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Korean Journal of Radiology Jun 2024Hepatocellular carcinoma (HCC) is a biologically heterogeneous tumor characterized by varying degrees of aggressiveness. The current treatment strategy for HCC is... (Review)
Review
Hepatocellular carcinoma (HCC) is a biologically heterogeneous tumor characterized by varying degrees of aggressiveness. The current treatment strategy for HCC is predominantly determined by the overall tumor burden, and does not address the diverse prognoses of patients with HCC owing to its heterogeneity. Therefore, the prognostication of HCC using imaging data is crucial for optimizing patient management. Although some radiologic features have been demonstrated to be indicative of the biologic behavior of HCC, traditional radiologic methods for HCC prognostication are based on visually-assessed prognostic findings, and are limited by subjectivity and inter-observer variability. Consequently, artificial intelligence has emerged as a promising method for image-based prognostication of HCC. Unlike traditional radiologic image analysis, artificial intelligence based on radiomics or deep learning utilizes numerous image-derived quantitative features, potentially offering an objective, detailed, and comprehensive analysis of the tumor phenotypes. Artificial intelligence, particularly radiomics has displayed potential in a variety of applications, including the prediction of microvascular invasion, recurrence risk after locoregional treatment, and response to systemic therapy. This review highlights the potential value of artificial intelligence in the prognostication of HCC as well as its limitations and future prospects.
Topics: Humans; Liver Neoplasms; Carcinoma, Hepatocellular; Artificial Intelligence; Prognosis; Image Interpretation, Computer-Assisted
PubMed: 38807336
DOI: 10.3348/kjr.2024.0070 -
Clinical and Molecular Hepatology Sep 2019Gadoxetic acid, a hepatocyte-specific magnetic resonance imaging (MRI) contrast agent, has emerged as an important tool for hepatocellular carcinoma (HCC) diagnosis.... (Review)
Review
Gadoxetic acid, a hepatocyte-specific magnetic resonance imaging (MRI) contrast agent, has emerged as an important tool for hepatocellular carcinoma (HCC) diagnosis. Gadoxetic acid-enhanced MRI is useful for the evaluation of earlystage HCC, diagnosis of HCC precursor lesions, and highly sensitive diagnosis of HCC. Furthermore, functional information provided by gadoxetic acid-enhanced MRI can aid in the characterization of focal liver lesions. For example, whereas lesions lack functioning hepatocytes appear hypointense in the hepatobiliary phase, preserved or enhanced expression of organic anion transporting polypeptides in some HCCs as well as focal nodular hyperplasia lead to hyperintensity in the hepatobiliary phase; and a targetoid appearance on transitional phase or hepatobiliary phase imaging can be helpful for identifying the histopathological composition of tumors. While gadoxetic acid-enhanced MRI may improve the sensitivity of HCC diagnosis and provide new insights into the characterization of focal liver lesions, there are many challenges associated with its use. This article reviews the pros and cons of HCC diagnosis with gadoxetic acid-enhanced MRI and discuss some clues in the radiological differentiation of HCC from HCC mimickers.
Topics: Angiomyolipoma; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; beta Catenin
PubMed: 30661336
DOI: 10.3350/cmh.2018.0107 -
Gut and Liver Jul 2015Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide. This cancer commonly arises against a background of chronic liver disease. As a... (Review)
Review
Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide. This cancer commonly arises against a background of chronic liver disease. As a result, a patient with HCC requires multidisciplinary care. Treatment options vary widely based on tumor burden and metastases. The most widely utilized staging system is the Barcelona Clinic Liver Cancer staging system, which recommends treatments based on tumor size and the underlying liver disease and functional status of the patient. Treatment options range from surgical resection or transplantation to locoregional therapies with modalities such as radiofrequency ablation and transarterial chemoembolization to systemic chemotherapies. Future care involves the development of combination therapies that afford the best tumor response, further clarification of the patients best suited for therapies and the development of new oral chemotherapeutic agents.
Topics: Antineoplastic Agents; Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Combined Modality Therapy; Forecasting; Humans; Liver Neoplasms; Liver Transplantation; Neoplasm Staging
PubMed: 26087860
DOI: 10.5009/gnl15022 -
Experimental and Clinical... Jul 2023Patients with neuroendocrine tumors with unresec-table liver involvement can benefit from liver transplant. There is a specific set of guidelines for neuroendocrine... (Review)
Review
Patients with neuroendocrine tumors with unresec-table liver involvement can benefit from liver transplant. There is a specific set of guidelines for neuroendocrine tumors with liver metastasis that involve less than 50% of the liver. However, beyond those guidelines, there are reports of exceptional criteria patients who benefited from liver transplant. Here, we present 2 unusual cases of patients with exceptional circumstances and with neuroendocrine tumors who underwent liver transplant. The first case describes a patient with an extremely rare neuroen-docrine tumor of the proximal common bile duct that caused liver biliary cirrhosis. The patient underwent tumor resection and liver transplant concurrently. The second case describes a patient with a neuroendocrine tumor of unknown primary origin with more than 50% hepatic involvement who received a liver transplant after downstaging. In our center, patients with unresectable hepatic metastases from neuroendoc-rine tumors are currently selected for liver transplant based on well-established criteria. However, these 2 cases did not meet the criteria for consideration of liver transplant; thus, multidisciplinary team sessions were held to discuss these 2 cases. After a period of nonsurgical treatment and evaluation of the tumor behavior, we selected the patients as candidates for liver transplant based on the favorable tumor behavior and favorable response to treatment. For both patients, we did not observe any signs of tumor recurrence during follow-up. The outcomes were acceptable, and the patients tolerated treatment well. Considering the favorable tumor pathology (G1 phase and low Ki67 index), we suggest that more studies should be conducted to evaluate the outcomes of patients with low-grade tumors and that the criteria for patients with low-grade tumors could be extended based on such future data.
Topics: Humans; Neuroendocrine Tumors; Liver Transplantation; Neoplasm Recurrence, Local; Liver Neoplasms
PubMed: 37584538
DOI: 10.6002/ect.2023.0110 -
Clinical and Molecular Hepatology Apr 2023Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case... (Review)
Review
Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case load, extensive local expertise on HCC has been accumulated. This article summarized local guidelines and real-life practice on HCC management in Hong Kong. For HCC surveillance, liver ultrasound and serum alpha-fetoprotein for periodic screening is recommended in viral hepatitis or cirrhotic patients, and this is adhered to in clinical practice. HCC diagnosis is not covered in local guidelines, yet our practice is in-line with regional guidelines, where diagnosis is usually achieved by cross-sectional imaging and without the need for histology. Our guidelines recommend using the Hong Kong Liver Cancer Staging for pre-treatment staging, yet we routinely use other widely-adopted systems such as the Barcelona Clinic Liver Cancer Staging and the Tumor-Node-Metastasis Staging as well. Our local guidelines have provided clear treatment algorithms for the whole range of HCC therapies, including resection, ablation, transplant, transarterial chemoembolization, transarterial radioembolization, stereotactic body radiation therapy, targeted therapy, and immunotherapy. Real-life treatment choices are largely in line with the guidelines, although treatment protocols are individualized, and availability of specific therapies can vary between centers. Overall, HCC guidelines in Hong Kong are tailored based on local expertise and our unique patient population. The guidelines are up-to-date and provide practical pathways to assist our routine practice. Regular updates of local guidelines are warranted to account for the rapidly evolving paradigm of HCC management.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Hong Kong; Chemoembolization, Therapeutic; Neoplasm Staging
PubMed: 36577426
DOI: 10.3350/cmh.2022.0399 -
BMJ Open May 2021The association between ABO blood group and risk of liver cancer is unclear, although few studies have reported positive results. This study examined the relationship...
OBJECTIVE
The association between ABO blood group and risk of liver cancer is unclear, although few studies have reported positive results. This study examined the relationship between ABO blood group and liver cancer in hepatitis B surface antigen (HBsAg)-positive individuals.
DESIGN
A high-risk population-based cohort study.
SETTING
The study was started in 2007 and closed in 2019; the number of observed person-years as obtained by ABO blood group.
PARTICIPANTS
The study included 3663 individuals with positive HBsAg, including men aged 30-70 and women aged 40-70.
OUTCOME MEASURES
The frequencies of ABO group in the cohort population and patients with liver cancer were calculated, respectively. χ test was used to compare differences, and the relative risk (95% CI) for development of liver cancer was evaluated.
RESULTS
The frequency distribution of blood types A, B, O and AB was 1118 (30.52%), 1073 (29.29%), 1104 (30.14%) and 368 (10.05%), respectively, among 3663 cohort individuals. In the cohort, patients with liver cancer (n=336) were of the following frequencies: type A: 104 (30.95%); type B: 97 (28.87%); type O: 95 (28.27%); and type AB: 40 (11.90%). No significant difference was found between patients with liver cancer and other individuals. The annual incidence rate of liver cancer was 906.34 per 100 000 person-years, and for blood type A, B, O and AB the rates were 917.76, 893.78, 846.02 and 1093.43 per 100 000 person-years, respectively. The relative risk (95% CI) was 0.97 (0.74 to 1.29), 0.92 (0.70 to 1.22) and 1.19 (0.82 to 1.72) for blood types B, O and AB, respectively, compared with blood type A.
CONCLUSION
There were no significant differences in the frequency distribution of ABO blood groups in patients with liver cancer within this high-risk cohort, which demonstrates lack of positive association between ABO blood group and risk of liver cancer.
Topics: ABO Blood-Group System; Cohort Studies; Female; Hepatitis B Surface Antigens; Humans; Liver Neoplasms; Male; Prospective Studies; Risk Factors
PubMed: 33980521
DOI: 10.1136/bmjopen-2020-044039 -
Oncotarget Mar 2017Currently, the Barcelona Clinic Liver Cancer staging system remains huge controversies in the management of hepatocellular carcinoma. To determine the best therapeutic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Currently, the Barcelona Clinic Liver Cancer staging system remains huge controversies in the management of hepatocellular carcinoma. To determine the best therapeutic strategy for patients at each stage, we conducted a network meta-analysis and aimed to provide a new treatment concept.
MATERIALS AND METHODS
PubMed, Embase and Cochrane Library database were searched for observational studies up to August 31, 2016. We extracted data on overall survival rate from studies that compared various strategies for use with patients at different stages. Network meta-analysis was conducted by evaluating the different overall survival rate of each stage. Cumulative probability value was utilized to rank the strategies under examination. A node-splitting model was employed to assess consistency and inconsistency.
RESULTS
A total of 198 observational studies were included in the network meta-analysis with a focus on Stages 0-D. By comparing the overall survival rate of each stage, the results revealed that liver transplantation and liver transplantation plus transcatheter arterial chemoembolization were the best options for patients with Stages 0 and A. The applications of surgical resection plus transcatheter arterial chemoembolization and surgical resection plus sorafenib were the best strategies for Stages B and C. For Stage D, whole net connection could not be established, but intra-arterial infusion chemotherapy and liver transplantation could be potential primary options.
CONCLUSIONS
The existing therapeutic flowchart needs to be updated. Potential best strategies relating to all stages were identified and should be used as references for clinical treatments.
Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Neoplasm Staging; Observational Studies as Topic
PubMed: 28099898
DOI: 10.18632/oncotarget.14668 -
Comprehensive Review of Hepatocellular Carcinoma in India: Current Challenges and Future Directions.JCO Global Oncology Oct 2022There is not much information on hepatocellular carcinoma (HCC) in India. Here, we review the existing data, available treatment choices, and future directions in HCC... (Review)
Review
There is not much information on hepatocellular carcinoma (HCC) in India. Here, we review the existing data, available treatment choices, and future directions in HCC management. An extensive search was conducted through PubMed and MEDLINE for studies published between January 2000 and June 2022 on the epidemiology of HCC in India using the following key words: atezolizumab, BCLC staging, hepatocellular carcinoma, immune checkpoint inhibitors, immunotherapy, and programmed cell death ligand-1, with the filters humans and English language. The most frequent risk factors for the development of HCC in India include nonalcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infection, liver cirrhosis, and alcohol intake. On the basis of new findings, the Barcelona Clinic Liver Cancer (BCLC) Staging Criteria need to be revised. As most cases in India are discovered at a later stage, curative treatments such as surgical resection, ablation, or liver transplantation may not be an option. Clinical trials are underway for a number of immune checkpoint drugs that target cytotoxic T-cell lymphocyte-4 and programmed cell death-1/programmed cell death-ligand 1. In India, phase III trials of atezolizumab in combination with other drugs are underway for the treatment of various malignancies. Renin angiotensin system inhibitors, antivirals, primary hepatocyte transplantation, and bioartificial liver devices are among the future options for the management of HCC. In developing countries like India, HCC is often diagnosed at an advanced stage because of a delay in routine testing or screening. Therefore, developing effective treatment regimens for such stages is critical. Immunotherapy is a promising treatment option that has the potential to increase overall response and survival rate.
Topics: Antiviral Agents; Carcinoma, Hepatocellular; Humans; Immune Checkpoint Inhibitors; Ligands; Liver Neoplasms; Neoplasm Staging
PubMed: 36198133
DOI: 10.1200/GO.22.00118 -
World Journal of Gastroenterology May 2018Tumor immunity proceeds through multiple processes, which consist of antigen presentation by antigen presenting cells (APCs) to educate effector cells and destruction by... (Review)
Review
Tumor immunity proceeds through multiple processes, which consist of antigen presentation by antigen presenting cells (APCs) to educate effector cells and destruction by the effector cytotoxic cells. However, tumor immunity is frequently repressed at tumor sites. Malignantly transformed cells rarely survive the attack by the immune system, but cells that do survive change their phenotypes to reduce their immunogenicity. The resultant cells evade the attack by the immune system and form clinically discernible tumors. Tumor microenvironments simultaneously contain a wide variety of immune suppressive molecules and cells to dampen tumor immunity. Moreover, the liver microenvironment exhibits immune tolerance to reduce aberrant immune responses to massively-exposed antigens via the portal vein, and immune dysfunction is frequently associated with liver cirrhosis, which is widespread in hepatocellular carcinoma (HCC) patients. Immune therapy aims to reduce tumor burden, but it is also expected to prevent non-cancerous liver lesions from progressing to HCC, because HCC develops or recurs from non-cancerous liver lesions with chronic inflammatory states and/or cirrhosis and these lesions cannot be cured and/or eradicated by local and/or systemic therapies. Nevertheless, cancer immune therapy should augment specific tumor immunity by using two distinct measures: enhancing the effector cell functions such as antigen presentation capacity of APCs and tumor cell killing capacity of cytotoxic cells, and reactivating the immune system in immune-suppressive tumor microenvironments. Here, we will summarize the current status and discuss the future perspective on immune therapy for HCC.
Topics: Antigen Presentation; Antigens, Neoplasm; Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Humans; Immune Tolerance; Immunotherapy; Liver; Liver Neoplasms; Lymphocyte Activation; Neoplasm Recurrence, Local; Tumor Microenvironment
PubMed: 29740200
DOI: 10.3748/wjg.v24.i17.1839 -
World Journal of Gastroenterology Nov 2015Hepatocellular carcinoma is one of the leading causes of cancer-related death worldwide. Liver transplantation can be a curative treatment in selected patients. However,... (Review)
Review
Hepatocellular carcinoma is one of the leading causes of cancer-related death worldwide. Liver transplantation can be a curative treatment in selected patients. However, there are several factors that influence disease-free survival after transplantation. This review addresses the pre-, intra- and postoperative factors that influence the risk of tumor recurrence after liver transplantation.
Topics: Carcinoma, Hepatocellular; Chemotherapy, Adjuvant; Disease Progression; Disease-Free Survival; Humans; Immunosuppressive Agents; Liver Neoplasms; Liver Transplantation; Neoplasm Recurrence, Local; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 26576092
DOI: 10.3748/wjg.v21.i42.12071