Shirin Nkongolo, Isabelle Mohr, Jürgen J. Wenzel, Dina Khalid, Markus Mieth, Arianeb Mehrabi, Karl Heinz Weiss, Paul Schnitzler
Background and Aims
Hepatitis E virus (HEV) is an increasingly recognised pathogen in industrialised countries, in particular genotype 3. Patients with underlying liver disease are at increased risk for severe course of the infection. Additionally, patients receiving immunosuppressive therapy can develop chronic HEV infection, which may cause further liver damage and ultimately lead to cirrhosis, decompensation or death.
Methods
This retrospective study assessed 1023 patients on the waiting list for liver transplantation, of which 636 were transplanted, for conducted HEV diagnostics, courses of disease and management, in the time from 2007 to 2018. Viral loads and HEV genotypes were determined retrospectively for selected cases.
Results
We found a seroprevalence of 29.7%. Forty-five patients (4.4%) seroconverted during the study period, indicating newly acquired infection. HEV replication was detected in nine patients (0.9%), seven of which were managed in our clinic and further analysed. Three of these patients were diagnosed with active HEV infection retrospectively. All patients with replicating HEV were liver-transplanted and therefore treated with immunosuppressants; four developed chronic infection >3 months. Two patients were also diagnosed with graft rejection when they had active hepatitis E. Patients who received antiviral treatment with Ribavirin cleared the infection and normalised alanine aminotransferase (ALT) levels within few weeks.
Conclusion
The results argue for more and systematic HEV testing of liver-transplanted patients, in routine settings and especially when ALT is elevated, as infections may be significantly underdiagnosed. Patients receiving immunosuppressive therapy who develop chronic infection can effectively be treated to prevent further liver damage.
{"title":"Hepatitis E seroprevalence, cases and management in a large German centre for liver transplantation","authors":"Shirin Nkongolo, Isabelle Mohr, Jürgen J. Wenzel, Dina Khalid, Markus Mieth, Arianeb Mehrabi, Karl Heinz Weiss, Paul Schnitzler","doi":"10.1002/lci2.48","DOIUrl":"10.1002/lci2.48","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Hepatitis E virus (HEV) is an increasingly recognised pathogen in industrialised countries, in particular genotype 3. Patients with underlying liver disease are at increased risk for severe course of the infection. Additionally, patients receiving immunosuppressive therapy can develop chronic HEV infection, which may cause further liver damage and ultimately lead to cirrhosis, decompensation or death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study assessed 1023 patients on the waiting list for liver transplantation, of which 636 were transplanted, for conducted HEV diagnostics, courses of disease and management, in the time from 2007 to 2018. Viral loads and HEV genotypes were determined retrospectively for selected cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found a seroprevalence of 29.7%. Forty-five patients (4.4%) seroconverted during the study period, indicating newly acquired infection. HEV replication was detected in nine patients (0.9%), seven of which were managed in our clinic and further analysed. Three of these patients were diagnosed with active HEV infection retrospectively. All patients with replicating HEV were liver-transplanted and therefore treated with immunosuppressants; four developed chronic infection >3 months. Two patients were also diagnosed with graft rejection when they had active hepatitis E. Patients who received antiviral treatment with Ribavirin cleared the infection and normalised alanine aminotransferase (ALT) levels within few weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results argue for more and systematic HEV testing of liver-transplanted patients, in routine settings and especially when ALT is elevated, as infections may be significantly underdiagnosed. Patients receiving immunosuppressive therapy who develop chronic infection can effectively be treated to prevent further liver damage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93331,"journal":{"name":"Liver cancer international","volume":"3 2","pages":"72-81"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lci2.48","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45326777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessandro Vitale, Silvia Caregari, Edoardo G. Giannini
The complexity of the evaluation of patients with hepatocellular carcinoma (HCC) is related to the need of simultaneously considering – when planning treatment and assessing prognosis – not only the magnitude of tumour burden and the degree of general well-being of patients (i.e. their Performance Status [PS]) as in other malignancies, but also the extent of the concomitant liver dysfunction. Moreover, adding further complications to the difficulties faced in streamlining this complex process, various evidence-based treatments are available to treat patients with HCC. This has led, through the years, to the development of several, variously designed prognostic scores and staging systems, without having yet reached a consensus on the universally accepted best one.
HCC prognostic assessment scores can be divided into two main categories, differing in design characteristics (data based or evidence based), prognostic value, significance in treatment allocation.1 Evidence-based staging systems (Tumour Nodes Metastasis [TNM], Barcelona Clinic Liver Cancer [BCLC] and Chinese Liver Cancer [CNLC] classifications) are defined based on HCC patients' prognostic evidence from the literature and typically offer a linkage, sometimes univocal, with treatment modalities. Data-based prognostic scores (Okuda staging system, Cancer of the Liver Italian Program [CLIP] score, Japan Integrated Staging [JIS] score, Model to Estimate Survival for HCC [MESH] score], on the other hand, are obtained with rigorous statistical methodology and demonstrated to have a better prognostic performance compared to evidence-based staging systems.2 Lastly, a third category can also be identified, namely combined prognostic systems, used both as prognostic scores and staging systems. A recent example of one of these systems, based on literature evidence but weighted in a real population, is the Italian Liver Cancer (ITA.LI.CA) prognostic system.3
The Hepatocellular Carcinoma Survival Prediction Score (HCC-SPS), proposed by Tan et al. in the current issue of Liver Cancer International, can be categorised as a data-based prognostic score. Indeed, this study is an interesting example of how this kind of scores are created, relying on real-life population data, solid statistical bases, internal and external validation.4 Noteworthy, the HCC-SPS score incorporates a multitude of parameters in comparison with other HCC survival scores. In addition to tumour characteristics, it also assesses liver functional reserve, the albumin–bilirubin (ALBI) grade and patient's physical functional status. Furthermore, it includes the only humoral parameter which is widely available in clinical practice to assess the ‘biological aggressiveness’ of HCC, such as alpha-fetoprotein.5 One of its limits, though, is the scarce numerosity of the external validation populations.
{"title":"Need for independence of treatment allocation from prognostic evaluation for hepatocellular carcinoma","authors":"Alessandro Vitale, Silvia Caregari, Edoardo G. Giannini","doi":"10.1002/lci2.49","DOIUrl":"10.1002/lci2.49","url":null,"abstract":"<p>The complexity of the evaluation of patients with hepatocellular carcinoma (HCC) is related to the need of simultaneously considering – when planning treatment and assessing prognosis – not only the magnitude of tumour burden and the degree of general well-being of patients (i.e. their Performance Status [PS]) as in other malignancies, but also the extent of the concomitant liver dysfunction. Moreover, adding further complications to the difficulties faced in streamlining this complex process, various evidence-based treatments are available to treat patients with HCC. This has led, through the years, to the development of several, variously designed prognostic scores and staging systems, without having yet reached a consensus on the universally accepted best one.</p><p>HCC prognostic assessment scores can be divided into two main categories, differing in design characteristics (data based or evidence based), prognostic value, significance in treatment allocation.<span><sup>1</sup></span> Evidence-based staging systems (Tumour Nodes Metastasis [TNM], Barcelona Clinic Liver Cancer [BCLC] and Chinese Liver Cancer [CNLC] classifications) are defined based on HCC patients' prognostic evidence from the literature and typically offer a linkage, sometimes univocal, with treatment modalities. Data-based prognostic scores (Okuda staging system, Cancer of the Liver Italian Program [CLIP] score, Japan Integrated Staging [JIS] score, Model to Estimate Survival for HCC [MESH] score], on the other hand, are obtained with rigorous statistical methodology and demonstrated to have a better prognostic performance compared to evidence-based staging systems.<span><sup>2</sup></span> Lastly, a third category can also be identified, namely combined prognostic systems, used both as prognostic scores and staging systems. A recent example of one of these systems, based on literature evidence but weighted in a real population, is the Italian Liver Cancer (ITA.LI.CA) prognostic system.<span><sup>3</sup></span></p><p>The Hepatocellular Carcinoma Survival Prediction Score (HCC-SPS), proposed by Tan et al. in the current issue of Liver Cancer International, can be categorised as a data-based prognostic score. Indeed, this study is an interesting example of how this kind of scores are created, relying on real-life population data, solid statistical bases, internal and external validation.<span><sup>4</sup></span> Noteworthy, the HCC-SPS score incorporates a multitude of parameters in comparison with other HCC survival scores. In addition to tumour characteristics, it also assesses liver functional reserve, the albumin–bilirubin (ALBI) grade and patient's physical functional status. Furthermore, it includes the only humoral parameter which is widely available in clinical practice to assess the ‘biological aggressiveness’ of HCC, such as alpha-fetoprotein.<span><sup>5</sup></span> One of its limits, though, is the scarce numerosity of the external validation populations.</p><p","PeriodicalId":93331,"journal":{"name":"Liver cancer international","volume":"3 2","pages":"51-52"},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lci2.49","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43207214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ken Liu, Terry C. F. Yip, Steven Masson, Waleed Fateen, Tae-Hwi Schwantes-An, Geoffrey W. McCaughan, Timothy R. Morgan, Guruprasad P. Aithal, Devanshi Seth
Background and Aims
The aMAP score was recently devised to predict hepatocellular carcinoma (HCC) development. However, its performance was not tested in alcohol-related cirrhosis (ALC). We aimed to validate the aMAP score in a cohort of ALC patients.
Method
Study participants with ALC from a prior genome-wide association study were included. All participants had a history of high alcohol consumption. Cirrhosis was defined clinically, using fibroscan and/or histology. Patients were followed until the last liver imaging, HCC, liver transplantation (LT) or death with the latter two adjusted as competing risks.
Results
A total of 269 ALC patients were included: male (72.5%), Caucasian (98.9%), median age 56 years, and median Child-Pugh score 7. The median aMAP score was 60: 12.3% low-risk, 35.3% medium-risk and 52.4% high-risk. After a median follow-up of 41 months, 14 patients developed HCC, 27 received LT and 104 died. The aMAP score predicted HCC development (hazard ratio 1.12 per point increase, P < .001) with good separation of cumulative incidence function between risk groups. The area under the time-dependent receiver operating characteristics curve for predicting HCC development was 0.83 at 1 year and 0.82 at 5 years which was similar to ADRESS-HCC and Veterans Affairs Healthcare System scores respectively.
Conclusions
We validated the excellent performance of the aMAP score in ALC and affirm its applicability across wider aetiologies.
{"title":"Validation of the aMAP score to predict hepatocellular carcinoma development in a cohort of alcohol-related cirrhosis patients","authors":"Ken Liu, Terry C. F. Yip, Steven Masson, Waleed Fateen, Tae-Hwi Schwantes-An, Geoffrey W. McCaughan, Timothy R. Morgan, Guruprasad P. Aithal, Devanshi Seth","doi":"10.1002/lci2.47","DOIUrl":"10.1002/lci2.47","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>The aMAP score was recently devised to predict hepatocellular carcinoma (HCC) development. However, its performance was not tested in alcohol-related cirrhosis (ALC). We aimed to validate the aMAP score in a cohort of ALC patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Study participants with ALC from a prior genome-wide association study were included. All participants had a history of high alcohol consumption. Cirrhosis was defined clinically, using fibroscan and/or histology. Patients were followed until the last liver imaging, HCC, liver transplantation (LT) or death with the latter two adjusted as competing risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 269 ALC patients were included: male (72.5%), Caucasian (98.9%), median age 56 years, and median Child-Pugh score 7. The median aMAP score was 60: 12.3% low-risk, 35.3% medium-risk and 52.4% high-risk. After a median follow-up of 41 months, 14 patients developed HCC, 27 received LT and 104 died. The aMAP score predicted HCC development (hazard ratio 1.12 per point increase, <i>P</i> < .001) with good separation of cumulative incidence function between risk groups. The area under the time-dependent receiver operating characteristics curve for predicting HCC development was 0.83 at 1 year and 0.82 at 5 years which was similar to ADRESS-HCC and Veterans Affairs Healthcare System scores respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We validated the excellent performance of the aMAP score in ALC and affirm its applicability across wider aetiologies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93331,"journal":{"name":"Liver cancer international","volume":"3 2","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"2022-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lci2.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41821684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Terence J.Y. Tan, Liang Shen, Saur Hajiev, Lung-Yi Mak, Rohini Sharma, George B.B. Goh, Pik-Eu Chang, Man-Fung Yuen, David J. Pinato, Chee-Kiat Tan
Background & Aims
Survival in hepatocellular carcinoma (HCC) is associated with several factors. Our aim was to develop and validate an HCC survival prediction score (HCC-SPS) based on common clinical parameters and excluding the subsequent therapy received, which would be able to prognosticate all patients with HCC at the time of diagnosis.
Methods
The development cohort comprised 1270 patients with HCC seen in our department since January 1988. Univariate analysis was performed for known HCC prognostic parameters. Parameters with P < .1 on univariate analysis were then included in a Cox regression with backward model selection. The HCC-SPS was derived based on the coefficients estimated by Cox regression with selected parameters. The derived HCC-SPS was then validated with 2 independent international cohorts of 220 patients from the United Kingdom and 90 patients from Hong Kong (HK). Points were allocated to the following variables: ALBI grade, AFP level, portal vein invasion, ECOG status and TNM stage.
Results
The total score classified a patient into 3 distinct survival risk categories of low, medium and high risk with median survival (weeks) of 249 (95% CI 195–303), 45 (95% CI 38–52) and 9 (95% CI 8–10) respectively. The scoring system was validated by the cohorts from United Kingdom and HK.
Conclusions
We have formulated an HCC survival prediction score using readily available clinical parameters to risk stratify all HCC patients into distinct survival categories at the time of HCC diagnosis regardless of subsequent treatment received. The score was validated with other independent international cohorts of patients.
背景,目的肝细胞癌(HCC)患者的生存与多种因素相关。我们的目的是开发和验证HCC生存预测评分(HCC- sps)，该评分基于常见的临床参数，不包括随后接受的治疗，能够在诊断时预测所有HCC患者。方法回顾性分析1988年1月以来我科收治的1270例肝癌患者。对已知的HCC预后参数进行单因素分析。参数带P <.1的单因素分析，然后纳入Cox回归与逆向模型选择。采用Cox回归法对各参数进行系数估计，得到HCC-SPS。然后用来自英国的220名患者和来自香港的90名患者的2个独立国际队列验证了衍生的HCC-SPS。对ALBI分级、AFP水平、门静脉侵犯、ECOG状态、TNM分期进行评分。结果总评分将患者分为低、中、高风险3个不同的生存风险类别，中位生存期(周)分别为249 (95% CI 195 ~ 303)、45 (95% CI 38 ~ 52)和9 (95% CI 8 ~ 10)。来自英国和香港的队列验证了评分系统。我们已经制定了一个HCC生存预测评分，使用现成的临床参数，将所有HCC患者在HCC诊断时分为不同的生存类别，而不管随后接受了什么治疗。该评分通过其他独立的国际患者队列进行验证。
{"title":"Development and validation of a therapy-independent hepatocellular carcinoma survival prediction score","authors":"Terence J.Y. Tan, Liang Shen, Saur Hajiev, Lung-Yi Mak, Rohini Sharma, George B.B. Goh, Pik-Eu Chang, Man-Fung Yuen, David J. Pinato, Chee-Kiat Tan","doi":"10.1002/lci2.45","DOIUrl":"10.1002/lci2.45","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background & Aims</h3>\u0000 \u0000 <p>Survival in hepatocellular carcinoma (HCC) is associated with several factors. Our aim was to develop and validate an HCC survival prediction score (HCC-SPS) based on common clinical parameters and excluding the subsequent therapy received, which would be able to prognosticate all patients with HCC at the time of diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The development cohort comprised 1270 patients with HCC seen in our department since January 1988. Univariate analysis was performed for known HCC prognostic parameters. Parameters with <i>P</i> < .1 on univariate analysis were then included in a Cox regression with backward model selection. The HCC-SPS was derived based on the coefficients estimated by Cox regression with selected parameters. The derived HCC-SPS was then validated with 2 independent international cohorts of 220 patients from the United Kingdom and 90 patients from Hong Kong (HK). Points were allocated to the following variables: ALBI grade, AFP level, portal vein invasion, ECOG status and TNM stage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The total score classified a patient into 3 distinct survival risk categories of low, medium and high risk with median survival (weeks) of 249 (95% CI 195–303), 45 (95% CI 38–52) and 9 (95% CI 8–10) respectively. The scoring system was validated by the cohorts from United Kingdom and HK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We have formulated an HCC survival prediction score using readily available clinical parameters to risk stratify all HCC patients into distinct survival categories at the time of HCC diagnosis regardless of subsequent treatment received. The score was validated with other independent international cohorts of patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93331,"journal":{"name":"Liver cancer international","volume":"3 2","pages":"82-89"},"PeriodicalIF":0.0,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lci2.45","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42782300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Following Article belonging to this SPECIAL ISSUE has been Published in a previous issue of “Volume 2, Issue 3”","authors":"","doi":"10.1002/lci2.65","DOIUrl":"https://doi.org/10.1002/lci2.65","url":null,"abstract":"","PeriodicalId":93331,"journal":{"name":"Liver cancer international","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49230188","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}
E. Gigante, O. Sutter, P. Nahon, O. Seror, J. Nault
The main curative treatments of early hepatocellular carcinoma (HCC) are liver resection, liver transplantation and percutaneous ablation. Monopolar radiofrequency ablation (RFA) was the most widely used percutaneous treatment but has limitations in terms of applicability and efficacy. These limitations could be responsible for downgrading the treatment of early HCC not amenable to usual monopolar RFA, transplantation or resection and to a shift to palliative treatment. However, improvement in ablation techniques during the last 10 years including the development of microwave ablation, multibipolar RFA, irreversible electroporation but also new technical tricks for ablation allowed to optimize the efficacy and promote the wide application of percutaneous treatments in patients with early HCC. It helped also to explore the ability of percutaneous ablation to treat HCC outside current guidelines in order to ablate more lesions of larger sizes. In this review, we aim to describe how the improvement of ablation methods helps to maximize the number of patients treated for early HCC and to discuss if we could extend the usual ablation criteria in order to allocate more patients in a curative setting.
{"title":"Percutaneous treatments of hepatocellular carcinoma: Improving efficacy, applicability and extending ablation criteria","authors":"E. Gigante, O. Sutter, P. Nahon, O. Seror, J. Nault","doi":"10.1002/lci2.35","DOIUrl":"https://doi.org/10.1002/lci2.35","url":null,"abstract":"The main curative treatments of early hepatocellular carcinoma (HCC) are liver resection, liver transplantation and percutaneous ablation. Monopolar radiofrequency ablation (RFA) was the most widely used percutaneous treatment but has limitations in terms of applicability and efficacy. These limitations could be responsible for downgrading the treatment of early HCC not amenable to usual monopolar RFA, transplantation or resection and to a shift to palliative treatment. However, improvement in ablation techniques during the last 10 years including the development of microwave ablation, multibipolar RFA, irreversible electroporation but also new technical tricks for ablation allowed to optimize the efficacy and promote the wide application of percutaneous treatments in patients with early HCC. It helped also to explore the ability of percutaneous ablation to treat HCC outside current guidelines in order to ablate more lesions of larger sizes. In this review, we aim to describe how the improvement of ablation methods helps to maximize the number of patients treated for early HCC and to discuss if we could extend the usual ablation criteria in order to allocate more patients in a curative setting.","PeriodicalId":93331,"journal":{"name":"Liver cancer international","volume":"3 1","pages":"37 - 46"},"PeriodicalIF":0.0,"publicationDate":"2022-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42533759","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}
A. Vitale, M. Finotti, F. Trevisani, F. Farinati, E. Giannini
Treatment allocation of patients with hepatocellular carcinoma (HCC) is an extremely complex process as this tumour usually arises in patients with liver cirrhosis, that may be complicated by features of portal hypertension and liver failure, and patients often present additional comorbidities, thus making the therapeutic decision process even more challenging.1 The complexity of this scenario has further increased in the last years due to a dramatic change in the treatment paradigm of HCC patients as well as in the landscape of patients developing this tumour.2,3 These changes mainly concerned systemic and surgical therapies of HCC but also the treatment of unresectable advanced tumours due to the current availability of three lines of systemic therapy with tyrosine kinase inhibitors and the recent advent of a frontline therapy more effective than sorafenib (ie, atezolizumab plus bevacizumab) that are the available novel standard of care as it is European Medicines Agency and Food and Drug Administration approved them for unresectable HCC.4,5 These advancements are expanding the reach of systemic therapy beyond the conventional limit of the advanced stage of the disease and, likely, such therapies will represent a valid therapeutic option together, or as an alternative, to locoregional therapies in all patients with unresectable HCC independently of tumour stage. On the contrary, the rising spread of miniinvasive approaches has radically improved the surgical treatment of HCC. The miniinvasive approach, in fact, has become a wellestablished positive prognostic factor in patients undergoing liver resection for HCC.6 The optimal candidacy to liver resection, in fact, now depends on a multiparametric evaluation that includes residual liver function, grade of portal hypertension, the volume of the remaining liver parenchyma and the possibility to apply a miniinvasive approach.7 Based on this new concept of resectability,8 liver resection should not be confined to specific subpopulations (or substages) based on the absence of a single adverse prognostic factor (ie, clinically relevant portal hypertension, increased serum bilirubin, multinodular pattern or vascular invasion). Lastly, the boundaries for the selection of patients for liver transplantation have widened due to the application of the transplant benefit concept and to the results of wellconducted, prospective studies that have demonstrated the effectiveness of downstaging strategies, thus increasing the candidacy to this curative procedure. Thus, on the basis of local organ resources, availability of alternative therapies, and waiting list competition issues, the indication to liver transplantation for HCC can include patients in almost all stages of liver disease (from very early to terminal stage HCC). These recent, relevant advances in the treatment, both systemic and surgical, of HCC patients, have made even more evident the limitations of a ‘stage hierarchy approach’ rigidly linking ea
{"title":"Treatment allocation in patients with hepatocellular carcinoma: Need for a paradigm shift?","authors":"A. Vitale, M. Finotti, F. Trevisani, F. Farinati, E. Giannini","doi":"10.1002/lci2.42","DOIUrl":"https://doi.org/10.1002/lci2.42","url":null,"abstract":"Treatment allocation of patients with hepatocellular carcinoma (HCC) is an extremely complex process as this tumour usually arises in patients with liver cirrhosis, that may be complicated by features of portal hypertension and liver failure, and patients often present additional comorbidities, thus making the therapeutic decision process even more challenging.1 The complexity of this scenario has further increased in the last years due to a dramatic change in the treatment paradigm of HCC patients as well as in the landscape of patients developing this tumour.2,3 These changes mainly concerned systemic and surgical therapies of HCC but also the treatment of unresectable advanced tumours due to the current availability of three lines of systemic therapy with tyrosine kinase inhibitors and the recent advent of a frontline therapy more effective than sorafenib (ie, atezolizumab plus bevacizumab) that are the available novel standard of care as it is European Medicines Agency and Food and Drug Administration approved them for unresectable HCC.4,5 These advancements are expanding the reach of systemic therapy beyond the conventional limit of the advanced stage of the disease and, likely, such therapies will represent a valid therapeutic option together, or as an alternative, to locoregional therapies in all patients with unresectable HCC independently of tumour stage. On the contrary, the rising spread of miniinvasive approaches has radically improved the surgical treatment of HCC. The miniinvasive approach, in fact, has become a wellestablished positive prognostic factor in patients undergoing liver resection for HCC.6 The optimal candidacy to liver resection, in fact, now depends on a multiparametric evaluation that includes residual liver function, grade of portal hypertension, the volume of the remaining liver parenchyma and the possibility to apply a miniinvasive approach.7 Based on this new concept of resectability,8 liver resection should not be confined to specific subpopulations (or substages) based on the absence of a single adverse prognostic factor (ie, clinically relevant portal hypertension, increased serum bilirubin, multinodular pattern or vascular invasion). Lastly, the boundaries for the selection of patients for liver transplantation have widened due to the application of the transplant benefit concept and to the results of wellconducted, prospective studies that have demonstrated the effectiveness of downstaging strategies, thus increasing the candidacy to this curative procedure. Thus, on the basis of local organ resources, availability of alternative therapies, and waiting list competition issues, the indication to liver transplantation for HCC can include patients in almost all stages of liver disease (from very early to terminal stage HCC). These recent, relevant advances in the treatment, both systemic and surgical, of HCC patients, have made even more evident the limitations of a ‘stage hierarchy approach’ rigidly linking ea","PeriodicalId":93331,"journal":{"name":"Liver cancer international","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47212601","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}
Biliary tract cancer (BTC) represents a major public health problem due to its increasing rates of incidence and mortality, especially the intrahepatic cholangiocarcinoma (IHCCA) subtype. First line palliative systemic treatment with cisplatin and gemcitabine has been the unique level IA evidence option until last few years when a deeper understanding of its molecular landscape has unveiled CCA as a very rich targetable disease. This has revolutionised the patient's scenario and has brought new targeted therapies guided by molecular aberrations. Isocitrate dehydrogenase (IDH)1 mutations are the most prevalent targetable alteration in CCA (13% of IHCCA). Ivosidenib has been very recently approved by FDA for IDH1 mutated CCA patients based on a randomised clinical trial (ClarIDHy).
{"title":"Current development and future perspective of IDH1 inhibitors in cholangiocarcinoma","authors":"J. Adeva","doi":"10.1002/lci2.43","DOIUrl":"https://doi.org/10.1002/lci2.43","url":null,"abstract":"Biliary tract cancer (BTC) represents a major public health problem due to its increasing rates of incidence and mortality, especially the intrahepatic cholangiocarcinoma (IHCCA) subtype. First line palliative systemic treatment with cisplatin and gemcitabine has been the unique level IA evidence option until last few years when a deeper understanding of its molecular landscape has unveiled CCA as a very rich targetable disease. This has revolutionised the patient's scenario and has brought new targeted therapies guided by molecular aberrations. Isocitrate dehydrogenase (IDH)1 mutations are the most prevalent targetable alteration in CCA (13% of IHCCA). Ivosidenib has been very recently approved by FDA for IDH1 mutated CCA patients based on a randomised clinical trial (ClarIDHy).","PeriodicalId":93331,"journal":{"name":"Liver cancer international","volume":"3 1","pages":"17 - 31"},"PeriodicalIF":0.0,"publicationDate":"2021-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43410346","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":"Latest advances in cholangiocarcinoma","authors":"A. Lamarca","doi":"10.1002/lci2.44","DOIUrl":"https://doi.org/10.1002/lci2.44","url":null,"abstract":"","PeriodicalId":93331,"journal":{"name":"Liver cancer international","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49191081","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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