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The BCLC staging system for HCC. M, metastasis classification; N, node classification; PS, performance status; RFA, radiofrequency ablation; TACE, transarterial chemoembolization.
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In the previous guideline, groups were specified for which surveillance was likely to be cost-effective because the hepatocellular carcinoma (HCC) incidence was high enough. New data on defining HCC risk have emerged for hepatitis B virus,1, 2 hepatitis C virus,3 and autoimmune hepatitis.4 Surveillance is deemed cost-effective if the expected HCC r...
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Citations
... Hepatocellular carcinoma (HCC) ranks as the fifth most common cancer globally, with an annual incidence estimated at 500.000 cases [1] . The diagnosis and staging of HCC are primarily conducted using contrast-enhanced computed tomography (CECT) and dynamic contrast-enhanced magnetic resonance (DCE-MRI), as outlined in the latest clinical practice guidelines by the European Association for the Study of the Liver, the European Organisation for Research and Treatment of Cancer (EASL-EORTC), and the American Association for the Study of Liver Diseases (AASLD) [2][3][4]. ...
... Although not mandatory in the international guidelines on HCC management, magnetic resonance imaging (MRI) with hepatospecific contrast agents has demonstrated higher sensibility and specificity for the non-invasive detection of HCC nodules compared to contrast-enhanced ultrasound (CEUS) and CECT [2,4,5]. Moreover, the 2021 Consensus report from the 10th International Forum for Liver Magnetic Resonance Imaging and earlier the recommendations from the Japan Society of Hepatology have recognized hepatobiliary-enhanced MRI as a precise method for diagnosing and staging HCC [6]. ...
Background and Objectives To compare navigator-gated three-dimensional T1-weighted gradient-echo sequences (NG-3D T1W-GRE) with standard breath-hold T1W-GRE (BH T1W-GRE) for the detection of HCC nodules in patients with chronic viral hepatitis which undergo at magnetic resonance imaging (MRI) using gadoxetic acid. Methods and materials We evaluated 58 patients with hepatic nodules at least 1 cm in diameter detected by ultrasound who underwent liver MRI including NG-3D T1W-GRE sequences and breath hold T1-weighted gradient-echo sequences with different flip angles(FA) at 10-25-40° after contrast administration of gadoxetic acid at magnetic scanner operating at1.5 Tesla. Image quality and relative hepatic and nodular enhancement were evaluated by three blinded reviewers. Results In these patients, image quality of NG-3D T1W-GRE was assessed significantly better than quality of BHT1W- GRE (P < 0.005) and relative enhancement was significantly higher than that of BH- T1W-GRE ( P
... Liver cancer, predominantly hepatocellular carcinoma (HCC), ranks as the fourth leading cause of global cancer-related mortality, constituting 75-85% of primary liver tumors [1]. Surgical resection, the gold standard for HCC treatment, is applicable in only about 10% of cases due to limitations such as inadequate liver function, coexisting diseases, or prohibitive lesion locations [2]. Consequently, thermal ablation technologies have emerged as crucial alternatives, demonstrating efficacy in disease control and improved survival rates for patients ineligible for surgery [3,4]. ...
One of the most effective parameters in the thermal treatment of liver cancer by microwave heating method is the changes in the input power to the antenna. This study aims to numerically investigate the effects of the change in the input power to the microwave antenna in the presence of magnetic nanoparticles using the finite element method in liver tumors. Also, the importance of the type of nanoparticles, treatment time and side effects were investigated. According to the results, after the injection of maghemite nanoparticles, the purification time is 7.35 s at a power of 10 W and reaches 6.1 s when the power is increased to 100 W. Also, the ratio of the destroyed healthy volume of the tissue to the tumor volume is less than 20% in the mentioned powers, and the treatment can be considered independent of the power. After the injection of magnetite and FccFePt nanoparticles at a power of 10 W, the treatment time was calculated as 176 s and 295 s, respectively, and with the increase of the input power, the reduction of the treatment time was observed. So that the treatment time was reduced to 58 s and 74 s, respectively, at 100 W. In terms of side effects, for the mentioned nanoparticles, 4.89 and 8.93 times the volume of the tumor with a power of 10 W and when the power reaches 100 W, 4.05 and 5.6 times the volume of the tumor is destroyed from the healthy tissue, respectively. However, the lowest amount of healthy tissue destruction in these two nanofluids occurs at moderate powers—60 W and 50 W, respectively—so the dependence of treatment time and side effects on input power was observed.
... Consequently, indirect clinical indices that have been widely employed in clinical practice were adopted as the standard surrogate criteria in this study. 39 Finally, the proportion of patients who would develop perpetual PH in the PHPH group remains unknown. We only evaluated the PH status 1 month after hepatectomy because post-recurrence treatments may affect surrogate markers of PH, such as platelet count and splenic volume. ...
Aims
Portal venous pressure frequently increases after a major hepatectomy. We aimed to assess the outcomes of patients with hepatocellular carcinoma (HCC) with different post‐hepatectomy portal pressure statuses and the predictive factors correlated with prognosis and post‐hepatectomy portal hypertension (PHPH).
Methods
Data from consecutive patients who underwent curative‐intent hepatectomy for HCC at the Eastern Hepatobiliary Surgery Hospital and Mengchao Hepatobiliary Hospital of Fujian Medical University between January 2008 and December 2016 were retrospectively analyzed. Patients were followed up until March 1, 2022. PHPH was defined as new‐onset portal hypertension (PH) in patients without preoperative PH within 1 month of hepatectomy. Patients were classified into two groups according to the presence or absence of PHPH: non‐PH and PHPH. The clinicopathological characteristics were compared between the two groups. Univariate and multivariate analyses were used to identify independent risk factors for early and late recurrence of HCC, overall survival (OS), and PHPH.
Results
Disease‐free survival rates were significantly higher in the non‐PH group ( n = 1068) than those in the PHPH group ( n = 423) (62.0%, 39.0%, and 31.0% vs. 46.2%, 24.5%, and 19.3% at 1, 3, and 5 years, respectively; all p < 0.001). The 1‐, 3‐, and 5‐year OS rates were 91.0%, 66.4%, and 51.4% in the non‐PH group and 80.0%, 48.9%, and 32.6% in the PHPH group, respectively (all p < 0.001). Multivariate analysis revealed that PHPH was independently associated with early recurrence of HCC and poor OS (hazard ratio [HR] 1.476, 95% confidence interval [CI] 1.279–1.704, p < 0.001 and HR 1.601, 95% CI 1.383–1.853, p < 0.001, respectively). Furthermore, hepatitis B virus infection, cirrhosis, preoperative alanine aminotransferase > 40 U/L, and major hepatectomy were identified as independent risk factors for PHPH.
Conclusions
PHPH was associated with early recurrence of HCC and poor OS but not with late recurrence. Therefore, PHPH may be an attractive target for therapeutic interventions and follow‐up surveillance to improve prognosis.
... The Barcelona Clinic Liver Cancer (BCLC) staging system is the most commonly used system to classify HCCs and has recently been revised [8][9][10][11][12]. Sadly, most HCCs discovered are not amenable to curative treatment, either because of delayed diagnosis or because of complicated end-stage liver disease [13,14]. Therefore, non-invasive treatment options have been used to treat patients in the non-curative stages. ...
Background/Objectives: International guidelines recommend transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC). However, it is used outside these recommendations and has proven beneficial in prolonging survival. Since the role of TACE outside BCLC stage B is unclear, the present study analyzed the results of TACE performed at a tertiary center in Switzerland for different treatment groups, and aims to highlight the treatment outcomes for these groups. Methods: This retrospective cohort study includes 101 HCC patients undergoing TACE at our center. Patients were further subdivided into groups according to therapy combinations (therapies applied before and after index TACE). Kaplan–Meier survival curves were calculated for the Barcelona Center for Liver Cancer (BCLC) subgroups. Results: After TACE, the median survival was 28.1 months for BCLC 0, 31.5 months for BCLC A, 20.5 months for BCLC B, 10.8 for BCLC C, and 7.5 months for BCLC D. A lesion size larger than 55 mm was negatively associated with survival (HR 2.8, 95% CI 1.15–6.78). Complications occurred after TACE procedures: Clavien–Dindo I + II = 30, Clavien–Dindo > 3 = 2. Conclusions: TACE was performed in a substantial part of our cohort outside of routinely used treatment guidelines. The combination of the survival data and complication rate in these patients suggests it was a safe and beneficial strategy. Furthermore, our data show that in our cohort, the survival benefit associated with TACE was restricted to patients with a lesion size smaller than 55 mm.
... Chronic hepatitis B (CHB) infection and hepatocellular carcinoma (HCC) are closely linked (1,2). Elevated levels of hepatitis B virus (HBV) DNA and viral hepatitis B surface antigen (HBsAg) are established risk factors for liver carcinogenesis, and their increase is significantly correlated with an increased incidence of HCC (3,4). ...
We herein report a 40-year-old Japanese man with chronic hepatitis B genotype C (viral load 6.7 LC/mL) who developed hepatocellular carcinoma (HCC) despite achieving undetectable hepatitis B virus (HBV) DNA levels with nucleos (t) ide analog (NA) treatment (entecavir). Notably, his hepatitis B surface antigen (HBsAg) level remained elevated at 388.4 IU/mL. Given the continued risk of carcinogenesis associated with HBsAg positivity, we initiated pegylated interferon (PEG-IFN) therapy one month after HCC surgery. Following three periods of PEG-IFN treatment, HBsAg seroclearance (HBsAg-negative state) was achieved.
... 1 For early-stage HCC, therapeutic options include surgical resection, ablation, and liver transplantation, while transarterial chemoembolization (TACE) or transarterial radioembolization (TARE) is preferred for intermediate-stage cases. 2 However, unresectable disease affects a substantial portion of patients, with recurrence impacting up to 70% of those who have undergone tumor resection or ablation within 5 years. [3][4][5] Consequently, over 50% of HCC patients ultimately require systemic therapies, typically during the advanced disease stages. 4,6 HCC is resistant to conventional chemotherapy, leading to the use of targeted therapies such as sorafenib or lenvatinib (tyrosine kinase inhibitors, TKIs) as first-line treatments. ...
Despite recent therapeutic advancements, outcomes for advanced hepatocellular carcinoma (HCC) remain unsatisfactory, highlighting the need for novel treatments. The CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) gene-editing technology offers innovative treatment approaches, involving genetic manipulation of either cancer cells or adoptive T cells to combat HCC. This review comprehensively assesses the applications of CRISPR systems in HCC treatment, focusing on in vivo targeting of cancer cells and the development of chimeric antigen receptor (CAR) T cells and T cell receptor (TCR)-engineered T cells. We explore potential synergies between CRISPR-based cancer therapeutics and existing treatment options, discussing ongoing clinical trials and the role of CRISPR technology in improving HCC treatment outcomes with advanced safety measures. In summary, this review provides insights into the promising prospects and current challenges of using CRISPR technology in HCC treatment, with the ultimate goal of improving patient outcomes and revolutionizing the landscape of HCC therapeutics.
... Early diagnosis is critical to the prognosis of HCC patients. Serum AFP is currently the most widely used biomarker for HCC diagnosis, but its sensitivity and specificity are about 50% [105]. ...
Liver cancer, primarily hepatocellular carcinoma, remains a global health challenge with rising incidence and limited therapeutic options. Genetic factors play a pivotal role in the development and progression of liver cancer. This state-of-the-art paper provides a comprehensive review of the current landscape of genetic screening strategies for liver cancer. We discuss the genetic underpinnings of liver cancer, emphasizing the critical role of risk-associated genetic variants, somatic mutations, and epigenetic alterations. We also explore the intricate interplay between environmental factors and genetics, highlighting how genetic screening can aid in risk stratification and early detection via using liquid biopsy, and advancements in high-throughput sequencing technologies. By synthesizing the latest research findings, we aim to provide a comprehensive overview of the state-of-the-art genetic screening methods for liver cancer, shedding light on their potential to revolutionize early detection, risk assessment, and targeted therapies in the fight against this devastating disease.
... Early diagnosis is critical to the prognosis of HCC patients. Serum AFP is currently the most widely used biomarker for HCC diagnosis, but its sensitivity and specificity are about 50% [105]. ...
... However, there is disagreement over the value of CEUS in the diagnosis of HCC. For example, it has been reported that a false positive diagnosis of HCC can be given to individuals with cholangiocarcinoma by CEUS [9]. Investigating the usefulness of CEUS with perfluorobutane in the diagnosis of primary HCC is the primary goal of this thorough analysis. ...
To investigate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in the diagnosis of primary hepatocellular carcinoma (HCC), a thorough search was conducted for pertinent literature using PubMed, SCOPUS, Web of Science, Science Direct, and Wiley Library. This was a meta-analysis of diagnostic test accuracy. MetaDiSc 1.4 was used for all analyses and assessed statistical heterogeneity with the I2 index and the chi-square test. The random-effects model was applied where there was considerable heterogeneity. Using the eight elements of the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies, we assessed the quality of the included studies. Our results included nine studies with a total of 2598 patients, and 1607 (61.8%) were males. The pooled overall sensitivity of perfluorobutane with CEUS was 85.6% (95% CI 0.832, -0.878, and P=0.000) and specificity was 91.5% (95% CI 0.899, -0.930, and P=0.000) with significant inter heterogeneity between studies (I2=94.3% and 95.7%), respectively. The pooled positive likelihood ratio was 12.42 (4.59 to 33.61, P=0.000). Our analysis revealed a symmetric summary receiver operating characteristic (SROC) curve and seven of the included studies are near the top left corner of the graph, indicating that this test has a high diagnostic value. The results showed that CEUS augmented with perfluorobutane contrast had good diagnostic accuracy (sensitivity and specificity) for primary HCC. Further real-world data studies are needed to confirm the good diagnosis accuracy of perfluorobutane CEUS in primary HCC.
... Based on the characteristic vascular enhancement in triphasic CT abdomen, sixty adult Egyptian patients were enrolled and divided into two groups: one for cirrhosis, comprising 20 patients with liver cirrhosis without HCC, and another for HCC, comprising 40 patients with liver cirrhosis and HCC. In accordance with 2011 AASLD guidelines [6]. The study excluded patients with extrahepatic metastases, other malignancies, platelet counts less than 50 × 10 9 /L, and prothrombin activities less than 50%. ...
Background
Hepatocellular carcinoma constitutes the most common primary hepatic cancer and remains a major medical burden in both developing and developed world. It ranks fifth in terms of global cases and second in terms of deaths for males.CD24 is known as a heavily glycosylated cell surface molecule that is highly expressed in a wide variety of human malignancies. It plays an important role in self-renewal, proliferation, migration, invasion, and drug resistance. The aim of this work was to evaluate the potential role of serum CD24 in the diagnosis and prediction of response to interventional therapy among hepatocellular carcinomas.
Methods
This study included 40 adult Egyptian patients who had liver cirrhosis and hepatocellular carcinoma (HCC group). Another group of 20 patients with liver cirrhosis only served as controls (Cirrhosis group). All patients underwent standard laboratory tests and abdominal ultrasound. For HCC patients, a triphasic CT scan, alpha-fetoprotein was done. CD24 levels were measured in all patients, and in HCC patients at baseline and one month after intervention.
Results
Baseline CD24 was significantly higher among HCC group in comparison to cirrhosis group (19.463 ± 8.573 vs. 0.725 ± 0.125 mg/L) with an overall p value < 0.001. Serum CD24 levels significantly declined after locoregional treatment from 19.463 ± 8.573 mg/L to 3.569 ± 1.248 mg/L (p < 0.001). Baseline CD24 was a useful marker in eligibility for HCC intervention with 80% sensitivity and 74.29% specificity at a cutoff of ≤ 23 mg/L, and it also had 62.96% sensitivity and 100% specificity in prediction of cure after locoregional treatment at a cutoff of ≤ 19.5 mg/L.
Conclusion
CD24 could be a helpful diagnostic and prognostic marker for HCC, as its baseline level is useful in predicting both eligibility for intervention and cure after locoregional treatment.
