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Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. The rising incidence, genetic heterogeneity, multiple etiologies, and concurrent chronic liver diseases make diagnosis, staging, and selection of treatment options challenging in patients with HCC. The best approach to optimize the management of HCC is one...
Citations
... Key aspects include prevention through managing risk factors like chronic hepatitis B and C, alcohol use, diabetes, and obesity [37]. Diagnosis often relies on imaging studies and histopathological confirmation, with staging based on the Barcelona Clinic Liver Cancer system [38]. Treatment options range from curative surgeries like resection and transplantation to palliative measures such as radiofrequency ablation and chemotherapy [39], [40]. ...
This study aims to provide an overview of the current state-of-the-art applications of artificial intelligence (AI) and machine learning in the management of hepatocellular carcinoma (HCC), and to explore future directions for continued progress in this emerging field. This study is a comprehensive literature review that synthesizes recent findings and advancements in the application of AI and machine learning techniques across various aspects of HCC care, including screening and early detection, diagnosis and staging, prognostic modeling, treatment planning, interventional guidance, and monitoring of treatment response. The review draws upon a wide range of published research studies, focusing on the integration of AI and machine learning with diverse data sources, such as medical imaging, clinical data, genomics, and other multimodal information. The results demonstrate that AI-based systems have shown promise in improving the accuracy and efficiency of HCC screening, diagnosis, and tumor characterization compared to traditional methods. Machine learning models integrating clinical, imaging, and genomic data have outperformed conventional staging systems in predicting survival and recurrence risk. AI-based recommendation systems have the potential to optimize personalized therapy selection, while augmented reality techniques can guide interventional procedures in real-time. Moreover, longitudinal application of AI may enhance the assessment of treatment response and recurrence monitoring. Despite these promising findings, the review highlights the need for rigorous multicenter prospective validation studies, standardized multimodal datasets, and thoughtful consideration of ethical implications before widespread clinical implementation of AI technologies in HCC management.
... 1,2 This requires collaborated efforts from specialists in pathology, radiology, and hepatology for the diagnosis of HCC. 3 Selecting the most appropriate treatment modality for HCC is also complex. Nowadays, multiple treatment options are available. ...
Management of hepatocellular carcinoma (HCC) is challenging due to the complex relationship between underlying liver disease, tumor burden, and liver function. HCC is also notorious for its high recurrence rate even after curative treatment for early-stage tumor. Liver transplantation can substantially alter patient prognosis, but donor availability varies by each patient which further complicates treatment decision. Recent advancements in HCC treatments have introduced numerous potentially efficacious treatment modalities. However, high level evidence comparing the risks and benefits of these options is limited. In this complex situation, multidisciplinary approach or multidisciplinary team care has been suggested as a valuable strategy to help cope with escalating complexity in HCC management. Multidisciplinary approach involves collaboration among medical and health care professionals from various academic disciplines to provide comprehensive care. Although evidence suggests that multidisciplinary care can enhance outcomes of HCC patients, robust data from randomized controlled trials are currently lacking. Moreover, the implementation of a multidisciplinary approach necessitates increased medical resources compared to conventional cancer care. This review summarizes the current evidence on the role of multidisciplinary approach in HCC management and explores potential future directions.
... A multidisciplinary approach may be the key to effective patient management and formulating an individualized treatment plan for patients with unresectable HCC in Saudi Arabia. 76 The experts opined that patients with unresectable HCC in Saudi Arabia who were ineligible for atezolizumab plus bevacizumab, durvalumab plus tremelimumab, or durvalumab monotherapy, received TKIs sorafenib or lenvatinib as first-line therapy. In this regard, the selection of the appropriate option depended on careful analysis of the clinical, radiological, and biochemical profile of the patients, so that they fit into the target population enrolled in the trials where safety and efficacy were demonstrated. ...
Hepatocellular carcinoma (HCC) is the sixth most common type of cancer in the world associated with high morbidity and mortality. Despite being a significant healthcare burden there is limited information on the unmet needs and current treatment practices for intermediate and advanced-stage HCC in Saudi Arabia. This article analyzes the gaps and provides expert consensus on the management strategies for unresectable HCC in Saudi Arabia. A pre-meeting online questionnaire, comprising 20 objective questions about the treatment landscape and diagnosis of HCC in Saudi Arabia, was distributed to experts in the field of HCC management. An advisory board meeting including a panel of 13 experts was held in September 2022 where the responses to the survey questionnaire were reviewed and discussed. The survey results and experts’ discussion highlighted the growing incidence of liver cancer in Saudi Arabia. HCC comprised the majority of all liver cancer cases due to rising rates of chronic viral infections and lifestyle-related risk factors. Most physicians in Saudi Arabia follow the Barcelona Clinic Liver Cancer guidelines as a prognostic tool for the detection and staging of patients with HCC. Most of the patients with HCC in Saudi Arabia are diagnosed in the intermediate or advanced stages with poor prognoses and limited therapeutic options. Establishing evidence-based surveillance techniques, a multidisciplinary approach to diagnosis, and better accessibility of treatment options is vital for the management of HCC in Saudi Arabia.
... In centers with a mature and comprehensive ablation program, IRE presents a safe and viable option in treating hepatobiliary malignancies in close proximity to critical structures such as bile ducts, gall bladder, and vasculature. The option of IRE is typically discussed in a multidisciplinary setting like any other interventional oncology treatment option with a recommendation to be used in cases where it will offer an advantage over thermal ablation techniques [57,58]. ...
Liver cancer remains a leading cause of cancer-related deaths worldwide despite numerous advances in treatment. While surgical resection remains the gold standard for curative treatment, it is only possible for a minority of patients. Thermal ablation is an effective option for the treatment of smaller tumors; however, its use is limited to tumors that are not located in proximity to sensitive structures due to the heat sink effect and the potential of thermal damage. Irreversible electroporation (IRE) is a non-thermal ablative modality that can deliver targeted treatment and the effective destruction of tumors that are in close proximity to or even surrounding vascular or biliary ducts with minimal damage to these structures. IRE produces short pulses of high-frequency energy which opens pores in the lipid bilayer of cells leading to apoptosis and cell death. IRE has been utilized clinically for over a decade in the treatment of liver cancers with multiple studies documenting an acceptable safety profile and high efficacy rates.
... Liver cancer is the 6th most common cancer in both sexes and the 5th leading cause of cancer death in the United States. 1 Hepatocellular carcinoma (HCC), which most often arises in the setting of chronic liver disease, comprises 75-85% of primary liver cancers. 2 As HCC includes heterogeneous tumors that arise in patients with a variety of pre-existing chronic liver disease, its management is complex and nuanced. 3 There are several classification systems for staging HCC. The system most commonly used for treatment purposes is the Barcelona Clinic Liver Cancer (BCLC) classification system, which incorporates liver function, performance status, and tumor burden to recommend specific treatments by stage. ...
... Due to the high complexity of managing patients with HCC, MDLTBs are crucial for timely diagnosis, staging, and formulating individualized treatment plans. 3,12,13 Evaluation by an MDLTB has been shown to be associated with reduced mortality, 14 suggesting that adherence to MDLTB recommendations may provide a clinical benefit. ...
Background
Hepatocellular carcinoma (HCC) is a heterogeneous disease that typically arises in the setting of chronic liver disease, making treatment selection complex. Multidisciplinary liver tumor boards (MDLTB) have been shown to improve outcomes in patients with HCC. However, in many cases, patients evaluated by MDLTBs ultimately do not receive the board’s recommended treatment.
Purpose
This study aims to assess adherence to MDLTB recommendations for the treatment of HCC, the reasons for non-adherence, and the survival of Barcelona Clinic Liver Cancer (BCLC) Stage A patients treated with curative treatment compared to palliative locoregional therapy.
Patients and Methods
A single-site, retrospective cohort study was conducted of all patients with treatment-naïve HCC who were evaluated by an MDLTB at a tertiary care center in Connecticut between 2013 and 2016, of which 225 patients met inclusion criteria. Investigators conducted a chart review and recorded adherence to the MDLTB’s recommendations, and in cases of discordance, evaluated and recorded the underlying cause; investigators assessed MDLTB recommendations’ compliance with BCLC guidelines. Survival data was accrued through February 1st of 2022 and analyzed via Kaplan–Meier analysis and multivariate Cox regression.
Results
Treatment adherent to MDLTB recommendations occurred in 85.3% of patients (n=192). The majority of non-adherence occurred in the management of BCLC Stage A disease. In cases where adherence was possible but the recommendation was not followed, most discrepancies were whether to treat with curative or palliative intent (20/24), with almost all discrepancies occurring in patients (19/20) with BCLC Stage A disease. For patients with Stage A unifocal HCC, those who received curative therapy lived significantly longer than patients who received palliative locoregional therapy (5.55 years vs 4.26 years, p=0.037).
Conclusion
Most forms of non-adherence to MDLTB recommendations were unavoidable; however, treatment discordance in the management of patients with BCLC Stage A unifocal disease may present an opportunity for clinically significant quality improvement.
... There is a lack of information on post-progression treatment after first-line therapy with atezolizumab plus bevacizumab or with the STRIDE regimen. A multidisciplinary approach may be the key to effective patient management and formulating an individualized treatment plan, particularly in those patients who progress after first-line therapy with atezolizumab plus bevacizumab or the STRIDE regimen [114]. ...
The burden of hepatocellular carcinoma (HCC) is on the rise in the Gulf region, with most patients being diagnosed in the intermediate or advanced stages. Surgery is a treatment option for only a few, and the majority of patients receive either locoregional treatment (percutaneous ethanol injection, radiofrequency ablation, transarterial chemoembolization [TACE], radioembolization, radiotherapy, or transarterial radioembolization) or systemic therapy (for those ineligible for locoregional treatments or who do not benefit from TACE). The recent emergence of novel immunotherapies such as immune checkpoint inhibitors has begun to change the landscape of systemic HCC treatment in the Gulf. The combination of atezolizumab and bevacizumab is currently the preferred first-line therapy in patients not at risk of bleeding. Additionally, the HIMALAYA trial has demonstrated the superiority of the durvalumab plus tremelimumab combination (STRIDE regimen) therapy in efficacy and safety compared with sorafenib in patients with unresectable HCC. However, there is a lack of data on post-progression treatment after first-line therapy with either atezolizumab plus bevacizumab or durvalumab plus tremelimumab regimens, highlighting the need for better-designed studies for improved management of patients with unresectable HCC in the Gulf region.
... Despite these recent advancements, sorafenib remains the standard control arm for ongoing randomized trials in advanced HCC. Better medical care, increasing availability of 2nd-line systemic therapy options, as well as safe and effective antivirals for hepatitis C virus (HCV) and hepatitis B virus (HBV), may have contributed to improved survival of patients with advanced HCC [11,[14][15][16][17][18]. Any improvement in the survival of patients receiving sorafenib for advanced HCC may have important implications for clinical trial design as sorafenib is typically used as the comparator in trials of novel therapeutic agents [19][20][21]. ...
Background: Emerging data suggest that outcomes for advanced hepatocellular carcinoma (HCC) treated with sorafenib may have improved over time. We aimed to provide robust, time-to-event estimates of survival outcomes for sorafenib in advanced HCC.
Summary: In this systematic review and individual patient data meta-analysis of randomized-controlled trials (RCTs), we searched MEDLINE and Embase from inception till September 2022 for RCTs that provided data for overall survival (OS) and progression-free survival (PFS) for sorafenib monotherapy as first-line systemic therapy for advanced HCC. We performed a pooled analysis using reconstructed individual participant data from published Kaplan-Meier curves to obtain robust estimates for OS and PFS. Of 1,599 articles identified, 29 studies (5,525 patients) met the inclusion criteria. Overall, the median OS was 10.4 (95% CI 9.6 – 11.4) months. Median OS increased over time, from 9.8 (95% CI 8.8¬ – 10.7) months in studies before 2015, to 13.4 (95% CI 11.03 – 15.24) months in studies from 2015 onwards, p
... On contrary, there is an increased risk of HCC in non-cirrhotic Asian hepatitis-B carriers irrespective of their replication status [11,12]. In HBV-infected individuals, the severity of inflammation, fibrosis, cirrhosis and eventually HCC development is determined by viral load [6,13,14]. The factors found to correlate found to correlate with HCC development include high viral load, cirrhosis, HBe-Anitgen positive disease, HBV genotype "C", and elevated serum HBsAg levels [6]. ...
Hepatocellular carcinoma with portal vein thrombosis is rarely seen in young patients. Hepatitis B can lead to HCC with PVT in the absence of cirrhosis. However, it is uncommon in age less than 40 years. Here we present to you a case of an eight year old boy with a family history of hepatitis B who developed HCC with PVT.
... These therapeutic modalities are divided into surgical therapies (ST) (resection, cryo-ablation, and liver transplantation) and non-surgical therapies (NST), which could be directed to liver (i.e., percutaneous ethanol injection, radiofrequency/microwave ablation, trans-arterial embolization, radiation therapy) or systemic (chemotherapy, molecularly targeted therapy and immunotherapy) [5]. The management of HCC involves a complex decision-making process, based on the tumor burden (total number of HCC lesions, diameter of the biggest target lesion, and total diameter of all the target lesions), degree of metastasis, hepatic decompensation asperity, comorbidities, and cancer related symptoms, as well as the patients' desire to manage the condition [6]. In addition, the availability of treatment options is highly variable between medical centers in different countries with various levels of expertise and resources. ...
According to data provided by World Health Organization, hepatocellular carcinoma (HCC) is the sixth most common cause of deaths due to cancer worldwide. Tremendous progress has been achieved over the last 10 years developing novel agents for HCC treatment, including small-molecule kinase inhibitors. Several small molecule inhibitors currently form the core of HCC treatment due to their versatility since they would be more easily absorbed and have higher oral bioavailability, thus easier to formulate and administer to patients. In addition, they can be altered structurally to have greater volumes of distribution, allowing them to block extravascular molecular targets and to accumulate in a high concentration in the tumor microenvironment. Moreover, they can be designed to have shortened half-lives to control for immune-related adverse events. Most importantly, they would spare patients, healthcare institutions, and society as a whole from the burden of high drug costs. The present review provides an overview of the pharmaceutical compounds that are licensed for HCC treatment and other emerging compounds that are still investigated in preclinical and clinical trials. These molecules are targeting different molecular targets and pathways that are proven to be involved in the pathogenesis of the disease.
... Multidisciplinary team (MDT) care, with contributions from oncologists, hepatologists, gastroenterologists, surgeons, and radiologists, is widely regarded as the standard of care in HCC [46,82,83], irrespective of the choice of MRI contrast agent. In several retrospective studies, MDT care was associated with improved survival [84,85] and reduced mortality [86], particularly in patients with poor liver function [87]. ...
Gadoxetate magnetic resonance imaging (MRI) is widely used in clinical practice for liver imaging. For optimal use, we must understand both its advantages and limitations. This article is the outcome of an online advisory board meeting and subsequent discussions by a multidisciplinary group of experts on liver diseases across the Asia-Pacific region, first held on September 28, 2020. Here, we review the technical considerations for the use of gadoxetate, its current role in the management of patients with hepatocellular carcinoma (HCC), and its relevance in consensus guidelines for HCC imaging diagnosis. In the latter part of this review, we examine recent evidence evaluating the impact of gadoxetate on clinical outcomes on a continuum from diagnosis to treatment decision-making and follow-up. In conclusion, we outline the potential future roles of gadoxetate MRI based on an evolving understanding of the clinical utility of this contrast agent in the management of patients at risk of, or with, HCC.
