Hepatocellular Carcinoma Recurrence Research Articles

Hepatocellular carcinoma recurrence after liver transplantation: risk factors, targeted surveillance and management options

Hepatocellular carcinoma (HCC) represents a well-recognized indication for liver transplantation (LT), with improving graft and patient survival rates due to medical and surgical advancements over time. Despite the implementation of selection criteria to ensure the highest transplant benefit, post-LT recurrence of HCC is not uncommon and is often associated with poor outcomes. Therefore, a post-transplant surveillance strategy appears to be a cost-effective approach, particularly in the early post-surgery period when the recurrence rate is high. Although specific guidelines are still lacking, emerging strategies tailored to pre-transplant tumor history and explant pathology show promise. Moreover, new immunosuppressive therapy schemes and aggressive management of post-transplant medical complications can be implemented to reduce the risk of cancer recurrence. Finally, multimodal oncological strategies are increasingly used to improve survival even after cancer recurrence. This paper reviews the evidence on HCC recurrence after LT, providing insights into risk factors, targeted surveillance, and management strategies.

HBcrAg is associated with prognosis of hepatitis B virus-related hepatocellular carcinoma in patients after hepatectomy undergoing antiviral therapy.

Serum hepatitis B core-related antigen (HBcrAg) is considered a surrogate marker of the amount and activity of intrahepatic covalently closed circular DNA. This study aimed to explore the prognostic value of HBcrAg on patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative hepatectomy undergoing antiviral therapy (AVT). Data of 949 consecutive patients with HBV-related HCC undergoing curative resection between 2010 and 2013 were reviewed. Serum HBcrAg levels were measured at surgery (baseline) for all patients and at the time of 2 years postoperatively (on-treatment) for those without recurrence. Primary endpoint was tumor recurrence. High HBcrAg levels are associated with malignant phenotypes. HBcrAg independently affected both recurrence and overall survival (OS) in patients with negative hepatitis B e antigen (HBeAg-, p = .007 and p = .042, respectively) but not in their positive HBeAg (HBeAg+) counterparts (p = .100 and p = .075, respectively). Patients with high baseline HBcrAg had higher late, but not early recurrence rates than those with low baseline HBcrAg levels, regardless of HBeAg status (HBeAg+: p = .307 for early, p = .001 for late; HBeAg-: p = .937 for early, p < .001 for late). On-treatment HBcrAg independently affected late recurrence in patients stratified by both cirrhosis and HBeAg (p < .001 for all). The predictive power of HBcrAg kinetics for late recurrence was better than that of the baseline and on-treatment HBcrAg. High HBcrAg levels during long-term AVT are associated with late recurrence of HCC after hepatectomy. Combining baseline and on-treatment HBcrAg might be valuable in identifying patients at a high risk of relapse and stratifying surveillance strategies postoperatively.

Thyroid Metastases from Hepatocellular Carcinoma after Liver Transplantation

Hepatocellular carcinoma (HCC) patients with metastases to the thyroid are extremely rare. A patient who underwent liver transplantation for HCC recurrence had metastatic thyroid recurrence detected 4 years later. A literature review identi"ed six documented cases, analyzing relevant data on HCC with thyroid metastasis following liver transplantation. !ere is a prevalence of hepatitis B virus (HBV ) and hepatitis C virus (HCV ) as etiologies of liver disease (83.3%), with alpha-fetoprotein (AFP) levels elevated in "ve cases. Additionally, the time between the diagnosis of HCC and thyroid metastasis was within 3 years. !e patient remains clinically stable in outpatient follow-up, with an 8-month current survival after total thyroidectomy.

Glycomics as prognostic biomarkers of hepatocellular carcinoma: A systematic review.

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies, which is associated with a low 5-year survival rate. The importance of effective disease monitoring and prognostic evaluation is undeniable. For the present study, a systematic review was performed using extensive searches in Medline, Embase, Web of Science and Scopus up to December 29, 2023. The aim of the present study was to examine whether N-glycomics could predict the risk of developing HCC in adults with chronic liver disease and, if HCC was present, predict overall survival. As a secondary outcome, the prediction capability of HCC recurrence was assessed. After deduplication, 3,904 studies were identified, of which 30 were included. Overall, the median size of the study cohort was 144 patients, with a median follow-up time of 63.6 months. Three studies explored N-glycomics in whole serum, whereas the rest focused on individual glycoproteins, with Mac-2 binding protein glycosylation isomer (M2BPGi) being the most commonly studied. Most articles investigated baseline M2BPGi values as predictors for the development of HCC and demonstrated a median area under the curve of 0.83 with a cut-off index value of 1.8. In conclusion, it was revaled that N-glycan changes exhibit added value in determining patient prognosis in terms of survival, monitoring HCC development and recurrence.

Stereotactic body radiotherapy alone versus stereotactic body radiotherapy after incomplete transarterial therapy for hepatocellular carcinoma.

We investigated the clinical outcomes of stereotactic body radiation therapy (SBRT) alone versus SBRT after incomplete transarterial chemoembolization (TACE) for a single recurrent hepatocellular carcinoma (HCC) smaller than 5 cm. We retrospectively reviewed the medical records of patients who underwent SBRT for a single recurrent HCC ≤5 cm, without vascular invasion or extrahepatic metastasis. Patients were divided into the SBRT-alone group and the TACE-SBRT group. The primary outcome was the local control (LC) rate, and secondary outcomes were survivals and treatment-related toxicities. We additionally conducted a propensity score matching (PSM) analysis. A total of 477 patients were available for analysis. Among them, 54 patients received SBRT without prior treatment to the target lesion (SBRT-alone group), whereas 423 patients received SBRT for viable HCC after TACE (TACE-SBRT group). The 3-year LC rates did not differ between the two groups (SBRT-alone group, 88.6% vs. TACE-SBRT group, 89.6%, P = 0.918). The 3-year rates of overall survival, out-of-field intrahepatic recurrence-free survival and recurrence-free survival were also not significantly different (P = 0.479, 0.290 and 0.273, respectively). Even after PSM, LC and survival rates at 3 years were not significantly different. SBRT alone demonstrated comparable local control and survival outcomes to SBRT following incomplete TACE. SBRT alone may be considered an alternative treatment option for a single recurrent HCC smaller than 5 cm when curative treatments or TACE are not feasible.

Can Patient Characteristics and Pre-Treatment MRI Features Predict Survival After Stereotactic Ablative Radiotherapy (SABR) Treatment in Hepatocellular Carcinoma (HCC): Preliminary Assessment.

The study purpose was to develop a machine learning (ML)-based predictive model for event-free survival (EFS) in patients with hepatocellular carcinoma (HCC) undergoing stereotactic ablative radiotherapy (SABR). Patients receiving SABR for HCC at a single institution, between 2017 and 2020, were included in the study. They were split into training and test (85%:15%) cohorts. Events of interest were HCC recurrence or death. Three ML models were trained, the features were selected, and the hyperparameters were tuned. The performance was measured using Harrell's C index with the best-performing model being tested on the unseen cohort. Overall, 41 patients were included (training = 34, test = 7) and 64 lesions were analysed (training = 50, test = 14), resulting in 30 events (60% rate) in the training set (death = 6, recurrence = 24) and 8 events (57% rate) in the test set (death = 5, recurrence = 3). A Cox regression model, using age at treatment, albumin, and intra-lesional fat identified through MRI as variables, had the best performance with a mean training score of 0.78 (standard deviation (SD) 0.02), a mean validation of 0.78 (SD 0.18), and a test score of 0.94. Predicting the outcomes in patients with HCC, following SABR, using a novel model is feasible and warrants further evaluation.

Association between preoperative advanced lung cancer inflammation index and recurrence of hepatocellular carcinoma after curative resection.

The association between the advanced lung cancer inflammation index (ALI) and the recurrence of hepatocellular carcinoma (HCC) in patients treated with curative resection and its predictive value remains unclear. To assess the association between preoperative ALI and the recurrence of HCC in patients treated with surgical resection. This retrospective study analyzed patients with HCC treated with surgical resection at The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University (Huai'an, China) from 2019 to 2021. The advanced lung cancer inflammation index was calculated as (BMI × ALB/NLR), where BMI = body mass index, ALB = serum albumin and NLR = neutrophil-lymphocyte ratio. Univariate and multivariable Cox proportional risk models were performed to evaluate the association between the ALI and recurrence of HCC patients treated with surgical resection. Subgroup analyses were conducted based on age, sex, performance status (PS), cirrhosis, pathological staging, tumor grading, tumor size, and number of tumors. Among the 295 HCC patients treated with surgical resection, 180 patients (61.02%) had recurrences, with the mean follow-up being 462 (187, 730) days. Patients with higher ALI scores were significantly less likely to have a recurrence of HCC after surgical resection (hazard ratio (HR): 0.59, 95% confidence interval (95% CI): 0.42-0.83, p = 0.003). Based on subgroup analyses, HCC patients undergoing surgical resection with higher ALI scores were associated with recurrence in those ≥60 years of age, with tumors ≥5 cm, and in patients with single tumors and ≥2 tumors. This study confirms the association between ALI and the reduced risk of recurrence in HCC patients treated with surgical resection.

Racial Disparities in Liver Transplant for Hepatitis C-Associated Hepatocellular Carcinoma.

In the United States, hepatitis C virus-associated hepatocellular carcinoma incidence and mortality are highest among minorities. Socioeconomic constraints play a major role in inequitable treatment. We evaluated the association between race/ethnicity and outcomes in a population that overcame treatment barriers. We report a retrospective cohort study of 666 patients across 20 institutions in the United States Hepatocellular Carcinoma Liver Transplantation Consortium from 2015 to 2019 with hepatitis C virus-associated hepatocellular carcinoma who completed direct-acting antiviral therapy and underwent liver transplantation. Patients were excluded if they had a prior liver transplantation, hepatocellular carcinoma recurrence, no prior liver-directed therapy, or if race/ethnicity data were unavailable. Patients were stratified by race/ethnicity. Primary outcomes were recurrence-free survival and overall survival, and secondary outcome was major postoperative complication. Race/ethnicity was not associated with differences in 5-year recurrence-free survival (White 90%, Black 88%, Hispanic 92%, Other 87%; p = 0.85), overall survival (White 85%, Black 84%, Hispanic 84%, Other 93%; p = 0.70), or major postoperative complication. Race/ethnicity was not associated with worse oncologic or postoperative outcomes among those who completed direct-acting antiviral therapy and underwent liver transplantation, suggesting that overcoming socioeconomic constraints equalizes outcomes across racial/ethnic groups. Eliminating barriers that prohibit care access among minorities must be a priority.

Preoperative serum glutathione reductase activity and alpha-fetoprotein level are associated with early postoperative recurrence of hepatocellular carcinoma

Abstract Objectives The aim of this study is to investigate the correlation between preoperative serum glutathione reductase (GR) activity, alpha-fetoprotein (AFP) level, and early postoperative recurrence in patients diagnosed with hepatocellular carcinoma (HCC). Methods The data of 91 patients with HCC who underwent hepatectomy at Jinhua Hospital from January 2020 to December 2021 were retrospectively analyzed. A comparison of clinical characteristics between Non-Recurrent group and Recurrence group was conducted, and the association between GR activity, AFP levels, and early postoperative recurrence in HCC was investigated. Results Recurrence group (n=50) had a significantly higher AFP levels (median: 226.7 vs. 99.7 μg/L, p&lt;0.001) and significantly lower GR activity (median: 55.0 vs. 68.0 U/L, p&lt;0.0001) compared with Non-Recurrent group (n=41). The GR activity was negatively correlated with the AFP level (r=−0.4275, p&lt;0.01). Low GR activity (OR=0.948; 95 % CI: 0.910–0.988; p=0.011) and high AFP levels (OR=1.003; 95 % CI: 1.000–1.006; p=0.036) independently contribute to an increased risk of early postoperative recurrence in HCC patients. The area under receiver operating characteristic curve of GR activity and AFP level for predicting early postoperative recurrence of HCC was 0.790 and 0.708, respectively. Patients with GR &gt;60U/L had a higher early postoperative non-recurrence rate than patients with GR ≤60U/L (71.4 % [30/42] vs. 22.4 % [11/49]; HR=4.026; 95 % CI: 2.254–7.188; p&lt;0.01); Patients with AFP ≤100 μg/L had a higher early postoperative non-recurrence rate than patients with AFP &gt;100 μg/L (65.6 % [21/32] vs. 33.9 % [20/59]; HR=2.490; 95 % CI: 1.397–4.438; p&lt;0.01). Conclusions The preoperative serum GR activity and AFP level hold significant predictive value for early postoperative recurrence in HCC patients.

Definition of early recurrence of hepatocellular carcinoma based on the concordance index and optimal treatment strategy

BackgroundHepatocellular carcinoma (HCC) has a high rate of recurrence and requires multiple treatment options. Early recurrence has been associated with poor prognosis; however, the timing of early recurrence varies in the literature. Therefore, in this study, we aimed to determine the timing of early recurrence with the best prognostic value and clarify the appropriate treatment strategy. MethodsThis retrospective study conducted to determine prognosis and treatments included 274 patients with HCC who underwent liver resection at the Saitama Cancer Center. The prognostic value of early recurrence at each surveillance period was calculated using Harrell's concordance index (C-index). ResultsThe C-index at 9 months postoperatively was 0.656, which was the highest cut-off value for early recurrence. Notably, 122 patients had no recurrence, 58 had early recurrence (<9 months), and 94 had late recurrence (≥9 months). The 5-year overall survival (OS) of patients with early recurrence was worse (16.5 %, p<0.001), whereas that of those with late and no recurrences were similar (79.2 % vs. 70.9 %, p=0.86). The 5-year OS rate of patients with late intrahepatic recurrence in the surgery group was 100 %. ConclusionThe optimal cutoff value for the timing of early recurrence was 9 months postoperatively. The early recurrence group had a high rate of extrahepatic recurrence and poor OS, whereas late recurrences were mostly intrahepatic, with no difference in prognosis between the late and no recurrence groups. Patients with intrahepatic recurrence after >9 months are considered for rehepatectomy because of its good outcomes. SynopsisThe C-index-based optimal cutoff for the timing of early HCC recurrence was 9 months postoperatively. The early recurrence group had a high rate of extrahepatic recurrence and poor OS, whereas late recurrences were mostly intrahepatic with a good prognosis.

Insights about exosomal circular RNAs as novel biomarkers and therapeutic targets for hepatocellular carcinoma.

One of the most prevalent pathological types of Primary Liver Cancer (PLC) is the Hepatocellular Carcinoma (HCC) poses a global health issue. The high recurrence and metastasis rate of HCC, coupled with a low 5-year survival rate, result in a bleak prognosis. Exosomes, small extracellular vesicles released by various cells, contain diverse non-coding RNA molecules, including circular RNAs (circRNAs), which play a significant role in intercellular communication and can impact HCC progression. Studies have revealed the potential clinical applications of exosomal circRNAs as biomarkers and therapeutic targets for HCC. These circRNAs can be transferred via exosomes to nearby non-cancerous cells, thereby regulating HCC progression and influencing malignant phenotypes, such as cell proliferation, invasion, metastasis, and drug resistance. This review provides a comprehensive overview of the identified exosomal circRNAs, highlighting their potential as non-invasive biomarkers for HCC, and suggesting new perspectives for HCC diagnosis and treatment. The circRNA from exosomal organelles promotes metastasis and immune scape because of their unique chirality which is different from the Biomolecular Homochirality.

Mesoporous cerium oxide nanoenzyme for Efficacious impeding tumor and metastasis via Conferring resistance to anoikis

Tumor cells can survive when detached from the extracellular matrix or lose cell-to-cell connections, leading to a phenomenon known as anoikis resistance (AR). AR is closely associated with the metastasis and proliferation of tumor cells, enabling them to disseminate, migrate, and invade after detachment. Here, we have investigated a novel composite nanoenzyme comprising mesoporous silica/nano-cerium oxide (MSN-Ce@SP/PEG). This nanoenzyme exhibited satisfactory catalase (CAT) activity, efficiently converting high levels of H2O2 within tumor cells into O2, effectively alleviating tumor hypoxia. Furthermore, MSN-Ce@SP/PEG nanoenzyme demonstrated high peroxidase (POD) activity, elevating reactive oxygen species (ROS) levels and attenuating AR in hepatocellular carcinoma (HCC) cells. The MSN-Ce@SP/PEG nanoenzyme exhibited satisfactory dual bioactivity in CAT and POD and was significantly enhanced under favorable photothermal conditions. Through the synergistic effects of these capabilities, the nanoenzyme disrupted the epithelial-mesenchymal transition (EMT) process in detached HCC cells, ultimately inhibiting the recurrence and metastasis potential of anoikis-resistant HCC cells. This study represents the first report of a novel nanoenzyme based on mesoporous silica/nano-cerium oxide for treating AR in HCC cells, thereby suppressing HCC recurrence and metastasis. The findings of this work offer a pioneering perspective for the development of innovative strategies to prevent the recurrence and metastasis of HCC.

Multiparametric MRI based deep learning model for prediction of early recurrence of hepatocellular carcinoma after SR following TACE.

Surgical resection (SR) following transarterial chemoembolization (TACE) is a promising treatment for unresectable hepatocellular carcinoma (uHCC). However, biomarkers for the prediction of postoperative recurrence are needed. To develop and validate a model combining deep learning (DL) and clinical data for early recurrence (ER) in uHCC patients after TACE. A total of 511 patients who received SR following TACE were assigned to derivation (n = 413) and validation (n = 98) cohorts. Deep learning features were taken from the largest tumor area in liver MRI. A nomogram using DL signatures and clinical data was made to forecast early recurrence risk in uHCC patients. Model performance was evaluated using area under the curve (AUC). A total of 2278 subsequences and 31,346 slices multiparametric MRI including contrast-enhanced T1WI, T2WI and DWI were input in the DL model simultaneously. Multivariable analysis identified three independent predictors for the development of the nomogram: tumor number (hazard ratio [HR]:3.42, 95% confidence interval [CI]: 2.75-4.31, P = 0.003), microvascular invasion (HR: 9.21, 6.24-32.14; P < 0.001), and DL scores (HR: 17.46, 95% CI: 12.94-23.57, P < 0.001). The AUC of the nomogram was 0.872 and 0.862 in two cohorts, significantly outperforming single-subsequence-based DL mode and clinical model (all, P < 0.001). The nomogram provided two risk strata for cumulative overall survival in two cohorts, showing significant statistical results (P < 0.001). The DL-based nomogram is essential to identify patients with uHCC suitable for treatment with SR following TACE and may potentially benefit personalized decision-making.

HBx-induced upregulation of MAP1S drives hepatocellular carcinoma proliferation and migration via MAP1S/Smad/TGF-β1 loop

Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), has a significantly higher risk of recurrence. However, the exact mechanism by which HBV prompts HCC recurrence remains largely unknown. In this study liver microarray test revealed significant upregulation of microtubule associated protein 1S (MAP1S) in metastatic HCC compared to control. MAP1S knockdown suppressed growth of HCCLM3 cells in vitro and in vivo. Mechanistically, HBV-encoded X protein (HBx) upregulates MAP1S, which enhances microtubule (MT) acetylation by promoting the degradation of histone deacetylase 6 (HDAC6), and facilitates the nuclear translocation of Smad complex, and thereby enhancing downstream TGF-β signaling. Smad complex, in turn, increases MAP1S, establishing a feedback loop of MAP1S/Smad/TGF-β1. Finally, survival analysis of 150 HBV-associated HCC patients demonstrated both increased MAP1S and decreased HDAC6 were significantly associated with shorter relapse-free survival. Collectively, this study reveals a unique mechanism whereby HBx-induced upregulation of MAP1S drives HBV-related HCC proliferation and migration through the MAP1S/Smad/TGF-β1 feedback loop. TeaserMAP1S is a key link between HBV infection and a higher risk of metastatic recurrence of HCC.

Prognostic implications of CK19 positivity in patients with early recurrent hepatocellular carcinoma after hepatic resection undergoing transarterial chemoembolization

BackgroundThis study aimed to compare the survival outcomes of transarterial chemoembolization (TACE) between patients with early recurrent hepatocellular carcinoma (rHCC) after hepatic resection, stratified by cytokeratin (CK) 19 expression.MethodsA retrospective analysis was conducted on 63 patients with early rHCC after hepatic resection who underwent TACE between January 2017 and December 2021. Patients were divided into two groups based on CK19 expression: CK19-negative (n=31) and CK19-positive (n=32). Overall survival (OS) and progression-free survival (PFS) were compared between the two groups using the Kaplan-Meier method and log-rank test. Cox regression analysis was performed to identify independent risk factors for OS and PFS.ResultsThe CK19-negative group demonstrated a significantly longer median OS compared to the CK19-positive group (635 days vs. 432 days, p=0.013). Similarly, the CK19-negative group had a longer median PFS than the CK19-positive group (291 days vs. 117 days, p=0.014). Multivariate Cox analysis identified Child-Pugh A grade, CK19-negative expression, and increased TACE sessions as protective factors for OS. No severe TACE-related adverse events were observed.ConclusionIn patients with early rHCC after hepatic resection, those with CK19-positive expression had poorer survival outcomes following TACE compared to CK19-negative patients. These findings suggest the need for additional therapies to improve survival in CK19-positive individuals.

Analysis of treatment benefits and prognostic factors for posttransplant HCC recurrence in a large Euro-American-Asian cohort.

Posttransplant HCC recurrence significantly impacts survival, yet its management is challenging due to limited evidence. With recent advancements in HCC treatment, updated data on managing recurrent diseases are needed. In this retrospective study across 6 centers (2000-2022), we employed Cox proportional-hazards regression and log-rank tests to assess survival differences. A prognostic score model was developed to categorize patient survival. The efficacy of tyrosine kinase inhibitors was evaluated through propensity score matching. In our study, 431 of 3349 (14%) patients with HCC who underwent transplantation developed recurrence within a median interval of 18 (IQR: 9-32) months. One hundred forty-seven (34%) underwent curative-intent treatments, 207 (48%) received palliative treatments, and 77 (18%) were given best-supportive care. Patients undergoing curative-intent treatments had better survival from the time of recurrence with a median survival of 45 (95% CI: 36-63) months and 1/3/5-year survival of 90%/56%/43% compared to those receiving noncurative treatments (median: 11 [95% CI: 10-13] mo, 1/3/5-y survival of 46%/10%/7%, log-rank p < 0.001). Patients with recurrence diagnosed in the era 2018-2022 showed improved survival over the previous era (HR 0.64 [95% CI: 0.47-0.86]). Multivariable analysis identified 5 prognostic factors: ineligibility for curative-intent treatment (HR: 3.5 [95% CI: 2.7-4.6]), recurrence within 1 year (HR: 1.7 [95% CI: 1.3-2.1]), poor tumor differentiation (HR: 1.5 [95% CI: 1.1-1.9]), RETREAT score ≥3 (HR: 1.4 [95% CI: 1.1-1.8]), and alpha-fetoprotein at recurrence ≥400ng/mL (HR: 1.4 [95% CI: 1.1-1.9]). These factors contributed to a prognostic scoring system (0-9) that stratified patients into 3 prognosis groups. Both propensity score-matched analysis and multivariable regression indicated that lenvatinib was not statistically superior to sorafenib in terms of efficacy. Curative-intent treatments should be advocated for patients with posttransplant recurrence whenever possible. Prognostic factors linked to aggressive tumor biology significantly influence survival. Advancements in HCC management have improved survival outcomes over the past 5 years.

Glycerophospholipid-driven lipid metabolic reprogramming as a common key mechanism in the progression of human primary hepatocellular carcinoma and cholangiocarcinoma

Metabolic reprogramming, a key mechanism regulating the growth and recurrence of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), still lacks effective clinical strategies for its integration into the precise screening of primary liver cancer. This study utilized ultra-high-performance liquid chromatography with quadrupole time-of-flight mass spectrometry to conduct a comprehensive, non-targeted metabolomics analysis, revealing significant upregulation of lipid metabolites such as phosphatidylcholine and lysophosphatidylcholine in patients with HCC and CCA, particularly within the glycerophospholipid metabolic pathway. Hematoxylin and eosin and immunohistochemical staining demonstrated marked upregulation of phospholipase A2 in tumor tissues, further emphasizing the potential of lipid metabolism as a therapeutic target and its important part in the course of cancer. This work provides a new viewpoint for addressing the clinical challenges associated with HCC and CCA, laying the groundwork for the broad application of early diagnosis and personalized treatment strategies, and ultimately aiming to provide tailored and precise therapeutic options for patients.

Current management of hepatobiliary malignancies between centers with or without a liver transplant program: A multi-society national survey

BackgroundAvailability of liver transplantation (LT) as a treatment for hepatocellular carcinoma (HCC) and other liver malignancies may determine heterogeneity of therapeutic strategies across different centers. AimsTo investigate the practice between hepato-biliary centers without (HB centers) and with a LT program (LT centers), we launched a 38-item web-based national survey, with directors of centers as a target. MethodsThe survey, including 4 clinical vignettes, collected data on their approach to HCC and transplant oncology. ResultsAfter duplicates removal, 75 respondents were considered. Respondents from LT centers (n = 22, 29.3 %) were more in favor of LT in the case of HCC outside Milan criteria (90.9 % vs. 67.9 %, p = 0.037), recurrent HCC (95.5 % vs. 50.9 %, p = 0.002) and other malignancies such as cholangiocarcinoma or neuroendocrine tumors. No significant difference was observed concerning the proportion of centers favorable to LT for unresectable colorectal liver metastases (100 % vs. 88.7 %, p = 0.100). ConclusionThis national survey showed how management of HCC and awareness of transplant oncology may differ between HB and LT centers. Effective networking between HB and LT centers is crucial to provide optimal treatment and access to LT.

Sequential living donor liver transplantation after liver resection optimizes outcomes for patients with high-risk hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seqLDLT) after LR as a strategy for HCC patients with high-risk of recurrence. MethodsWe analyzed data from 27 adult patients who underwent seqLDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS). ResultsAmong 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqLDLT. Five patients (19%) underwent LDLT following LR as a downstaging strategy while the rest received seqLDLT as a preemptive strategy. The median age was 53.5 years with 85% males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0% and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors > 5 cm (19%), and a total tumor diameter > 10 cm (7%). ConclusionsSeqLDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seqLDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.

Predictors of early recurrence of hepatocellular carcinoma after hepatic resection in a single Egyptian institute: A retrospective study.

Predictors of early recurrence of hepatocellular carcinoma after hepatic resection in a single Egyptian institute: A retrospective study.