Criteria For Hepatocellular Carcinoma Research Articles

Changes in the Liver Transplant Waiting List after Expanding to the 'Up-to-Seven' Criteria for Hepatocellular Carcinoma.

We aimed to assess changes in the composition of the waiting list for liver transplantation (LT) after expanding from Milan to "up-to-seven" criteria in patients with hepatocellular carcinoma (HCC). A consecutive cohort of 255 LT candidates was stratified in a pre-expansion era (2016-2018; n = 149) and a post-expansion era (2019-2021; n = 106). The most frequent indication for LT was HCC in both groups (47.7% vs. 43.4%; p = 0.5). The proportion of patients exceeding the Milan criteria in the explanted liver was nearly doubled after expansion (12.5% vs. 21.1%; p = 0.25). Expanding criteria had no effect in drop-out (12.3% vs. 20.4%; p = 0.23) or microvascular invasion rates (37.8% vs. 38.7%; p = 0.93). The length on the waiting list did not increase after the expansion (172 days [IQR 74-282] vs. 118 days [IQR 67-251]; p = 0.135) and was even shortened in the post-expansion HCC subcohort (181 days [IQR 125-232] vs. 116 days [IQR 74-224]; p = 0.04). Tumor recurrence rates were reduced in the post-expansion cohort (15.4% vs. 0%; p = 0.012). In conclusion, expanding from Milan to up-to-seven criteria for LT in patients with HCC had no meaningful impact on the waiting list length and composition, thus offering the opportunity for the adoption of more liberal policies in the future.

EASL versus LI-RADS: Intra-individual comparison of MRI with extracellular contrast and gadoxetic acid for diagnosis of small HCC.

Liver Imaging Reporting and Data System (LI-RADS) and European Association for the Study (EASL) criteria for hepatocellular carcinoma (HCC) diagnosis have been updated in 2018. We aimed to compare the HCC diagnostic performance of LI-RADS and EASL criteria with extracellular contrast agents-MRI (ECA-MRI) and hepatobiliary agents-MRI (HBA-MRI). We prospectively evaluated 179 participants with cirrhosis (n=105) or non-cirrhotic chronic hepatitis B (CHB) (n=74) who underwent both ECA-MRI and HBA-MRI before surgery for de novo nodule(s) measuring 10-30mm. We compared the HCC diagnostic performance of EASL and LR-5 in both MRIs. In an analysis of 215 observations (175 HCCs, 17 non-HCC malignancies and 23 benign lesions) identified from cirrhotic or non-cirrhotic CHB participants, LR-5 with ECA-MRI provided the highest sensitivity (80.7%), followed by EASL with ECA-MRI (76.2%), LR-5 with HBA-MRI (67.3%) and EASL with HBA-MRI (63.0%, all P<.05). The specificities were comparable (89.4%-91.5%). When the analysis is limited to participants with pathological cirrhosis (123 observations), the sensitivity of LR-5 with ECA-MRI was similar to that of EASL with ECA-MRI (82.7% vs 80.2%, P=.156), but higher than LR-5 with HBA-MRI (65.1%) or EASL with HBA-MRI (62.8%, both P<.001), with comparable specificities (87.5%-91.7%). The LR-5 with ECA-MRI yielded the highest sensitivity with a similar specificity for HCC diagnosis in cirrhosis and non-cirrhotic CHB participants, while the sensitivities of LR-5 and EASL with ECA-MRI are similar for cirrhosis participants. This indicates non-invasive diagnosis criteria can differ by contrast agents and presence of cirrhosis.

Diagnostic Accuracy of Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) for Differentiating Between Hepatocellular Carcinoma and Other Hepatic Malignancies in High-Risk Patients: A Meta-Analysis.

The American College of Radiology (ACR) contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS), which includes diagnostic criteria for hepatocellular carcinoma (HCC) and other hepatic malignancies (OM), is increasingly used in clinical practice. This study performed a meta-analysis to assess the diagnostic accuracy of CEUS LI-RADS for differentiating between HCC and OM in high-risk patients. PubMed, Embase (Ovid), and Cochrane (CENTRAL) were searched for relevant studies. All studies that reported the percentage of HCC and OM in the LI-RADS categories were included. Random-effects models were used to calculate the pooled sensitivity and specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve. Eight studies involving 4215 focal liver lesions were included in the final analysis. The pooled sensitivity and specificity of the LR-5 criteria for HCC were 0.71 (95 % CI, 0.69-0.72) and 0.88 (0.85-0.91), respectively, the DOR was 18.36 (7.41-45.52), and the area under the SROC curve (AUC) was 0.8128. The pooled sensitivity and specificity of the LR-M criteria for OMs were 0.85 (0.81-0.88) and 0.86 (0.85-0.87), the DOR was 27.82 (11.83-65.40), respectively, and the SROC AUC was 0.9098. The CEUS LI-RADS can effectively distinguish HCC from other hepatic malignancy in high-risk patients based on LR-5 criteria and LR-M criteria. However, further studies are needed for validation due to the limited number of included studies and the potential heterogeneity among the included studies.

What Should Be the Rules for Downstaging for Hepatocellular Carcinoma?

Liver transplantation remains the main curative treatment method for hepatocellular carcinoma. There are several criteria for hepatocellular carcinoma to be eligible for liver transplantation, and it depends on main transplantation centers worldwide. Locoregional treatments and downstaging protocols are used for either to achieve these criteria or to prevent drop outs on the transplant waiting lists. But who can benefit from these bridging therapies effectively for the main purpose of curative treatment? Main contraindications are known for locoregional treatments like cirrhosis or low hepatic function, total main portal vein occlusion, and extrahepatic metastasis. HCCs, which are confined to liver but have high tumor burden, remains the main controversial issue. On this aspect, we reviewed the literature for downstaging protocols for hepatocellular carcinoma with their effect on survival and recurrence rates after liver transplantation. Although candidates for downstaging is still controversial, with the absence of main contraindications, LRT can be applied to selected HCCs, which have a certain degree of tumor burden.

RECIST criteria: our experience in daily practice

Content organisation Our cases will be presented in a pictorial essay mode. Key differential diagnostic points will be highlighted in the discussion of each case. It is important to consider: Complete knowledge of clinical-oncologic status and treatments time points. Recognition of smallest measured value (NADIR) between time points for adequate selection of comparative review. Sum of target lesions (baseline and current time points) including percentage of change. Select no more than two target lesions by sector. Complete knowledge of actinic extension field which often could present different behavior than other lesional sites. Local tumour growth over vital organs regardless strict RECIST criteria in exceptional cases. Further criteria utilization in line with oncological disease being studied (mRECIST criteria for hepatocellular carcinoma or CHOI criteria for GIST). Use of SUL on baseline PET CT studies with greater accuracy in assessing response on further evaluations (PERCIST criteria).

Tumor response criteria for hepatocellular carcinoma treated by transarterial chemoembolization - a radiologist's point-of-view

Hepatocellular carcinoma is a common malignancy which, in specific stages, benefits from transarterial chemoembolization. The survival of treated patients depends on the accurate interpretation of follow-up studies after the procedure, with focus on the early detection of residual tumor or tumor recurrence. Dynamical contrast enhanced CT and MRI are sensitive methods in evaluating tumor response, although diffusion weighted imaging and other new modalities can improve the diagnostic role of these tests. A strong knowledge of common and rare imaging signs of neoplastic tissue in a chemoembolized nodule can lead to a prompt and effective complementary treatment. Some lesions related to the endovascular intervention mimic tumor behavior and should always be sought and correctly identified, in order to avoid unnecessary treatment and impacts in the patient’s quality of life.

Toward More Than 400 Liver Transplantations a Year at a Single Center

BackgroundFor the first time at Asan Medical Center (AMC) we performed more than 400 liver transplantations (LTs) per year in 2011, despite same number of living donor liver transplantations (LDLTs). MethodsOur OLT program was started in 1992, but not activated well due to the scarcity of deceased donor organs. Since adult LDLTs using a left lobe and then a right lobe were successfully performed in 1997, we have developed several innovative techniques and approaches for adult LDLT, for example, modified right-lobe graft reconstructing middle hepatic branches in 1998, dual graft LDLT using 2 left lobes in 2000; new criteria for hepatocellular carcinoma (HCC); as well as ABO-incompatible LDLT, the first in the world. As a result, the number of LDLTs has increased rapidly but reached a plateau recently. Nationwide efforts to promote deceased donation increased the number of deceased donor liver transplantation (DDLT). ResultsWe have performed 317 LDLTs per year in 2010 and 2011, respectively. The number of LTs reached 403 in 2011. This large number was possible due to a remarkable increase of DDLTs from 50 in 2010 to 86 in 2011. Seventy-nine patients (68.1%) among 116 patients (28.8%) required an urgent LT receiving a DDLT. LT for HCC or ABO-mismatch comprised 50.3% (n = 150) or 8.7% (n = 35), respectively. In-hospital mortality rate in 2011 was 4.7%. ConclusionsThe increased LTs number at AMC was aided by the nationwide campaign.

Correlating radiologic response criteria with pathologic tumor viability in HCC patients undergoing localized radiation followed by surgical resection.

217 Background: Various radiologic response criteria have been developed for solid tumors. This study attempts to identify the optimal criteria for hepatocellular carcinoma (HCC) after localized treatment including radiotherapy. Methods: We reviewed 40 consecutive HCC patients who underwent surgical resection after radiotherapy of curative intent between 2000 and 2011. Radiation was delivered concurrently with intraarterial 5-fluorouracil/cisplatin (36), concurrently with capecitabine (2), and after receiving transarterial chemoembolization (2). For radiotherapy, 45 Gy in 25 fractions (32) or 50 Gy in 20 fractions (8) was delivered. Images from pre-RT and pre-resection CT were compared to determine treatment response according to Response Evaluation Criteria in Solid Tumors (RECIST), the World Health Organization (WHO) criteria, modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) criteria. Findings from pathologic reports including extent of tumor necrosis were correlated with degree of response from each set of criteria. Results: Intermodal agreement among criteria was highest between RECIST and WHO (p&lt;0.0001) and between mRECIST and EASL (p&lt;0.0001). All criteria showed strong correlation with reduction in α-fetoprotein (p=0.001 for EASL and mRECIST, 0.026 for RECIST, and 0.043 for WHO). Percent of viable tumor by EASL was most strongly correlated with percent of pathologic viable tumor (p&lt;0.0001), followed by RECIST, mRECIST, and WHO (p = 0.011, 0.013, and 0.013). Resection was carried out after 2 complete (5%), 36 partial (90%), and 2 stable (5%) responses according to EASL criteria. Three year disease-free (DFS) and overall survival (OS) were 29 and 61 months. Complete necrosis showed trends toward improved DFS (p=0.136) and OS (p=0.088). Multiplicity was independent prognostic factor for both DFS and OS (p=0.005 and 0.001). Conclusions: EASL criteria showed strongest correlation with pathologic tumor viability after localized treatment for HCC. Prospective clinical trial is warranted.

Pathological Features and Pathological Prognostic Indicators in Hepatocellular Carcinoma

The pathological features and diagnostic criteria of hepatocellular carcinoma are described. Tumour cells differentiate in a way similar to that of normal liver cells, in aspects of cytological and hi