BACKGROUND Hepatocellular carcinoma(HCC)is the most common pathological type of liver cancer and was the third leading cause of cancer-related deaths worldwide in 2020.AIM To evaluate the diagnostic potential of key t...BACKGROUND Hepatocellular carcinoma(HCC)is the most common pathological type of liver cancer and was the third leading cause of cancer-related deaths worldwide in 2020.AIM To evaluate the diagnostic potential of key tumor markers in serum,bile,and fecal samples for detecting HCC.METHODS Blood,bile,and fecal samples were collected from patients(n=265)with HCC and cholecystitis from Guangxi Medical University’s First Affiliated Hospital.Immunohistochemistry was performed on 69 HCC samples,and 16S ribosomal RNA sequencing was conducted on 166 fecal samples.Tumor marker cut-off values in bile and feces were determined using the Youden index,while serum biomarkers followed hospital standards.Diagnostic performance was evaluated using receiver operating characteristic analysis.RESULTS The areas under the curve(AUCs)for distinguishing HCC were 0.898,0.904,and 0.859 for serum alpha-fetoprotein(AFP),prothrombin induced by vitamin K absence-II(PIVKA-II),and bile AFP,respectively.Serum AFP had the highest diagnostic value(80%)for early-stage HCC.Combination analysis found that bile AFP and serum PIVKAII achieved the highest AUC of 0.965(P<0.001),suggesting that bile AFP may serve as a valuable complementary biomarker,particularly in cases where serum AFP is not significantly elevated.Additionally,bile AFP was positively correlated with Actinomyces,which plays a significant role in promoting tumorigenesis;and was negatively correlated with Faecalibacterium,which was associated with robust anticancer immune responses(P<0.05).These findings suggest the potential role of gut microbiota in modulating AFP levels and HCC progression.CONCLUSION Bile AFP improved the sensitivity of HCC detection,with the combination of bile AFP and PIVKA-II demonstrating the highest AUC for HCC diagnosis.AFP is associated with poorer clinical outcomes.展开更多
Hepatocellular carcinoma(HCC)is a highly heterogeneous,invasive,and conventional chemotherapy-insensitive tumor with unique biological characteristics.The main methods for the radical treatment of HCC are surgical res...Hepatocellular carcinoma(HCC)is a highly heterogeneous,invasive,and conventional chemotherapy-insensitive tumor with unique biological characteristics.The main methods for the radical treatment of HCC are surgical resection or liver transplantation.However,recurrence rates are as high as 50%and 70%at 3 and 5 years after liver resection,respectively,and even in Milan-eligible recipients,the recurrence rate is approximately 20%at 5 years after liver transplantation.Therefore,reducing the postoperative recurrence rate is key to improving the overall outcome of liver cancer.This review discusses the risk factors for recurrence in patients with HCC radical surgical resection and adjuvant treatment options that may reduce the risk of recurrence and improve overall survival,including local adjuvant therapy(e.g.,transcatheter arterial chemoembolization),adjuvant systemic therapy(e.g.,molecular targeted agents and immunotherapy),and other adjuvant therapies(e.g.,antiviral and herbal therapy).Finally,potential research directions that may change the paradigm of adjuvant therapy for HCC are analyzed.展开更多
BACKGROUND In the translational therapy of giant hepatocellular carcinoma(HCC),hepatic arterial infusion chemotherapy(HAIC)combined with anti-PD-1 immunotherapy and tyrosine kinase inhibitors(TKI)after laparoscopic po...BACKGROUND In the translational therapy of giant hepatocellular carcinoma(HCC),hepatic arterial infusion chemotherapy(HAIC)combined with anti-PD-1 immunotherapy and tyrosine kinase inhibitors(TKI)after laparoscopic portal vein ligation(PVL)is extremely rare.This is a dual conversion therapy that combines surgery and oncology.Here,we report two cases of successful surgical completion after dual conversion therapy.CASE SUMMARY We report that a 54-year-old man and a 69-year-old woman were diagnosed with primary HCC combined with hepatitis B cirrhosis(case 2 also combined with fatty liver)on physical examination.Due to the insufficient residual liver volume assessed before surgery,laparoscopic right PVL was performed,followed by HAIC combined with anti-PD-1 immunotherapy and TKI.Finally,surgical resection was successfully completed,and pathology confirmed that the tumor was mostly necrotic(90%)in one case,and no live tumor tissue was found in the other case.CONCLUSION In the process of surgical transformation,our treatment plan takes into account the control and transformation of oncology at the same time,which is expected to provide more opportunities for radical hepatectomy and improve the prognosis of patients with large liver cancer.展开更多
BACKGROUND The prognostic impact of preoperative gamma-glutamyl transpeptidase to platelet ratio(GPR)levels in patients with solitary hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC)following radical resec...BACKGROUND The prognostic impact of preoperative gamma-glutamyl transpeptidase to platelet ratio(GPR)levels in patients with solitary hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC)following radical resection has not been established.AIM To examine the clinical utility of GPR for prognosis prediction in solitary HBVrelated HCC patients.METHODS A total of 1167 solitary HBV-related HCC patients were retrospectively analyzed.GPR levels were compared with 908 non-HCC individuals.Overall survival(OS)and recurrence-free survival(RFS)were evaluated,and cox proportional hazard model analyses were performed to identify independent risk factors.Differences in characteristics were adjusted by propensity score matching(PSM).Subgroup and stratified survival analyses for HCC risks were performed,and a linear trend of the hazard ratio(HR)according to GPR levels was constructed.RESULTS GPR levels of patients with solitary HBV-related HCC were higher than those with hepatic hemangiomas,chronic hepatitis B and healthy control(adjusted P<0.05).Variable bias was diminished after the PSM balance test.The low GPR group had improved OS(P<0.001)and RFS(P<0.001)in the PSM analysis and when combined with other variables.Multivariate cox analyses suggested that low GPR levels were associated with a better OS(HR=0.5,95%CI:0.36-0.7,P<0.001)and RFS(HR=0.57,95%CI:0.44-0.73,P<0.001).This same trend was confirmed in subgroup analyses.Prognostic nomograms were constructed and the calibration curves showed that GPR had good survival prediction.Moreover,stratified survival analyses found that GPR>0.6 was associated with a worse OS and higher recurrence rate(P for trend<0.001).CONCLUSION Preoperative GPR can serve as a noninvasive indicator to predict the prognosis of patients with solitary HBVrelated HCC.展开更多
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the most common pathological type of liver cancer and was the third leading cause of cancer-related deaths worldwide in 2020.AIM To evaluate the diagnostic potential of key tumor markers in serum,bile,and fecal samples for detecting HCC.METHODS Blood,bile,and fecal samples were collected from patients(n=265)with HCC and cholecystitis from Guangxi Medical University’s First Affiliated Hospital.Immunohistochemistry was performed on 69 HCC samples,and 16S ribosomal RNA sequencing was conducted on 166 fecal samples.Tumor marker cut-off values in bile and feces were determined using the Youden index,while serum biomarkers followed hospital standards.Diagnostic performance was evaluated using receiver operating characteristic analysis.RESULTS The areas under the curve(AUCs)for distinguishing HCC were 0.898,0.904,and 0.859 for serum alpha-fetoprotein(AFP),prothrombin induced by vitamin K absence-II(PIVKA-II),and bile AFP,respectively.Serum AFP had the highest diagnostic value(80%)for early-stage HCC.Combination analysis found that bile AFP and serum PIVKAII achieved the highest AUC of 0.965(P<0.001),suggesting that bile AFP may serve as a valuable complementary biomarker,particularly in cases where serum AFP is not significantly elevated.Additionally,bile AFP was positively correlated with Actinomyces,which plays a significant role in promoting tumorigenesis;and was negatively correlated with Faecalibacterium,which was associated with robust anticancer immune responses(P<0.05).These findings suggest the potential role of gut microbiota in modulating AFP levels and HCC progression.CONCLUSION Bile AFP improved the sensitivity of HCC detection,with the combination of bile AFP and PIVKA-II demonstrating the highest AUC for HCC diagnosis.AFP is associated with poorer clinical outcomes.
文摘Hepatocellular carcinoma(HCC)is a highly heterogeneous,invasive,and conventional chemotherapy-insensitive tumor with unique biological characteristics.The main methods for the radical treatment of HCC are surgical resection or liver transplantation.However,recurrence rates are as high as 50%and 70%at 3 and 5 years after liver resection,respectively,and even in Milan-eligible recipients,the recurrence rate is approximately 20%at 5 years after liver transplantation.Therefore,reducing the postoperative recurrence rate is key to improving the overall outcome of liver cancer.This review discusses the risk factors for recurrence in patients with HCC radical surgical resection and adjuvant treatment options that may reduce the risk of recurrence and improve overall survival,including local adjuvant therapy(e.g.,transcatheter arterial chemoembolization),adjuvant systemic therapy(e.g.,molecular targeted agents and immunotherapy),and other adjuvant therapies(e.g.,antiviral and herbal therapy).Finally,potential research directions that may change the paradigm of adjuvant therapy for HCC are analyzed.
文摘BACKGROUND In the translational therapy of giant hepatocellular carcinoma(HCC),hepatic arterial infusion chemotherapy(HAIC)combined with anti-PD-1 immunotherapy and tyrosine kinase inhibitors(TKI)after laparoscopic portal vein ligation(PVL)is extremely rare.This is a dual conversion therapy that combines surgery and oncology.Here,we report two cases of successful surgical completion after dual conversion therapy.CASE SUMMARY We report that a 54-year-old man and a 69-year-old woman were diagnosed with primary HCC combined with hepatitis B cirrhosis(case 2 also combined with fatty liver)on physical examination.Due to the insufficient residual liver volume assessed before surgery,laparoscopic right PVL was performed,followed by HAIC combined with anti-PD-1 immunotherapy and TKI.Finally,surgical resection was successfully completed,and pathology confirmed that the tumor was mostly necrotic(90%)in one case,and no live tumor tissue was found in the other case.CONCLUSION In the process of surgical transformation,our treatment plan takes into account the control and transformation of oncology at the same time,which is expected to provide more opportunities for radical hepatectomy and improve the prognosis of patients with large liver cancer.
基金Supported by The National Natural Science Foundation of China,No.81560535,No.81802874 and No.81072321The Self-funded Scientific Research Project of Health Commission in Guangxi Zhuang Autonomous Region,China,No.Z20210977.
文摘BACKGROUND The prognostic impact of preoperative gamma-glutamyl transpeptidase to platelet ratio(GPR)levels in patients with solitary hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC)following radical resection has not been established.AIM To examine the clinical utility of GPR for prognosis prediction in solitary HBVrelated HCC patients.METHODS A total of 1167 solitary HBV-related HCC patients were retrospectively analyzed.GPR levels were compared with 908 non-HCC individuals.Overall survival(OS)and recurrence-free survival(RFS)were evaluated,and cox proportional hazard model analyses were performed to identify independent risk factors.Differences in characteristics were adjusted by propensity score matching(PSM).Subgroup and stratified survival analyses for HCC risks were performed,and a linear trend of the hazard ratio(HR)according to GPR levels was constructed.RESULTS GPR levels of patients with solitary HBV-related HCC were higher than those with hepatic hemangiomas,chronic hepatitis B and healthy control(adjusted P<0.05).Variable bias was diminished after the PSM balance test.The low GPR group had improved OS(P<0.001)and RFS(P<0.001)in the PSM analysis and when combined with other variables.Multivariate cox analyses suggested that low GPR levels were associated with a better OS(HR=0.5,95%CI:0.36-0.7,P<0.001)and RFS(HR=0.57,95%CI:0.44-0.73,P<0.001).This same trend was confirmed in subgroup analyses.Prognostic nomograms were constructed and the calibration curves showed that GPR had good survival prediction.Moreover,stratified survival analyses found that GPR>0.6 was associated with a worse OS and higher recurrence rate(P for trend<0.001).CONCLUSION Preoperative GPR can serve as a noninvasive indicator to predict the prognosis of patients with solitary HBVrelated HCC.
