Liver cancer international最新文献

Hepatocellular carcinoma (HCC) poses a significant global burden, with most patients being diagnosed at an advanced stage, leading to poor prognosis due to the lack of systemic treatment. The approval of oral tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors, and anti-angiogenic agents has rapidly expanded the treatment prospects for HCC. However, the use of these drugs has also increased the incidence of portal hypertension (PHT) and upper gastrointestinal variceal bleeding in HCC patients. The diagnosis, screening, emergency treatment, and secondary prevention of upper gastrointestinal variceal rebleeding in advanced HCC patients undergoing oral TKIs therapy have become clinically urgent and critical issues. This review provides an overview of the existing understanding regarding the uses and limitations of transjugular intrahepatic portosystemic shunt (TIPS) insertion for managing HCC in cirrhosis patients with PHT and variceal hemorrhage. Additionally, it explores the potential of TIPS in managing acute upper gastrointestinal bleeding and preventing rebleeding in advanced HCC patients undergoing TKIs therapy. The placement of TIPS within the treatment hierarchy is determined by the specific clinical environment and the individual attributes of the patient.

There is no consensus on which substances and which method should be used for transarterial chemoembolization. A publication commissioned by CIRSE 2021 attempted to formulate recommendations. However, only the spectrum of currently implemented procedures is outlined but no recommendation was made. In this article, therefore, basic considerations regarding the technique of chemoembolization are presented, and the authors discuss fundamental considerations about the embolic materials used, the cytostatic drugs and their dosage, as well as about pain therapy during treatment. Then, a technique is presented which used degradable starch microspheres as an embolic agent. This technique enables multiple treatments over a longer period. However, this proposal is not only evidence-based but also eminence-based. What we need are controlled studies that systematically compare different treatment techniques in a sufficient number of patients. This will hopefully help to find the best method for individual patients. Until then, the technique proposed by the authors can be applied.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. Recently, patient care was revolutionized by the introduction of immunotherapy combining anti-programmed death-ligand 1 (PD-L1) checkpoint inhibition with anti-vascular endothelial growth factor (VEGF) therapy as first-line treatment for advanced unresectable HCC. Additional promising studies with mono- or combination immunotherapy are in advanced phases of clinical testing. Currently, however, our understanding of which patients profit from immunotherapy and how therapy response may be related to the composition of the tumour immune microenvironment remains incomplete. Inhibitory receptors as targets of immune checkpoint inhibitor (ICI) therapies are strongly expressed by T cells in the tumour microenvironment (TME). However, the HCC microenvironment is highly heterogeneous as illustrated by distinct molecular subtypes and subclassifications with an immune-rich microenvironment representing only a small proportion of HCCs. A better understanding of the tumour immune microenvironment is expected to provide insights for clinically applicable biomarkers to optimize immunotherapies. Recent studies identified subtypes of PD-1 expressing CD8+ T cells with divergent function in the HCC TME associated with different outcomes, suggesting that specific PD-1 expressing CD8+ tissue-resident memory T cells (TRM), but not exhausted CD8+ T cells (TEX), govern positive therapy outcomes. This review discusses the T-cell response in the HCC TME in the context of its heterogeneity, molecular and immune classifications and implications for ICI therapy and biomarker discovery.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality and morbidity worldwide. Machine learning (ML) tools have been developed in recent years to generate diagnostic and prognostic molecular biomarkers for this high-fatality cancer. To delineate the landscape of ML in HCC, we performed a systematic search of Ovid Medline, Ovid Embase, Cochrane Database of Systematic Reviews (Ovid) and Cochrane CENTRAL (Ovid) to identify studies of HCC molecular biomarkers using ML strategies. In total, 75 studies met our inclusion criteria, 53 of which were pertinent to diagnosis of HCC and 22 of which were pertinent to prognostication of HCC. Genomic, transcriptomic, epigenomic, proteomic and metabolomic signatures were derived using various ML techniques (supervised, unsupervised and deep learning approaches) using serum, urine and tissue samples of HCC. The ML algorithms achieved a sensitivity of up to 95% for the diagnosis of HCC. Through pathway analysis of the signatures derived by ML tools, we identified regulators of epithelial-mesenchymal transition and the cancer pathway Ras/Raf/MAPK as being particularly prognostic of HCC outcome. The application of ML to molecular data in HCC has thus far resulted in the generation of highly sensitive diagnostic and prognostic signatures. In future, development of ML algorithms that incorporate clinical, laboratory, alongside molecular features will be needed to fulfil the promise of personalized HCC diagnosis and treatment.

Hepatocellular carcinoma (HCC) is a heterogeneous disease that often features dysregulated tumour lipid metabolism. ACSL3 and ACSL4 are two homologous long chain acyl-coenzyme A synthetases (ACSL) that preferentially catalyse the activation of monounsaturated and polyunsaturated fatty acids, respectively. Both enzymes are frequently overexpressed in HCC, and multiple reports have implicated ACSL4 in tumour progression. Increased expression of these isozymes in tumour cells can upregulate lipid metabolism through de novo lipogenesis, fatty acid β-oxidation and acyl chain remodelling of membrane phospholipids. We describe the subcellular functions of ACSL3 and ACSL4 in hepatocytes, and the transcriptional, epigenetic and post-translational mechanisms underpinning their regulation. We discuss the evidence that these enzymes can modulate hepatocarcinogenic signalling by oncoproteins, cell death by apoptosis or ferroptosis, and protein degradation through the ubiquitin-proteasome pathway. In addition, we survey how knowledge in this area may inform new approaches to the diagnosis and treatment of HCC and deepen our understanding of how lipid metabolic reprogramming can promote hepatic tumour growth.