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Adjusting BCLC staging system to the evolving landscape of Hepatocellular Carcinoma. A look to the future
... This is because there are different risk factors related to the development of these tumors in various geographic regions, which could influence the disease progression [13,14]. The Barcelona Clinic Liver Cancer (BCLC) classification is the most commonly used in our setting because, unlike other classifications, such as tumor node metastasis (TNM), which only take into account the tumor's own characteristics, it considers individual features such as the degree of functional hepatic reserve and the patient's baseline status [15]. ...
Metabolic dysfunction-associated steatotic liver disease (MASLD) currently represents the predominant cause of chronic liver disease and is closely linked to a significant increase in the risk of hepatocellular carcinoma (HCC), even in the absence of liver cirrhosis. In this retrospective multicenter study, machine learning (ML) methods were employed to investigate the relationship between metabolic profile and prognosis at diagnosis in a total of 219 HCC patients. The eXtreme Gradient Boosting (XGB) method demonstrated superiority in identifying mortality predictors in our patients. Etiology was the most determining prognostic factor followed by Barcelona Clinic Liver Cancer (BCLC) and Eastern Cooperative Oncology Group (ECOG) classifications. Variables related to the development of hepatic steatosis and metabolic syndrome, such as elevated levels of alkaline phosphatase (ALP), uric acid, obesity, alcohol consumption, and high blood pressure (HBP), had a significant impact on mortality prediction. This study underscores the importance of metabolic syndrome as a determining factor in the progression of HCC secondary to MASLD. The use of ML techniques provides an effective tool to improve risk stratification and individualized therapeutic management in these patients.
... According to several studies, the primary methods used to treat tumors at the moment are surgical removal, pharmacological chemotherapy, radiotherapy, targeted therapy, immunotherapy, and traditional Chinese medicine (Bae et al., 2023;Eisenberg et al., 2023;Lazaroff and Bolotin, 2023;Song et al., 2023). Additionally, it is believed that medicinal chemotherapy is still the primary method of tumor treatment, in accordance with a range of different criteria and consensus both domestically and internationally Reig et al., 2022;Strazzabosco et al., 2022). However, chemotherapy can kill and stop the growth of tumor cells, but it also has specific toxic and side effects on healthy human cells, which can easily result in some unavoidable adverse reactions/events like liver and kidney dysfunction, nausea, vomiting, headaches, chest tightness, and other reactions (Knezevic and Clarke, 2020;De Francia et al., 2022;Liu et al., 2022). ...
Objective: To analyze the clinical characteristics of adverse reactions/events based on chemotherapy in cancer patients, and then explore the potential mechanism of Danggui Buxue Decoction (DBD) against chemotherapy-induced bone marrow suppression (BMS).
Methods: Retrospectively collected and evaluated were the clinical data of patients in a hospital who experienced adverse reactions/events brought on by chemotherapeutic medications between 2015 and 2022. We explored the potential mechanism of DBD against BMS using network pharmacology based on the findings of the adverse reactions/events analysis.
Results: 151 instances (72.25%) experienced adverse reactions/events from a single chemotherapy medication. Besides, platinum-based medications produced the most unfavorable effects. The study also found that chemotherapy caused the highest number of cases of BMS, including platinum drugs. Consequently, BMS is the most prevalent adverse reaction disease caused by chemotherapy found in this part. According to network pharmacology findings, DBD can prevent BMS primarily involving 1,510 primary targets and 19 key active ingredients. Based on the enrichment analysis, PI3K-AKT, TNF, MAPK, and IL-17 signaling pathways made up the majority of the DBD-resisting BMS pathways. Molecular docking displayed that kaempferol, the major active ingredient of DBD, had the highest binding energy (−10.08 kJ mol ⁻¹ ) with PTGS2 (a key target of BMS).
Conclusion: Cancer patients who received chemotherapy had a risk to develop BMS. Regular blood tests should be performed while taking medicine; early discovery and treatment can reduce a patient’s risk of experiencing adverse reactions/events. Additionally, this study demonstrated that DBD, through a variety of targets and pathways, may be crucial in avoiding BMS.
... 13 Independent from the adopted stage or therapeutic hierarchy framework, in the past 10 years, support has grown for treatment deriving from decisions taken by an expert multidisciplinary tumour board, who are able to adopt a personalised therapeutic approach tailored to the characteristics of each patient. 3,[13][14][15][16] The complex management of hepatocellular carcinoma, both in the early and advanced stages, is recognised to require multidisciplinary expertise due to advances in the diagnosis, staging, and treatment options. ...
Advances in the surgical and systemic therapeutic landscape of hepatocellular carcinoma have increased the complexity of patient management. A dynamic adaptation of the available staging-based algorithms is required to allow flexible therapeutic allocation. In particular, real-world hepatocellular carcinoma management increasingly relies on factors independent of oncological staging, including patients' frailty, comorbid burden, critical tumour location, multiple liver functional parameters, and specific technical contraindications impacting the delivery of treatment and resource availability. In this Policy Review we critically appraise how treatment allocation strictly based on pretreatment staging features has shifted towards a more personalised treatment approach, in which expert tumour boards assume a central role. We propose an evidence-based framework for hepatocellular carcinoma treatment based on the novel concept of multiparametric therapeutic hierarchy, in which different therapeutic options are ordered according to their survival benefit (ie, from surgery to systemic therapy). Moreover, we introduce the concept of converse therapeutic hierarchy, in which therapies are ordered according to their conversion abilities or adjuvant abilities (ie, from systemic therapy to surgery).
... The BCLC staging system is the most popular for prognosis and therapeutic guidance in patients with HCC [42]. However, it is considered to be very restrictive regarding indications for surgical management, including resection and transplantation, and for this reason, it has been heavily questioned by the HPB community [20,[43][44][45][46][47][48]. ...
Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of death worldwide. The management of HCC is complex, with surgical treatment providing long-term survival in eligible patients. This study aims to present the experience of aggressive surgical management of HCC in Greece. Methods: This is a retrospective multicentre clinical study with 242 patients. Results: Most patients were male (79%) and had a median age of 71 yrs. According to the most recent BCLC criteria, 172 patients (71.1%) were classified as BCLC 0-A stage, 33 patients (13.6%) were classified as BCLC B, and 37 (15.3%) were classified as BCLC C. A total of 54% of the patients underwent major hepatectomy. Major postoperative morbidity was 15.6%, and the 90-day postoperative mortality rate was 4.5%. The median follow-up was 33.5 months. Three- and five-year overall survival was 65% and 48%, respectively. The median overall survival was 55 months. Significantly, five-year survival was 55% for BCLC A, and 34% and 21% for BCLC B and C, respectively. In univariate analysis, cirrhosis, type of resection (R status), and BCLC stage were associated with overall survival. Multivariate analysis indicated that R1 and R2 resections compared to R0, and BCLC C compared to BCLC 0-A, were independently associated with increased mortality. Conclusions: Aggressive surgical treatment of HCC offers satisfactory long-term survival prospects. A significant percentage (29%) of HCCs that underwent liver resection were of the intermediate and advanced BCLC stage. The management of patients with HCC should be discussed in multidisciplinary tumour board meetings on a case-by-case basis to be more effective.
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