J. Shindoh, Yusuke Kawamura, Keiichi Akahoshi, Masaru Matsumura, S. Okubo, Norio Akuta, Minoru Tanabe, N. Kokudo, Yoshiyuki Suzuki, M. Hashimoto
Introduction: Introduction of new systemic therapies for hepatocellular carcinoma (HCC) has led to the development of new oncological criteria of resectability for the resectability of HCC. This study was aimed at validating the prognosticating ability and clinical utility of the resectability classification based on the novel criteria in real world clinical practice. Methods: This study was conducted in 1,822 patients who had undergone curative resection for HCC (Population 1) and 107 patients with unresectable disease who had received lenvatinib therapy (Population 2). Patients were classified into three groups according to the novel oncological criteria for resectability (R, resectable; BR1, borderline resectable 1; and BR2, borderline resectable 2) and the prognosticating ability and clinical utility of this classification based on the novel criteria were examined. Results: Multivariate analysis confirmed that classification of the patients according to the oncological resectability criteria was significantly correlated with the overall survival (BR1: hazard ratio [HR], 1.88; 95% CI, 1.38-2.55; BR2: HR, 4.12; 95% CI, 3.01-5.65) and recurrence-free survival (BR1: HR, 1.86; 95% CI, 1.44-2.41; BR2: HR, 3.62; 95% CI, 2.71-4.82) in Population 1. In Population2, the resectability classification was correlated with the rates of successful additional intervention (surgery, transarterial chemoembolization, or radiotherapy) (BR1 65.7% vs. BR2 42.3%, P = 0.023) and curative-intent conversion surgery (BR1 17.1% vs. BR2 4.2%, P = 0.056) after lenvatinib therapy, and was also predictive of the overall survival (HR, 1.96; 95% CI, 1.13-3.38 for BR2 [vs. BR1]) and time-to-treatment failure (HR, 1.81; 95% CI, 1.04-3.17 for BR2 [vs. BR1]). Conclusion: The resectaility classification based on the noverl oncological criteria for resectability showed acceptable prognosticating ability in both surgically and medically treated populations with advanced HCC.
简介：肝细胞癌（HCC）新系统疗法的引入促使人们制定了可切除性的新肿瘤学标准。本研究旨在验证基于新标准的可切除性分类在实际临床实践中的预后能力和临床实用性。研究方法这项研究的对象是1822名接受过HCC根治性切除术的患者（人群1）和107名接受过来伐替尼治疗的无法切除的患者（人群2）。根据新的可切除性肿瘤学标准将患者分为三组（R，可切除；BR1，边缘可切除1；BR2，边缘可切除2），并研究了这种基于新标准的分类的预后能力和临床实用性。结果多变量分析证实，在人群1中，根据肿瘤可切除性标准对患者进行分类与总生存率（BR1：危险比[HR]，1.88；95% CI，1.38-2.55；BR2：HR，4.12；95% CI，3.01-5.65）和无复发生存率（BR1：HR，1.86；95% CI，1.44-2.41；BR2：HR，3.62；95% CI，2.71-4.82）显著相关。在研究对象 2 中，可切除性分级与额外干预（手术、经动脉化疗栓塞或放疗）的成功率（BR1 65.7% vs. BR2 42.3%，P = 0.023）和治愈意图转换手术的成功率（BR1 17.1% vs. BR2 4.2%，P = 0.023）相关。1% vs. BR2 4.2%, P = 0.056），还可预测总生存期（BR2 [vs. BR1]，HR，1.96；95% CI，1.13-3.38）和治疗失败时间（BR2 [vs. BR1]，HR，1.81；95% CI，1.04-3.17）。结论基于noverl肿瘤学可切除性标准的可切除性分类对手术和药物治疗的晚期HCC患者都显示出了可接受的预后能力。
{"title":"Clinical utility of the novel oncological criteria of resectability for advanced hepatocellular carcinoma","authors":"J. Shindoh, Yusuke Kawamura, Keiichi Akahoshi, Masaru Matsumura, S. Okubo, Norio Akuta, Minoru Tanabe, N. Kokudo, Yoshiyuki Suzuki, M. Hashimoto","doi":"10.1159/000539381","DOIUrl":"https://doi.org/10.1159/000539381","url":null,"abstract":"Introduction: Introduction of new systemic therapies for hepatocellular carcinoma (HCC) has led to the development of new oncological criteria of resectability for the resectability of HCC. This study was aimed at validating the prognosticating ability and clinical utility of the resectability classification based on the novel criteria in real world clinical practice. Methods: This study was conducted in 1,822 patients who had undergone curative resection for HCC (Population 1) and 107 patients with unresectable disease who had received lenvatinib therapy (Population 2). Patients were classified into three groups according to the novel oncological criteria for resectability (R, resectable; BR1, borderline resectable 1; and BR2, borderline resectable 2) and the prognosticating ability and clinical utility of this classification based on the novel criteria were examined. Results: Multivariate analysis confirmed that classification of the patients according to the oncological resectability criteria was significantly correlated with the overall survival (BR1: hazard ratio [HR], 1.88; 95% CI, 1.38-2.55; BR2: HR, 4.12; 95% CI, 3.01-5.65) and recurrence-free survival (BR1: HR, 1.86; 95% CI, 1.44-2.41; BR2: HR, 3.62; 95% CI, 2.71-4.82) in Population 1. In Population2, the resectability classification was correlated with the rates of successful additional intervention (surgery, transarterial chemoembolization, or radiotherapy) (BR1 65.7% vs. BR2 42.3%, P = 0.023) and curative-intent conversion surgery (BR1 17.1% vs. BR2 4.2%, P = 0.056) after lenvatinib therapy, and was also predictive of the overall survival (HR, 1.96; 95% CI, 1.13-3.38 for BR2 [vs. BR1]) and time-to-treatment failure (HR, 1.81; 95% CI, 1.04-3.17 for BR2 [vs. BR1]). Conclusion: The resectaility classification based on the noverl oncological criteria for resectability showed acceptable prognosticating ability in both surgically and medically treated populations with advanced HCC.","PeriodicalId":510489,"journal":{"name":"Liver Cancer","volume":"19 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140967401","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}
{"title":"A Changing Role of TACE in the Era of ICI plus Anti-VEGF/TKI plus TACE: From Total Embolization to Partial Embolization (Immune Boost TACE)","authors":"M. Kudo","doi":"10.1159/000539301","DOIUrl":"https://doi.org/10.1159/000539301","url":null,"abstract":"","PeriodicalId":510489,"journal":{"name":"Liver Cancer","volume":"81 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140984529","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}
{"title":"Reply to the letter regarding ‘Impact of Bevacizumab Being Skipped due to Adverse Events of Special Interest for Bevacizumab in Patients with Unresectable Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab: An Exploratory Analysis of the Phase III IMbrave150 Study’","authors":"Masatoshi Kudo, Kaoru Tsuchiya, Tatsuya Yamashita, Hironori Koga, Yuki Nakagawa, Masafumi Ikeda","doi":"10.1159/000539205","DOIUrl":"https://doi.org/10.1159/000539205","url":null,"abstract":"","PeriodicalId":510489,"journal":{"name":"Liver Cancer","volume":"45 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141010665","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}
Federico Rossari, Toshifumi Tada, G. Suda, S. Shimose, Masatoshi Kudo, Changhoon Yoo, J. Cheon, F. Finkelmeier, H. Lim, J. Presa, Gianluca Masi, Francesca Bergamo, Elisabeth Amadeo, Francesco Vitiello, T. Kumada, Naoya Sakamoto, H. Iwamoto, T. Aoki, Hongjae Chon, V. Himmelsbach, Massimo Iavarone, G. Cabibbo, M. Montes, F. Foschi, C. Vivaldi, C. Soldà, T. Sho, T. Niizeki, N. Nishida, Christoph Steup, M. Hirooka, K. Kariyama, J. Tani, M. Atsukawa, K. Takaguchi, E. Itobayashi, Shinya Fukunishi, K. Tsuji, T. Ishikawa, K. Tajiri, H. Ochi, S. Yasuda, H. Toyoda, C. Ogawa, Takashi Nishimura, T. Hatanaka, Satoru Kakizaki, N. Shimada, K. Kawata, Atsushi Hiraoka, F. Tada, H. Ohama, K. Nouso, A. Morishita, A. Tsutsui, T. Nagano, N. Itokawa, T. Okubo, M. Imai, H. Kosaka, A. Naganuma, Y. Koizumi, Shinichiro Nakamura, Masaaki Kaibori, Hiroko Iijima, Y. Hiasa, M. Persano, S. Foti, S. Camera, Bernardo Stefanini, M. Scartozzi, S. Cascinu, A. Casadei‐Gardini, M. Rimini
Introduction The impact of etiology on response to immunotherapy in advanced hepatocellular carcinoma (HCC) is being debated, with contrasting findings between early and recent post-hoc analyses of IMbrave-150 and metanalyses of clinical trials of PD-1/PD-L1 blockers. As a results, it is not clear whether the first-line systemic treatment atezolizumab plus bevacizumab is equally effective in viral and non-viral patients. Methods We retrospectively analyzed 885 HCC patients treated with first-line A + B from multiple centers from Eastern and Western countries, 53.9% having viral and 46.1% non-viral etiology. Baseline clinical and laboratory characteristics were analyzed with uni- and multi-variate models to explore potential differences on overall survival (OS), time to progression (TTP), disease control rates based on etiology and to identify putative prognostic factors in etiology subgroups. Treatment toxicities and access to second-line treatments and outcomes were also reported and compared between etiologies. Results Overall, no statistically significant differences were found in OS (mOS: viral 15.9 months; non-viral 16.3 months), TTP (mTTP: viral 8.3 months; non-viral 7.2 months), and disease control rates (DCR: viral 78.1%; non-viral 80.8%) based on etiology. Prognostic factors of survival and progression were mainly shared between viral and non-viral etiologies, including alpha-fetoprotein, aspartate transaminase, neutrophil-to-lymphocyte ratio (NLR) and ALBI score. Exploratory analyses highlighted a possible stronger association of immunological factors, i.e. NLR and eosinophil count, to treatment outcomes in viral patients. The toxicity profile, the access to and type of second-line treatments and their outcome in terms of OS almost overlap in the two etiology subgroups. Conclusion Atezolizumab plus bevacizumab efficacy does not vary according to underlying etiology of HCC in a multicenter, real-world population, matching recent post-hoc findings from the IMbrave-150 trial. Preliminary analyses suggest that some prognostic factors differ between viral and non-viral patients, potentially due to biological and immunological differences. Prospective and comparative trials stratifying by etiology are warranted to validate these findings and guide clinical practice.
{"title":"Disease etiology impact on outcomes of hepatocellular carcinoma patients treated with atezolizumab plus bevacizumab: a real-world, multicenter study","authors":"Federico Rossari, Toshifumi Tada, G. Suda, S. Shimose, Masatoshi Kudo, Changhoon Yoo, J. Cheon, F. Finkelmeier, H. Lim, J. Presa, Gianluca Masi, Francesca Bergamo, Elisabeth Amadeo, Francesco Vitiello, T. Kumada, Naoya Sakamoto, H. Iwamoto, T. Aoki, Hongjae Chon, V. Himmelsbach, Massimo Iavarone, G. Cabibbo, M. Montes, F. Foschi, C. Vivaldi, C. Soldà, T. Sho, T. Niizeki, N. Nishida, Christoph Steup, M. Hirooka, K. Kariyama, J. Tani, M. Atsukawa, K. Takaguchi, E. Itobayashi, Shinya Fukunishi, K. Tsuji, T. Ishikawa, K. Tajiri, H. Ochi, S. Yasuda, H. Toyoda, C. Ogawa, Takashi Nishimura, T. Hatanaka, Satoru Kakizaki, N. Shimada, K. Kawata, Atsushi Hiraoka, F. Tada, H. Ohama, K. Nouso, A. Morishita, A. Tsutsui, T. Nagano, N. Itokawa, T. Okubo, M. Imai, H. Kosaka, A. Naganuma, Y. Koizumi, Shinichiro Nakamura, Masaaki Kaibori, Hiroko Iijima, Y. Hiasa, M. Persano, S. Foti, S. Camera, Bernardo Stefanini, M. Scartozzi, S. Cascinu, A. Casadei‐Gardini, M. Rimini","doi":"10.1159/000537915","DOIUrl":"https://doi.org/10.1159/000537915","url":null,"abstract":"Introduction\u0000The impact of etiology on response to immunotherapy in advanced hepatocellular carcinoma (HCC) is being debated, with contrasting findings between early and recent post-hoc analyses of IMbrave-150 and metanalyses of clinical trials of PD-1/PD-L1 blockers. As a results, it is not clear whether the first-line systemic treatment atezolizumab plus bevacizumab is equally effective in viral and non-viral patients.\u0000Methods\u0000We retrospectively analyzed 885 HCC patients treated with first-line A + B from multiple centers from Eastern and Western countries, 53.9% having viral and 46.1% non-viral etiology. Baseline clinical and laboratory characteristics were analyzed with uni- and multi-variate models to explore potential differences on overall survival (OS), time to progression (TTP), disease control rates based on etiology and to identify putative prognostic factors in etiology subgroups. Treatment toxicities and access to second-line treatments and outcomes were also reported and compared between etiologies.\u0000Results\u0000Overall, no statistically significant differences were found in OS (mOS: viral 15.9 months; non-viral 16.3 months), TTP (mTTP: viral 8.3 months; non-viral 7.2 months), and disease control rates (DCR: viral 78.1%; non-viral 80.8%) based on etiology. Prognostic factors of survival and progression were mainly shared between viral and non-viral etiologies, including alpha-fetoprotein, aspartate transaminase, neutrophil-to-lymphocyte ratio (NLR) and ALBI score. Exploratory analyses highlighted a possible stronger association of immunological factors, i.e. NLR and eosinophil count, to treatment outcomes in viral patients.\u0000The toxicity profile, the access to and type of second-line treatments and their outcome in terms of OS almost overlap in the two etiology subgroups. \u0000Conclusion\u0000Atezolizumab plus bevacizumab efficacy does not vary according to underlying etiology of HCC in a multicenter, real-world population, matching recent post-hoc findings from the IMbrave-150 trial. Preliminary analyses suggest that some prognostic factors differ between viral and non-viral patients, potentially due to biological and immunological differences. \u0000Prospective and comparative trials stratifying by etiology are warranted to validate these findings and guide clinical practice.","PeriodicalId":510489,"journal":{"name":"Liver Cancer","volume":"5 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140720219","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}
B. G. Song, Aryoung Kim, M. Goh, W. Kang, G. Gwak, Yong-Han Paik, M. Choi, J. Lee, D. Sinn
Introduction: Steatotic liver disease (SLD) is a new overarching term proposed to replace non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction associated fatty liver disease (MAFLD). Subclassification includes metabolic dysfunction associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and cryptogenic SLD. This study aimed to investigate whether SLD and its subclassification could stratify hepatocellular carcinoma (HCC) risk. Methods: A cohort of 85,119 adults without viral hepatitis or heavy alcohol intake were analyzed for the risk of HCC according to SLD and its subclassification. Fibrosis-4 index (FIB-4) was used to estimate degree of liver fibrosis. Results: During a median follow-up of 11.9 years, HCC was diagnosed in 123 individuals. The incidence rate of HCC per 1,000 person-years was higher in individuals with SLD than in those without SLD (0.197 vs. 0.071, p < 0.001), with an adjusted hazard ratio of 2.02 (95% confidence interval: 1.40-2.92). The HCC incidence rate per 1,000 person-years was 0, 0.180, and 0.648 for cryptogenic SLD, MASLD, and MetALD, respectively. When participants with SLD was further stratified by FIB-4 index, the HCC incidence rate per 1,000 person-years was 0.074 for SLD with FIB-4 < 1.3 and 0.673 for SLD with FIB-4 ≥ 1.3. Of note, HCC risk was substantially high (HCC incidence rate: 1.847 per 1,000 person-years) for MetALD with FIB-4 ≥ 1.3. Conclusions: HCC risk was different by SLD and its subclassification. The utilization of SLD and its subclassification can aid in stratifying HCC risk and facilitate the identification of individuals requiring interventions to mitigate the risk of HCC.
{"title":"Risk of Hepatocellular Carcinoma by Steatotic Liver Disease and Its Newly Proposed Sub-Classification","authors":"B. G. Song, Aryoung Kim, M. Goh, W. Kang, G. Gwak, Yong-Han Paik, M. Choi, J. Lee, D. Sinn","doi":"10.1159/000538301","DOIUrl":"https://doi.org/10.1159/000538301","url":null,"abstract":"Introduction: Steatotic liver disease (SLD) is a new overarching term proposed to replace non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction associated fatty liver disease (MAFLD). Subclassification includes metabolic dysfunction associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and cryptogenic SLD. This study aimed to investigate whether SLD and its subclassification could stratify hepatocellular carcinoma (HCC) risk. Methods: A cohort of 85,119 adults without viral hepatitis or heavy alcohol intake were analyzed for the risk of HCC according to SLD and its subclassification. Fibrosis-4 index (FIB-4) was used to estimate degree of liver fibrosis. Results: During a median follow-up of 11.9 years, HCC was diagnosed in 123 individuals. The incidence rate of HCC per 1,000 person-years was higher in individuals with SLD than in those without SLD (0.197 vs. 0.071, p < 0.001), with an adjusted hazard ratio of 2.02 (95% confidence interval: 1.40-2.92). The HCC incidence rate per 1,000 person-years was 0, 0.180, and 0.648 for cryptogenic SLD, MASLD, and MetALD, respectively. When participants with SLD was further stratified by FIB-4 index, the HCC incidence rate per 1,000 person-years was 0.074 for SLD with FIB-4 < 1.3 and 0.673 for SLD with FIB-4 ≥ 1.3. Of note, HCC risk was substantially high (HCC incidence rate: 1.847 per 1,000 person-years) for MetALD with FIB-4 ≥ 1.3. Conclusions: HCC risk was different by SLD and its subclassification. The utilization of SLD and its subclassification can aid in stratifying HCC risk and facilitate the identification of individuals requiring interventions to mitigate the risk of HCC.","PeriodicalId":510489,"journal":{"name":"Liver Cancer","volume":"97 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140249569","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}
Background: Surveillance for hepatocellular carcinoma (HCC) has been proven to increase the proportion of tumors detected at early stages and the chance of receiving curative therapies, reducing mortality by 40%. Summary: Current recommendations consist of a semi-annual abdominal ultrasound with or without serum alpha-fetoprotein measurement in patients with cirrhosis and specific subgroups of populations with chronic viral hepatitis. Antiviral therapies, such as nucleot(s)ide analogs that efficiently suppress the replication of hepatitis B virus (HBV) and direct-acting antiviral drugs able to eliminate the hepatitis C virus (HCV) in > 90% of patients, have radically changed the outcomes of viral liver disease and decreased, but not eliminated, the risk of HCC in both cirrhotic and non-cirrhotic patients. HCC risk is a key starting point for implementing a cost-effective surveillance and should also guide the decision-making process concerning its modality. As the global number of effectively treated viral patients continues to rise, there is a pressing need to identify those for whom the benefit-to-harm ratio of surveillance is favourable and to determine how to conduct cost-effective screening on such patients. Key messages: This article addresses this topic and attempts to determine which patients should continue HCC surveillance after HBV suppression or HCV eradication, based on cost-effectiveness principles and the fact that HCC risk declines over time. We also formulate a proposal for a surveillance algorithm that switches the use of surveillance for HCC from the “one-size-fits-all” approach to individualized programs based on oncologic risk (precision surveillance).
{"title":"Surveillance for hepatocellular carcinoma in patients with successfully treated viral disease of the liver. A systematic review","authors":"L. Lani, B. Stefanini, Franco Trevisani","doi":"10.1159/000535497","DOIUrl":"https://doi.org/10.1159/000535497","url":null,"abstract":"Background: Surveillance for hepatocellular carcinoma (HCC) has been proven to increase the proportion of tumors detected at early stages and the chance of receiving curative therapies, reducing mortality by 40%. \u0000\u0000Summary: Current recommendations consist of a semi-annual abdominal ultrasound with or without serum alpha-fetoprotein measurement in patients with cirrhosis and specific subgroups of populations with chronic viral hepatitis. Antiviral therapies, such as nucleot(s)ide analogs that efficiently suppress the replication of hepatitis B virus (HBV) and direct-acting antiviral drugs able to eliminate the hepatitis C virus (HCV) in > 90% of patients, have radically changed the outcomes of viral liver disease and decreased, but not eliminated, the risk of HCC in both cirrhotic and non-cirrhotic patients. HCC risk is a key starting point for implementing a cost-effective surveillance and should also guide the decision-making process concerning its modality.\u0000As the global number of effectively treated viral patients continues to rise, there is a pressing need to identify those for whom the benefit-to-harm ratio of surveillance is favourable and to determine how to conduct cost-effective screening on such patients. \u0000\u0000Key messages: This article addresses this topic and attempts to determine which patients should continue HCC surveillance after HBV suppression or HCV eradication, based on cost-effectiveness principles and the fact that HCC risk declines over time.\u0000We also formulate a proposal for a surveillance algorithm that switches the use of surveillance for HCC from the “one-size-fits-all” approach to individualized programs based on oncologic risk (precision surveillance).","PeriodicalId":510489,"journal":{"name":"Liver Cancer","volume":"77 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139860968","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}
Background: Surveillance for hepatocellular carcinoma (HCC) has been proven to increase the proportion of tumors detected at early stages and the chance of receiving curative therapies, reducing mortality by 40%. Summary: Current recommendations consist of a semi-annual abdominal ultrasound with or without serum alpha-fetoprotein measurement in patients with cirrhosis and specific subgroups of populations with chronic viral hepatitis. Antiviral therapies, such as nucleot(s)ide analogs that efficiently suppress the replication of hepatitis B virus (HBV) and direct-acting antiviral drugs able to eliminate the hepatitis C virus (HCV) in > 90% of patients, have radically changed the outcomes of viral liver disease and decreased, but not eliminated, the risk of HCC in both cirrhotic and non-cirrhotic patients. HCC risk is a key starting point for implementing a cost-effective surveillance and should also guide the decision-making process concerning its modality. As the global number of effectively treated viral patients continues to rise, there is a pressing need to identify those for whom the benefit-to-harm ratio of surveillance is favourable and to determine how to conduct cost-effective screening on such patients. Key messages: This article addresses this topic and attempts to determine which patients should continue HCC surveillance after HBV suppression or HCV eradication, based on cost-effectiveness principles and the fact that HCC risk declines over time. We also formulate a proposal for a surveillance algorithm that switches the use of surveillance for HCC from the “one-size-fits-all” approach to individualized programs based on oncologic risk (precision surveillance).
{"title":"Surveillance for hepatocellular carcinoma in patients with successfully treated viral disease of the liver. A systematic review","authors":"L. Lani, B. Stefanini, Franco Trevisani","doi":"10.1159/000535497","DOIUrl":"https://doi.org/10.1159/000535497","url":null,"abstract":"Background: Surveillance for hepatocellular carcinoma (HCC) has been proven to increase the proportion of tumors detected at early stages and the chance of receiving curative therapies, reducing mortality by 40%. \u0000\u0000Summary: Current recommendations consist of a semi-annual abdominal ultrasound with or without serum alpha-fetoprotein measurement in patients with cirrhosis and specific subgroups of populations with chronic viral hepatitis. Antiviral therapies, such as nucleot(s)ide analogs that efficiently suppress the replication of hepatitis B virus (HBV) and direct-acting antiviral drugs able to eliminate the hepatitis C virus (HCV) in > 90% of patients, have radically changed the outcomes of viral liver disease and decreased, but not eliminated, the risk of HCC in both cirrhotic and non-cirrhotic patients. HCC risk is a key starting point for implementing a cost-effective surveillance and should also guide the decision-making process concerning its modality.\u0000As the global number of effectively treated viral patients continues to rise, there is a pressing need to identify those for whom the benefit-to-harm ratio of surveillance is favourable and to determine how to conduct cost-effective screening on such patients. \u0000\u0000Key messages: This article addresses this topic and attempts to determine which patients should continue HCC surveillance after HBV suppression or HCV eradication, based on cost-effectiveness principles and the fact that HCC risk declines over time.\u0000We also formulate a proposal for a surveillance algorithm that switches the use of surveillance for HCC from the “one-size-fits-all” approach to individualized programs based on oncologic risk (precision surveillance).","PeriodicalId":510489,"journal":{"name":"Liver Cancer","volume":"4 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139801155","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}
Introduction The progression patterns, dispositions, and outcomes of patients with advanced hepatocellular carcinoma (HCC) who achieved durable responses with immunotherapy remain poorly characterized. Methods Patients with advanced HCC who received immune checkpoint inhibitor (ICI)-based immunotherapy and achieved durable responses were retrospectively included. A durable response was defined as partial response (PR) or stable disease (SD) per RECIST 1.1 for more than 8 months after initiation of immunotherapy. Oligoprogression and polyprogression were defined as progression at ≤ 3 and > 3 lesions, respectively. Results A total of 91 durable responders (63 PR and 28 SD) were identified. The majority had chronic viral hepatitis (n=69, 75.8%). Forty-seven (51.6%) and 44 (48.4%) patients received the index immunotherapy as first-line and second or beyond-line therapy, respectively. Fifty-four (59.3%) patients subsequently developed progression, with a predominant pattern of oligoprogression (66.7%). The median overall survival (OS) was 46.2 months (95% CI: 34.1–58.3). For patients with subsequent progression, employment of locoregional therapy (LRT) for progression was associated with prolonged OS (univariate analysis: hazard ratio [HR] 0.397, p=0.009; multivariate analysis: HR 0.363, p=0.050). Patients with oligoprogression who received LRT showed longer median OS than those who did not (48.4 vs. 20.5 months, p<0.001). In contrast, the median OS of patients with polyprogression who received LRT was not different from those without LRT (27.7 vs. 25.5 months, p=0.794). Conclusion Approximately 60% of the post-immunotherapy durable responders of HCC subsequently develop progression. Proactive LRT may further rescue patients who develop subsequent oligoprogression. Prospective studies are mandatory to clarify the proper management of durable responders with subsequent progression.
{"title":"Outcomes of post-immunotherapy durable responders of advanced hepatocellular carcinoma - with emphasis on locoregional therapy for oligoprogression","authors":"Tsung-Hao Liu, San-Chi Chen, Kun-Ming Rau, Li‐Chun Lu, Po-Ting Lin, Yung-Yeh Su, Wei Teng, Shiue-Wei Lai, Ren-Hua Yeh, T. Kao, Pei‐Chang Lee, Chi-Jung Wu, Chien-Hung Chen, Chih-Hung Hsu, Shi-Ming Lin, Yi-Hsiang Huang, Li-Tzong Chen, Ann-Lii Cheng, Ying-Chun Shen","doi":"10.1159/000536549","DOIUrl":"https://doi.org/10.1159/000536549","url":null,"abstract":"Introduction\u0000The progression patterns, dispositions, and outcomes of patients with advanced hepatocellular carcinoma (HCC) who achieved durable responses with immunotherapy remain poorly characterized. \u0000\u0000Methods\u0000Patients with advanced HCC who received immune checkpoint inhibitor (ICI)-based immunotherapy and achieved durable responses were retrospectively included. A durable response was defined as partial response (PR) or stable disease (SD) per RECIST 1.1 for more than 8 months after initiation of immunotherapy. Oligoprogression and polyprogression were defined as progression at ≤ 3 and > 3 lesions, respectively. \u0000\u0000Results\u0000A total of 91 durable responders (63 PR and 28 SD) were identified. The majority had chronic viral hepatitis (n=69, 75.8%). Forty-seven (51.6%) and 44 (48.4%) patients received the index immunotherapy as first-line and second or beyond-line therapy, respectively. Fifty-four (59.3%) patients subsequently developed progression, with a predominant pattern of oligoprogression (66.7%). The median overall survival (OS) was 46.2 months (95% CI: 34.1–58.3). For patients with subsequent progression, employment of locoregional therapy (LRT) for progression was associated with prolonged OS (univariate analysis: hazard ratio [HR] 0.397, p=0.009; multivariate analysis: HR 0.363, p=0.050). Patients with oligoprogression who received LRT showed longer median OS than those who did not (48.4 vs. 20.5 months, p<0.001). In contrast, the median OS of patients with polyprogression who received LRT was not different from those without LRT (27.7 vs. 25.5 months, p=0.794).\u0000\u0000Conclusion\u0000Approximately 60% of the post-immunotherapy durable responders of HCC subsequently develop progression. Proactive LRT may further rescue patients who develop subsequent oligoprogression. Prospective studies are mandatory to clarify the proper management of durable responders with subsequent progression.\u0000","PeriodicalId":510489,"journal":{"name":"Liver Cancer","volume":"486 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139824934","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}
Introduction The progression patterns, dispositions, and outcomes of patients with advanced hepatocellular carcinoma (HCC) who achieved durable responses with immunotherapy remain poorly characterized. Methods Patients with advanced HCC who received immune checkpoint inhibitor (ICI)-based immunotherapy and achieved durable responses were retrospectively included. A durable response was defined as partial response (PR) or stable disease (SD) per RECIST 1.1 for more than 8 months after initiation of immunotherapy. Oligoprogression and polyprogression were defined as progression at ≤ 3 and > 3 lesions, respectively. Results A total of 91 durable responders (63 PR and 28 SD) were identified. The majority had chronic viral hepatitis (n=69, 75.8%). Forty-seven (51.6%) and 44 (48.4%) patients received the index immunotherapy as first-line and second or beyond-line therapy, respectively. Fifty-four (59.3%) patients subsequently developed progression, with a predominant pattern of oligoprogression (66.7%). The median overall survival (OS) was 46.2 months (95% CI: 34.1–58.3). For patients with subsequent progression, employment of locoregional therapy (LRT) for progression was associated with prolonged OS (univariate analysis: hazard ratio [HR] 0.397, p=0.009; multivariate analysis: HR 0.363, p=0.050). Patients with oligoprogression who received LRT showed longer median OS than those who did not (48.4 vs. 20.5 months, p<0.001). In contrast, the median OS of patients with polyprogression who received LRT was not different from those without LRT (27.7 vs. 25.5 months, p=0.794). Conclusion Approximately 60% of the post-immunotherapy durable responders of HCC subsequently develop progression. Proactive LRT may further rescue patients who develop subsequent oligoprogression. Prospective studies are mandatory to clarify the proper management of durable responders with subsequent progression.
{"title":"Outcomes of post-immunotherapy durable responders of advanced hepatocellular carcinoma - with emphasis on locoregional therapy for oligoprogression","authors":"Tsung-Hao Liu, San-Chi Chen, Kun-Ming Rau, Li‐Chun Lu, Po-Ting Lin, Yung-Yeh Su, Wei Teng, Shiue-Wei Lai, Ren-Hua Yeh, T. Kao, Pei‐Chang Lee, Chi-Jung Wu, Chien-Hung Chen, Chih-Hung Hsu, Shi-Ming Lin, Yi-Hsiang Huang, Li-Tzong Chen, Ann-Lii Cheng, Ying-Chun Shen","doi":"10.1159/000536549","DOIUrl":"https://doi.org/10.1159/000536549","url":null,"abstract":"Introduction\u0000The progression patterns, dispositions, and outcomes of patients with advanced hepatocellular carcinoma (HCC) who achieved durable responses with immunotherapy remain poorly characterized. \u0000\u0000Methods\u0000Patients with advanced HCC who received immune checkpoint inhibitor (ICI)-based immunotherapy and achieved durable responses were retrospectively included. A durable response was defined as partial response (PR) or stable disease (SD) per RECIST 1.1 for more than 8 months after initiation of immunotherapy. Oligoprogression and polyprogression were defined as progression at ≤ 3 and > 3 lesions, respectively. \u0000\u0000Results\u0000A total of 91 durable responders (63 PR and 28 SD) were identified. The majority had chronic viral hepatitis (n=69, 75.8%). Forty-seven (51.6%) and 44 (48.4%) patients received the index immunotherapy as first-line and second or beyond-line therapy, respectively. Fifty-four (59.3%) patients subsequently developed progression, with a predominant pattern of oligoprogression (66.7%). The median overall survival (OS) was 46.2 months (95% CI: 34.1–58.3). For patients with subsequent progression, employment of locoregional therapy (LRT) for progression was associated with prolonged OS (univariate analysis: hazard ratio [HR] 0.397, p=0.009; multivariate analysis: HR 0.363, p=0.050). Patients with oligoprogression who received LRT showed longer median OS than those who did not (48.4 vs. 20.5 months, p<0.001). In contrast, the median OS of patients with polyprogression who received LRT was not different from those without LRT (27.7 vs. 25.5 months, p=0.794).\u0000\u0000Conclusion\u0000Approximately 60% of the post-immunotherapy durable responders of HCC subsequently develop progression. Proactive LRT may further rescue patients who develop subsequent oligoprogression. Prospective studies are mandatory to clarify the proper management of durable responders with subsequent progression.\u0000","PeriodicalId":510489,"journal":{"name":"Liver Cancer","volume":"34 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139884510","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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