced molecular imaging technique, nuclear medicine has the potential to predict treatment efficacy in targeted and immunotherapy, though its predictive accuracy remains uncertain. This narrative review aims to summarize existing research on nuclear medicine applications in this area, providing clinicians with new perspectives.

Materials and methods: We conducted a literature review across multiple medical databases, including PubMed, Embase, Cochrane Library, Web of Science, and Scopus. Relevant studies were identified, organized, and summarized to present findings in the field.

Results: The findings indicate that metrics such as maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) correlate with the efficacy of targeted and immunotherapy. Additionally, emerging nuclear medicine techniques have shown promise in predicting PD-L1 expression.

Conclusion: Nuclear medicine holds potential for identifying patients who are likely to benefit from targeted and immunotherapy. However, further refinements are necessary to optimize its predictive capabilities.

Purpose: The study aims to further classify hepatocellular carcinoma (HCC) based on proliferative capacity, identify hub genes associated with highly proliferative HCC, and investigate its regulatory roles in HCC.

Materials and methods: Bioinformatics analysis was employed to establish classification of HCC and further identify the hub gene. Cell counting kit-8 (CCK-8) assay, colony formation assay, Western Blot assay and tumor xenograft assay were employed to detect the proliferation of HCC cells. Transwell assay and Western blot assay were employed to detect the migration of HCC cells. RNA sequencing analysis was employed to explore the signaling pathways activated by the gene and verify it through rescue experiments.

Results: We classified HCC into three more precise subtypes termed Prolifer-low, Prolifer-mid and Prolifer-high, and also found that Cms1 ribosomal small subunit homolog 1 (CMSS1) was a hub gene associated with stronger proliferative capacity subgroup of HCC. Functional studies revealed that CMSS1 overexpression significantly promoted the proliferation of HCC cells in vitro and in vivo. Additionally, CMSS1 could also promote the migration and epithelial-mesenchymal transition of HCC cells. Mechanistically, RNA sequencing analysis revealed that CMSS1 knockdown inhibited the tumor necrosis factor (TNF) and downstream nuclear factor kappa B (NF-κB) signaling pathways. More importantly, TNF or NF-κB suppression could reverse the promoting effects of CMSS1 on HCC cells proliferation and migration.

Conclusion: The study suggested that CMSS1 could be a critical modulator of HCC tumorigenesis and metastasis through the TNF/NF-κB signaling pathway, thus being considered as a potential therapeutic target for HCC. Targeting CMSS1 may offer a novel strategy to inhibit NF-κB-driven inflammatory signaling and suppress tumor progression in HCC.

Spontaneous rupture of hepatocellular carcinoma (srHCC) is a life-threatening complication with complex pathophysiology and heterogeneous clinical presentations. This review aims to provide an up-to-date summary of the pathogenesis, clinical features, treatment strategies, prognostic factors, and emerging research in srHCC. We discuss current understanding of risk factors and rupture mechanisms, outline diagnostic and therapeutic approaches-including surgical, interventional, and systemic options-and explore postoperative management and prognosis. We also highlight recent clinical evidence and unmet research needs. Understanding the multifaceted nature of srHCC is essential to improve outcomes and guide future research directions.

Background: This study aimed to evaluate the clinical efficacy of postoperative adjuvant transarterial chemoembolization (PA-TACE) in cytokeratin 19-positive (CK19+) hepatocellular carcinoma (HCC) patients and to identify cases that may benefit from PA-TACE.

Methods: We conducted a retrospective analysis of 453 CK19+ HCC patients who underwent hepatectomy between November 2013 and June 2019 at our institution. We compared the recurrence-free survival (RFS) and overall survival (OS) between patients who received PA-TACE and those who did not, utilizing propensity score matching (PSM) to balance the groups.

Results: Before and after PSM, both RFS and OS were significantly greater in PA-TACE group compared to the non-TACE group. Multivariable analysis identified PA-TACE as a significantly favorable factor of RFS and OS. In subgroups analyses, PA-TACE significantly improved RFS and OS in patients with CK19+ HCC under the following conditions: alpha-fetoprotein ≥ 400 ng/mL, cirrhosis, tumor size ≥ 5 cm, multiple tumors, major resection, Edmondson-Steiner stage III-IV, macrovascular invasion and microvascular invasion. Similar results were obtained in patients with higher tumor stages. Further recurrence model analyses revealed that PA-TACE significantly reduced early recurrence in patients with high-risk of postoperative recurrence, but had little effect on late recurrence.

Conclusion: Among CK19+ HCC patients with higher recurrence of postoperative risk, PA-TACE could greatly improve RFS and OS.