BACKGROUND Recurrence of hepatocellular carcinoma(HCC)following liver transplantation(LT)has a devastating influence on recipients’survival;however,the risk of recur-rence is not routinely stratified.Risk stratificat...BACKGROUND Recurrence of hepatocellular carcinoma(HCC)following liver transplantation(LT)has a devastating influence on recipients’survival;however,the risk of recur-rence is not routinely stratified.Risk stratification is vital with a long LT waiting time,as that could influence the recurrence despite strict listing criteria.AIM This study aims to identify predictors of recurrence and develop a novel risk pre-diction score to forecast HCC recurrence following LT.METHODS A retrospective review of LT for HCC recipients at University Hospitals Bir-mingham between July 2011 and February 2020.Univariate and multivariate analyses were performed to identify recurrence predictors,based on which the novel SIMAP500(satellite nodules,increase in size,microvascular invasion,AFP>500,poor differentiation)risk score was proposed.RESULTS 234 LTs for HCC were performed with a median follow-up of 5.3 years.Recurrence developed in 25 patients(10.7%).On univariate analyses,RETREAT score>3,α-fetoprotein(AFP)at listing 100-500 and>500,bridging,increased tumour size between imaging at the listing time and explant histology,increase in the size of viable tumour between listing and explant,presence of satellite nodules,micro-and macrovascular invasion on explant and poor differentiation of tumours were significantly associated with recurrence,based on which,the SIMAP500 risk score is proposed.The SIMAP500 demonstrated an excellent predictive ability(c-index=0.803)and outper-formed the RETREAT score(c-index=0.73).SIMAP500 is indicative of the time to disease recurrence.CONCLUSION SIMAP500 risk score identifies the LT recipients at risk of HCC recurrence.Risk stratification allows patient-centric post-transplant surveillance programs.Further validation of the score is recommended.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD)is now the most common chronic liver disease in the Western world,driven by obesity,insulin resistance,and systemic inflammation.Its progressive form,meta...Metabolic dysfunction-associated steatotic liver disease(MASLD)is now the most common chronic liver disease in the Western world,driven by obesity,insulin resistance,and systemic inflammation.Its progressive form,metabolic dysfunction-associated steatohepatitis(MASH),can culminate in cirrhosis and hepatocellular carcinoma(HCC).While lifestyle modification remains central to MASLD management,there is growing interest in pharmacological interventions,particularly nutrient-stimulated hormone-based therapies(NuSHs),such as GLP-1 receptor agonists.NuSHs exert metabolic and anti-inflammatory effects primarily via weight loss and improved insulin sensitivity.Emerging clinical data support their efficacy in resolving MASH without worsening fibrosis.However,benefits in cirrhotic patients are less evident,suggesting greater utility in early intervention.Observational studies and clinical trials suggest a reduction in liver-related morbidity with GLP-1 receptor agonist use,though fibrosis regression remains inconsistent.Preclinical models indicate that NuSHs may also reduce MASH-related HCC incidence and tumor burden,likely through systemic metabolic improvements rather than direct antineoplastic action.Observational human data following bariatric surgery reinforce this link,suggesting that weight loss itself plays a key preventive role.Herein,we propose that NuSHs are promising candidates for MASH-related HCC prevention.We provide mechanistic suggestions for how this may occur.Furthermore,incorporating NuSHs into the post-locoregional treatment pathway for HCC may delay the need for systemic anti-cancer therapies,improve immunotherapy synergy and transplant eligibility,and even slow disease progression through reversal of carcinogenic drivers.Future studies are needed to target oncological endpoints and clarify immunometabolic mechanisms to guide the integration of NuSHs into MASLD treatment algorithms.展开更多
The World Health Organisation(WHO)classifies clinical diagnoses with the International Statistical Classification of Disease and Related Health Problems(ICD).There have been various iterations of ICD since it is incep...The World Health Organisation(WHO)classifies clinical diagnoses with the International Statistical Classification of Disease and Related Health Problems(ICD).There have been various iterations of ICD since it is inception.For oncology,ICD-O was introduced in 1976 as a special adaption of ICD for cancers to facilitate greater coding detail of the topography,which describes the anatomical location of the tumour origin,and the morphology concerns the histology of a neoplasm.ICD-10 began in 1983 and was first used in 1994.At the same time,a code for cholangiocarcinoma(CCA)was also introduced(https://icd.who.int/browse10/2010/en).展开更多
Cholangiocarcinoma(CCA)is a rare and very aggressive malignancy arising from the biliary tract.Based on the location of the tumor,CCA can be divided in intrahepatic cholangiocarcinoma(iCCA),perihilar cholangiocarcinom...Cholangiocarcinoma(CCA)is a rare and very aggressive malignancy arising from the biliary tract.Based on the location of the tumor,CCA can be divided in intrahepatic cholangiocarcinoma(iCCA),perihilar cholangiocarcinoma(pCCA)and distal cholangiocarcinoma(dCCA).Many other characteristics differentiate these groups,including pathological features,oncological approach and surgical techniques,which in turn influences patient outcomes.展开更多
文摘BACKGROUND Recurrence of hepatocellular carcinoma(HCC)following liver transplantation(LT)has a devastating influence on recipients’survival;however,the risk of recur-rence is not routinely stratified.Risk stratification is vital with a long LT waiting time,as that could influence the recurrence despite strict listing criteria.AIM This study aims to identify predictors of recurrence and develop a novel risk pre-diction score to forecast HCC recurrence following LT.METHODS A retrospective review of LT for HCC recipients at University Hospitals Bir-mingham between July 2011 and February 2020.Univariate and multivariate analyses were performed to identify recurrence predictors,based on which the novel SIMAP500(satellite nodules,increase in size,microvascular invasion,AFP>500,poor differentiation)risk score was proposed.RESULTS 234 LTs for HCC were performed with a median follow-up of 5.3 years.Recurrence developed in 25 patients(10.7%).On univariate analyses,RETREAT score>3,α-fetoprotein(AFP)at listing 100-500 and>500,bridging,increased tumour size between imaging at the listing time and explant histology,increase in the size of viable tumour between listing and explant,presence of satellite nodules,micro-and macrovascular invasion on explant and poor differentiation of tumours were significantly associated with recurrence,based on which,the SIMAP500 risk score is proposed.The SIMAP500 demonstrated an excellent predictive ability(c-index=0.803)and outper-formed the RETREAT score(c-index=0.73).SIMAP500 is indicative of the time to disease recurrence.CONCLUSION SIMAP500 risk score identifies the LT recipients at risk of HCC recurrence.Risk stratification allows patient-centric post-transplant surveillance programs.Further validation of the score is recommended.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)is now the most common chronic liver disease in the Western world,driven by obesity,insulin resistance,and systemic inflammation.Its progressive form,metabolic dysfunction-associated steatohepatitis(MASH),can culminate in cirrhosis and hepatocellular carcinoma(HCC).While lifestyle modification remains central to MASLD management,there is growing interest in pharmacological interventions,particularly nutrient-stimulated hormone-based therapies(NuSHs),such as GLP-1 receptor agonists.NuSHs exert metabolic and anti-inflammatory effects primarily via weight loss and improved insulin sensitivity.Emerging clinical data support their efficacy in resolving MASH without worsening fibrosis.However,benefits in cirrhotic patients are less evident,suggesting greater utility in early intervention.Observational studies and clinical trials suggest a reduction in liver-related morbidity with GLP-1 receptor agonist use,though fibrosis regression remains inconsistent.Preclinical models indicate that NuSHs may also reduce MASH-related HCC incidence and tumor burden,likely through systemic metabolic improvements rather than direct antineoplastic action.Observational human data following bariatric surgery reinforce this link,suggesting that weight loss itself plays a key preventive role.Herein,we propose that NuSHs are promising candidates for MASH-related HCC prevention.We provide mechanistic suggestions for how this may occur.Furthermore,incorporating NuSHs into the post-locoregional treatment pathway for HCC may delay the need for systemic anti-cancer therapies,improve immunotherapy synergy and transplant eligibility,and even slow disease progression through reversal of carcinogenic drivers.Future studies are needed to target oncological endpoints and clarify immunometabolic mechanisms to guide the integration of NuSHs into MASLD treatment algorithms.
文摘The World Health Organisation(WHO)classifies clinical diagnoses with the International Statistical Classification of Disease and Related Health Problems(ICD).There have been various iterations of ICD since it is inception.For oncology,ICD-O was introduced in 1976 as a special adaption of ICD for cancers to facilitate greater coding detail of the topography,which describes the anatomical location of the tumour origin,and the morphology concerns the histology of a neoplasm.ICD-10 began in 1983 and was first used in 1994.At the same time,a code for cholangiocarcinoma(CCA)was also introduced(https://icd.who.int/browse10/2010/en).
文摘Cholangiocarcinoma(CCA)is a rare and very aggressive malignancy arising from the biliary tract.Based on the location of the tumor,CCA can be divided in intrahepatic cholangiocarcinoma(iCCA),perihilar cholangiocarcinoma(pCCA)and distal cholangiocarcinoma(dCCA).Many other characteristics differentiate these groups,including pathological features,oncological approach and surgical techniques,which in turn influences patient outcomes.
