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Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association. 肝细胞癌的动脉化疗栓塞:2023年韩国癌症协会基于专家共识的实用建议。
Pub Date : 2023-09-01 Epub Date: 2023-07-14 DOI: 10.17998/jlc.2023.05.22
Yuri Cho, Jin Woo Choi, Hoon Kwon, Kun Yung Kim, Byung Chan Lee, Hee Ho Chu, Dong Hyeon Lee, Han Ah Lee, Gyoung Min Kim, Jung Suk Oh, Dongho Hyun, In Joon Lee, Hyunchul Rhim

Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.

肝细胞癌(HCC)患者于1977年引入经动脉化疗栓塞(TACE),通过肝动脉向明胶海绵颗粒施用化疗剂,并于20世纪80年代被确定为使用碘油的常规TACE。2000年代,药物洗脱珠被开发并应用于临床。目前,TACE是不适合治疗的HCC患者常用的非手术治疗方式。考虑到TACE在HCC治疗中的重要作用,重要的是组织目前关于TACE患者准备、手术技术和治疗后护理的知识和专家意见,这可以提高治疗效果和安全性。由韩国癌症协会研究委员会召集的介入放射学和肝病学领域的12名专家组成的小组制定了基于专家共识的TACE实用建议。这些建议得到了韩国介入放射学学会的认可,为TACE手术以及术前和术后患者护理提供了有用的信息和指导。
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引用次数: 0
Clinical outcome of surgical resection for multifocal T2-T3 hepatocellular carcinoma up to 3 nodules: a comparative analysis with a single nodule. 多灶性T2-T3肝细胞癌手术切除3个结节的临床结果:与单个结节的比较分析。
Pub Date : 2023-09-01 Epub Date: 2023-09-15 DOI: 10.17998/jlc.2023.08.24
Sehyeon Yu, Hye-Sung Jo, Young-Dong Yu, Yoo Jin Choi, Dong-Sik Kim

Background/aims: Although the Barcelona Clinic Liver Cancer staging system seems to underestimate the impact of curative-intent surgical resection for multifocal hepatocellular carcinoma (HCC), recent studies have indicated favorable results for the surgical resection of multiple HCC. This study aimed to assess clinical outcomes and feasibility of surgical resection for multifocal HCC with up to three nodules compared with single tumor cases.

Methods: Patients who underwent surgical resection for HCC with up to three nodules between 2009 and 2020 were included, and those with the American Joint Committee on Cancer (AJCC) 8th edition, T1 and T4 stages were excluded to reduce differences in disease distribution and severity. Finally, 81 and 52 patients were included in the single and multiple treatment groups, respectively. Short- and long-term outcomes including recurrence-free survival (RFS) and overall survival (OS), were evaluated.

Results: All patients were classified as Child-Pugh class A. RFS and OS were not significantly different between the two groups (P=0.176 and P=0.966, respectively). Multivariate analysis revealed that transfusion and intrahepatic metastasis were significantly associated with recurrence (P=0.046 and P=0.005, respectively). Additionally, intrahepatic metastasis was significantly associated with OS (hazard ratio, 1.989; 95% confidence interval, 1.040-3.802; P=0.038).

Conclusions: Since there was no significant difference in survival between the single and multiple groups among patients with AJCC 8th stage T2 and T3, surgical resection with curative intent could be considered with acceptable long-term survival for selected patients with multiple HCC of up to three nodules.

背景/目的:尽管巴塞罗那临床癌症分期系统似乎低估了多发性肝细胞癌(HCC)的治疗性手术切除的影响,但最近的研究表明,多发性肝癌的手术切除取得了有利的结果。本研究旨在与单个肿瘤病例相比,评估多灶性HCC(最多三个结节)手术切除的临床结果和可行性。方法:纳入2009年至2020年间接受HCC手术切除的最多有三个结节的患者,并排除美国癌症联合委员会(AJCC)第8版T1和T4分期的患者,以减少疾病分布和严重程度的差异。最后,81名和52名患者分别被纳入单次和多次治疗组。评估短期和长期结果,包括无复发生存率(RFS)和总生存率(OS)。结果:所有患者均被归类为Child-Pugh A级。两组之间的RFS和OS没有显著差异(分别为P=0.176和P=0.966)。多因素分析显示,输血和肝内转移与复发显著相关(分别为P=0.046和P=0.005)。此外,肝内转移与OS显著相关(危险比为1.989;95%置信区间为1.040-3.802;P=0.038),对于选定的多发性HCC(最多三个结节)患者,具有治疗目的的手术切除可以被认为具有可接受的长期生存率。
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引用次数: 0
The efficacy of treatment for hepatocellular carcinoma in elderly patients. 老年人肝细胞癌的治疗效果。
Pub Date : 2023-09-01 Epub Date: 2023-09-14 DOI: 10.17998/jlc.2023.08.03
Han Ah Lee, Sangheun Lee, Hae Lim Lee, Jeong Eun Song, Dong Hyeon Lee, Sojung Han, Ju Hyun Shim, Bo Hyun Kim, Jong Young Choi, Hyunchul Rhim, Do Young Kim

Background/aim: Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established.

Methods: Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC.

Results: Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05).

Conclusions: Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.

背景/目的:尽管随着时间的推移,老年肝细胞癌(HCC)患者的比例不断增加,但在这一人群中的治疗效果尚不明确。方法:分析从韩国原发性肝癌癌症登记处收集的数据,该登记处是2008年至2017年间韩国新诊断为HCC的代表性患者队列。根据肿瘤分期和治疗方式,比较老年和非老年HCC患者的总生存率。结果:在15186名研究患者中,5829名(38.4%)为老年人。与非老年患者相比,未接受任何HCC治疗的老年患者比例更大(25.2%对16.7%)。然而,接受治疗的老年人的OS明显优于未接受治疗的患者(中位数为38.6对22.3个月;P0.05)。IPTW后,在中期HCC中,手术(中位数,66.0对90.3个月)和经动脉治疗(中位数,36.5对37.2个月),以及在晚期HCC中,在老年和非老年HCC患者中,经动脉(中位数为25.3个月vs.26.3个月)和全身治疗(中位数为253个月vs.26.3个个月)产生的OS相当(均P>0.05)。结论:针对个体患者的个性化治疗可以将老年HCC的预后提高到与非老年患者相当的水平。
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引用次数: 0
Diagnosis of hepatocellular carcinoma using Sonazoid: a comprehensive review. Sonazoid对肝细胞癌的诊断:综述。
Pub Date : 2023-09-01 Epub Date: 2023-09-19 DOI: 10.17998/jlc.2023.08.25
Woo Kyoung Jeong

Sonazoid contrast-enhanced ultrasonography (CEUS) is a promising technique for the detection and diagnosis of focal liver lesions, particularly hepatocellular carcinoma (HCC). Recently, a collaborative effort between the Korean Society of Radiology and Korean Society of Abdominal Radiology resulted in the publication of guidelines for diagnosing HCC using Sonazoid CEUS. These guidelines propose specific criteria for identifying HCC based on the imaging characteristics observed during Sonazoid CEUS. The suggested diagnostic criteria include nonrim arterial phase hyperenhancement, and the presence of late and mild washout, or Kupffer phase washout under the premise that the early or marked washout should not occur during the portal venous phase. These criteria aim to improve the accuracy of HCC diagnosis using Sonazoid CEUS. This review offers a comprehensive overview of Sonazoid CEUS in the context of HCC diagnosis. It covers the fundamental principles of Sonazoid CEUS and its clinical applications, and introduces the recently published guidelines. By providing a summary of this emerging technique, this review contributes to a better understanding of the potential role of Sonazoid CEUS for diagnosing HCC.

超声造影(CEUS)是一种很有前途的检测和诊断肝脏局灶性病变,特别是肝细胞癌(HCC)的技术。最近,韩国放射学会和韩国腹部放射学会的合作发表了使用Sonazoid CEUS诊断HCC的指南。这些指南根据Sonazoid CEUS期间观察到的成像特征,提出了识别HCC的具体标准。建议的诊断标准包括非边缘动脉期过度强化,以及在门静脉期不应发生早期或明显冲洗的前提下,存在晚期和轻度冲洗,或库普费尔期冲洗。这些标准旨在提高Sonazoid CEUS诊断HCC的准确性。这篇综述提供了Sonazoid CEUS在HCC诊断方面的全面概述。它涵盖了Sonazoid CEUS的基本原理及其临床应用,并介绍了最近发布的指南。通过对这一新兴技术进行总结,这篇综述有助于更好地理解Sonazoid CEUS在诊断HCC中的潜在作用。
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引用次数: 0
A single hepatic mass with two tales: hepatic tuberculosis and hepatocellular carcinoma. 一个单一的肝脏肿块,有两个故事:肝结核和肝细胞癌。
Pub Date : 2023-09-01 Epub Date: 2023-09-08 DOI: 10.17998/jlc.2023.08.30
Yi De Ian Koh, Wei-Qiang Leow

Hepatic tuberculosis (HTB) is an uncommon manifestation of tuberculous infections, and there has been no proven causal link between HTB and hepatocellular carcinoma (HCC). We herein present a rare case of a synchronous presentation of HTB and HCC within a single hepatic mass. A 57-year-old Chinese gentleman with recently diagnosed sigmoid adenocarcinoma was found to have a left lower lobe pulmonary nodule and solitary hepatic mass on staging computed tomography. Biopsies showed the hepatic mass to have both HTB and HCC components. This serves as a reminder that HTB is an important differential to consider for space-occupying lesions in the liver. Histological evaluation of suspected hepatic malignancies is recommended to exclude the presence of HTB in appropriate clinical settings.

肝结核(HTB)是结核性感染的一种罕见表现,目前尚未证实HTB与肝细胞癌(HCC)之间的因果关系。本文报告了一例罕见的肝肿块内同时出现HTB和HCC的病例。一名57岁的中国绅士最近诊断为乙状结肠腺癌,在计算机断层扫描分期中发现左下叶肺结节和孤立性肝肿块。活检显示肝脏肿块同时含有HTB和HCC成分。这提醒我们,HTB是肝脏占位性病变的一个重要区别。建议在适当的临床环境中对疑似肝脏恶性肿瘤进行组织学评估,以排除HTB的存在。
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引用次数: 0
The role of lenvatinib in the era of immunotherapy of hepatocellular carcinoma. 乐伐替尼在肝细胞癌免疫治疗时代的作用。
Pub Date : 2023-09-01 Epub Date: 2023-08-17 DOI: 10.17998/jlc.2023.07.17
Matthew Man Pok Lee, Landon Long Chan, Stephen Lam Chan

Hepatocellular carcinoma (HCC) frequently presents as advanced stage with poor prognosis and high mortality. Systemic treatment is the treatment of choice for advanced disease. In 2007, the first multi-kinase inhibitor (MKI) sorafenib was approved and shown to modestly prolong overall survival (OS). The progress of systemic therapy has been slow afterwards until 2018 when lenvatinib, another MKI, was shown to be non-inferior to sorafenib on median OS as the first-line therapy for HCC. Since then, remarkable progress has been achieved on the treatment of advanced HCC, including the development of second-line targeted treatment, including regorafenib, cabozantinib and ramucirumab from 2017 to 2019. A growing focus has been placed on immune checkpoint inhibitors (ICIs) targeting programmed cell death-1 (PD-1), its ligand PD-L1, and cytotoxic T-lymphocyte-associated protein 4. These ICIs have proven their potency in treating HCC as both initial and subsequent line of therapy. At present, both regimens of atezolizumab combined with bevacizumab, as well as the combination of tremelimumab and durvalumab, are recommended as the first-line treatments based on positive phase III clinical trials. With the advancement of ICIs, it is anticipated that the role of MKIs in the treatment of HCC will evolve. In this article, lenvatinib, one of the most commonly used MKIs in HCC, is chosen to be reviewed.

肝细胞癌(HCC)常表现为晚期,预后差,死亡率高。系统治疗是晚期疾病的首选治疗方法。2007年,第一个多激酶抑制剂(MKI)索拉非尼获得批准,并被证明可以适度延长总生存期(OS)。此后,系统治疗的进展一直很缓慢,直到2018年,另一种MKI乐伐替尼被证明在中位OS方面不劣于索拉非尼,是HCC的一线治疗方法。自那以后,晚期HCC的治疗取得了显著进展,包括2017年至2019年开发了二线靶向治疗,包括瑞戈非尼、卡博扎替尼和拉穆丘单抗。人们越来越关注靶向程序性细胞死亡-1(PD-1)、其配体PD-L1和细胞毒性T淋巴细胞相关蛋白4的免疫检查点抑制剂(ICIs)。这些ICI已证明其作为初始和后续治疗线在治疗HCC方面的效力。目前,根据阳性的III期临床试验,atezolizumab联合贝伐单抗的两种方案,以及tremlimumab和durvalumab的联合方案,都被推荐为一线治疗方案。随着ICIs的发展,预计MKIs在HCC治疗中的作用将不断发展。在这篇文章中,选择乐伐替尼作为HCC中最常用的MKI之一进行综述。
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引用次数: 0
Isolation and characterization of cancer-associated fibroblasts in the tumor microenvironment of hepatocellular carcinoma. 肝细胞癌肿瘤微环境中癌相关成纤维细胞的分离与鉴定。
Pub Date : 2023-09-01 Epub Date: 2023-06-12 DOI: 10.17998/jlc.2023.04.30
Kyoungdo Mun, Jiwon Han, Pureun Roh, Jonggeun Park, Gahee Kim, Wonhee Hur, Jeongwon Jang, Jongyoung Choi, Seungkew Yoon, Youngkyoung You, Hojoong Choi, Pilsoo Sung

Background/aim: Cancer-associated fibroblasts (CAFs) play an immunosuppressive role in the tumor microenvironment (TME) of human cancers; however, their characteristics and role in hepatocellular carcinoma (HCC) remain to be elucidated.

Methods: Nine tumor and surrounding liver tissue samples from patients with HCC who underwent surgery were used to isolate patient-derived CAFs. Cell morphology was observed using an optical microscope after culture, and cell phenotypes were evaluated using flow cytometry and immunoblotting. Cytokines secreted by CAFs into culture medium were quantified using a multiplex cytokine assay.

Results: CAFs were abundant in the TME of HCC and were adjacent to immune cells. After culture, the CAFs and non-tumor fibroblasts exhibited spindle shapes. We observed a robust expression of alpha-smooth muscle actin and fibroblast activation protein in CAFs, whereas alpha-fetoprotein, epithelial cell adhesion molecule, platelet/endothelial cell adhesion molecule-1, and E-cadherin were not expressed in CAFs. Furthermore, CAFs showed high secretion of various cytokines, namely C-X-C motif chemokine ligand 12, interleukin (IL)-6, IL-8, and C-C motif chemokine ligand 2.

Conclusions: CAFs are abundant in the TME of HCC and play a crucial role in tumor progression. These fibroblasts secrete cytokines that promote tumor growth and metastasis.

背景/目的:癌相关成纤维细胞(CAFs)在人类肿瘤微环境(TME)中发挥免疫抑制作用;然而,它们在肝细胞癌(HCC)中的特征和作用仍有待阐明。方法:从接受手术的HCC患者的9个肿瘤和周围肝组织样本中分离出患者来源的CAFs。培养后使用光学显微镜观察细胞形态,并使用流式细胞术和免疫印迹评估细胞表型。使用多重细胞因子测定法对CAFs分泌到培养基中的细胞因子进行定量。结果:肝癌TME中CAFs含量丰富,且与免疫细胞相邻。培养后,CAFs和非肿瘤成纤维细胞呈现梭形。我们观察到α-平滑肌肌动蛋白和成纤维细胞活化蛋白在CAFs中的强烈表达,而甲胎蛋白、上皮细胞粘附分子、血小板/内皮细胞粘附分子-1和E-钙粘蛋白在CAF中不表达。此外,CAFs表现出多种细胞因子的高分泌,即C-X-C基序趋化因子配体12、白细胞介素(IL)-6、IL-8和C-C基序趋化因子配体2。结论:CAFs在HCC的TME中丰富,在肿瘤进展中起着至关重要的作用。这些成纤维细胞分泌促进肿瘤生长和转移的细胞因子。
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引用次数: 0
Implications of the first edition of the Korean expert consensus-based practice recommendations for transarterial chemoembolization in the management of hepatocellular carcinoma. 第一版韩国专家基于共识的实践建议对肝细胞癌经动脉化疗栓塞治疗的影响。
Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.17998/jlc.2023.06.29
Jin Wook Chung
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引用次数: 0
Hepatic basidiobolomycosis masquerading as cholangiocarcinoma: a case report and literature review. 伪装成胆管癌的肝脏担担菌病:一例报告和文献复习。
Pub Date : 2023-09-01 Epub Date: 2023-08-17 DOI: 10.17998/jlc.2023.06.07
Roopali Sehrawat, Nalini Bansal, Ajitabh Srivastava, Dharmender Malik, Vivek Vij

Basidiobolus ranarum is known to cause subcutaneous mycoses; however, rare cases of hepatic and gastrointestinal involvement by basidiobolomycosis have been reported. Hepatic basidiobolomycosis may be confused with a carcinoma on imaging, and histological examination and fungal culture can help distinguish between these two. We report a rare case of basidiobolomycosis in a 16-year-old male with liver and gastrointestinal involvement.

众所周知,腊肠担子菌会引起皮下真菌病;然而,罕见的担子菌病累及肝脏和胃肠道的病例已有报道。肝脏担子菌病在影像学上可能与癌症混淆,组织学检查和真菌培养有助于区分这两者。我们报告了一例罕见的担子菌病病例,患者为16岁男性,肝脏和胃肠道受累。
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引用次数: 0
Imaging prognostication and tumor biology in hepatocellular carcinoma. 肝细胞癌的影像学预测和肿瘤生物学。
Pub Date : 2023-09-01 Epub Date: 2023-09-15 DOI: 10.17998/jlc.2023.08.29
Diana Kadi, Marilyn F Yamamoto, Emily C Lerner, Hanyu Jiang, Kathryn J Fowler, Mustafa R Bashir

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, and represents a significant global health burden with rising incidence rates, despite a more thorough understanding of the etiology and biology of HCC, as well as advancements in diagnosis and treatment modalities. According to emerging evidence, imaging features related to tumor aggressiveness can offer relevant prognostic information, hence validation of imaging prognostic features may allow for better noninvasive outcomes prediction and inform the selection of tailored therapies, ultimately improving survival outcomes for patients with HCC.

肝细胞癌(HCC)是最常见的原发性肝脏恶性肿瘤,尽管对HCC的病因和生物学以及诊断和治疗方式有了更深入的了解,但随着发病率的上升,它代表着全球健康的重大负担。根据新出现的证据,与肿瘤侵袭性相关的影像学特征可以提供相关的预后信息,因此,影像学预后特征的验证可以更好地预测无创结果,并为选择量身定制的治疗方法提供信息,最终改善HCC患者的生存结果。
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引用次数: 0
期刊
Journal of Liver Cancer
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