Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hyperten...Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.展开更多
This study aimed to develop and validate a novel pathological scoring system,the MSE score(microvascular invasion,satellite foci,Edmondson-Steiner grade),for predicting postoperative recurrence in hepatocellular carci...This study aimed to develop and validate a novel pathological scoring system,the MSE score(microvascular invasion,satellite foci,Edmondson-Steiner grade),for predicting postoperative recurrence in hepatocellular carcinoma(HCC)patients at BCLC stage 0-A following liver resection.The MSE score was compared to the established microvascular invasion/satellitosis(m VI/S)scoring system,which combines microvascular invasion and satellite nodules,both of which are significant predictors of aggressive recurrence and mortality.A total of 3,338 patients from 28 centers,who underwent curative liver resection between January 2017 and January 2020,were included.These patients were divided into a training cohort(n=2,337)and a validation cohort(n=1,001).Univariate and multivariate Cox regression models,along with Kaplan-Meier survival analysis,receiver operating characteristic(ROC)curves,and random forest modeling,were used to assess recurrence factors and compare predictive performance.The results showed that the MSE score had superior discriminatory power compared to m VI/S in predicting recurrence and overall survival.Kaplan-Meier analysis indicated a significantly better separation of low-and high-risk groups with the MSE score(P<0.001),while ROC analysis revealed higher AUC values for the MSE score at 1,3,and 5 years.Multivariate Cox analysis demonstrated higher predictive power for the MSE score(HR=2.900(1.808-4.652))compared to m VI/S(HR=2.134(1.567-3.043)).Additionally,logistic regression confirmed that the MSE score had stronger predictive power for aggressive recurrence(OR=2.992(1.816-4.862)vs.m VI/S OR=1.847(1.105-3.470)).SHAP analysis highlighted that the MSE score was more significant than m VI/S.The MSE score also outperformed traditional BCLC staging,TNM staging,and preoperative serum AFP levels in predicting recurrence.In conclusion,the MSE score provides reliable predictions for postoperative aggressive recurrence and survival in BCLC stage 0-A HCC,offering superior risk stratification compared to m VI/S and promising utility in guiding postoperative management.展开更多
BACKGROUND： The Barcelona Clinic Liver Cancer（BCLC）staging system for hepatocellular carcinoma（HCC） recommends transarterial chemoembolization（TACE） as the first line therapy for stage B patients and sorafenib ...BACKGROUND： The Barcelona Clinic Liver Cancer（BCLC）staging system for hepatocellular carcinoma（HCC） recommends transarterial chemoembolization（TACE） as the first line therapy for stage B patients and sorafenib treatment for stage C patients.However, stage C patients exhibit variations in terms of tumor burden, liver function, and extrahepatic metastasis, which could potentially affect disease outcome. Here, we assessed whether the Cancer of the Liver Italian Program（CLIP） scores can help identify stage C patients likely to benefit from TACE.METHODS： Out of 295 BCLC stage C HCC patients enrolled between January 2009 and December 2011, those with platelet counts 〉30×10~9 cells/L, total bilirubin 〈51 μmo L/L, and an unobstructed main portal vein were scheduled for TACE（n=195）. The remaining patients received best supportive care（BSC, n=100）.All the patients were followed up for symptoms, performance status, and Child-Pugh classification scores every 4 weeks until death or December 2013. The prognosis of each group was evaluated by using the log-rank test and Cox-Mantel test.RESULTS： The median overall survival（OS） was 6 months [95% confidence interval（CI）： 4.64-7.36]. The OS was 9 months for the TACE group and 4 months for the BSC group. The TACE group had a longer OS than the BSC subgroup for CLIP scores 0-2 [13 months（95% CI： 8.55-17.45） vs 4 months（95% CI：0.00-10.96）, P=0.001]. No significant differences were found between the TACE and BSC groups for CLIP scores 3-5. The CLIP score and treatment methods were found to be independent prognostic factors.CONCLUSIONS： BCLC stage C HCC patients exhibit definite disease heterogeneity and can be reclassified by using the CLIP scoring system. Moreover, patients with CLIP scores 0-2 are likely to benefit from TACE. However, additional studies with long-term follow-up will be required to validate these findings.展开更多
Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of e...Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of effectiveness and safety, as reported in recent research articles, systematic reviews and meta-analyses. In this report, we summarized for the first time the results of proton therapy treatment for HCC according with respect to the Barcelona Clinic Liver Cancer Staging System, the most adopted classification system for HCC which provides information on both prognostic prediction and treatment allocation.展开更多
Hepatocellular carcinoma(HCC)is the third-leading cause of cancer-related mortality worldwide(1).While upfront surgical resection has been established as an effective curative treatment for early-stage disease,up to 5...Hepatocellular carcinoma(HCC)is the third-leading cause of cancer-related mortality worldwide(1).While upfront surgical resection has been established as an effective curative treatment for early-stage disease,up to 53.6%of patients present with moderate-to-advanced stage disease(2).Traditional recommendations as per the latest Barcelona Clinic Liver Cancer(BCLC)2022 update have advised for palliative transarterial chemoembolization(TACE)or systemic treatment(3),leaving this patient group with only modest response rates of 5%to 40%(4).However,with oncological advancements in recent years,conversion therapy has emerged as an effective strategy to change the therapeutic trajectory of patients with BCLC stage B and BCLC stage C HCC,showing significantly improved long-term outcomes compared to systemic therapy alone(5).展开更多
Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a signific...Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a significant clinical challenge.However,transarterial chemoembolization(TACE)is the only recommended treatment option.Therefore,we aimed to investigate the patient characteristics and outcomes of living donor liver transplantation(LDLT)for BCLC stage B HCC.Methods:A total of 516 patients with BCLC stage B HCC who underwent LDLT(n=104)or did not undergo LDLT(non-LDLT;n=412)between 2004 to 2018 were analyzed by propensity score matching(PSM;1:4)analysis.Factors influencing overall survival(OS)and recurrence were analyzed using Cox’s proportional hazards models.Results:Patients treated with LDLT achieved better OS than the non-LDLT group,including liver-and non-liver related survival(all P<0.001).Multivariate Cox regression analysis showed age>60 years(P=0.006),a neutrophil-lymphocyte ratio(NLR)>4(P=0.016)and>3 locoregional therapies(LRT)before LDLT(P<0.001)were independent risk factors for HCC recurrence.In addition,age>60 years(P<0.001)and>3 LRT before LDLT(P=0.001)were independent risk factors for OS.Using a combination of age,NLR,and LRT before liver transplantation(LT),the patients can be divided into low-risk(none of risk),intermediate-risk(one of risk),and high risk(more than two of risk)groups.There were significant differences in the cumulative HCC recurrence(P<0.001)and mortality(P<0.001)rates among the three groups.Conclusions:LDLT may represent a valuable therapeutic option for selected patients with BCLC stage B HCC.展开更多
基金supported by grants from the Sichuan Science and Technology Program(2023YFQ0094)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(25HXJS028).
文摘Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.
基金supported by the National Key Research and Development Program of China(2023ZD0502001)the National Natural Science Foundation of China(82473040)+1 种基金Hubei Provincial Cutting-Edge Technology Research Project(2023BAA016-3)Tongji Hospital High-Quality Clinical Research Fund(2024TJCR014)。
文摘This study aimed to develop and validate a novel pathological scoring system,the MSE score(microvascular invasion,satellite foci,Edmondson-Steiner grade),for predicting postoperative recurrence in hepatocellular carcinoma(HCC)patients at BCLC stage 0-A following liver resection.The MSE score was compared to the established microvascular invasion/satellitosis(m VI/S)scoring system,which combines microvascular invasion and satellite nodules,both of which are significant predictors of aggressive recurrence and mortality.A total of 3,338 patients from 28 centers,who underwent curative liver resection between January 2017 and January 2020,were included.These patients were divided into a training cohort(n=2,337)and a validation cohort(n=1,001).Univariate and multivariate Cox regression models,along with Kaplan-Meier survival analysis,receiver operating characteristic(ROC)curves,and random forest modeling,were used to assess recurrence factors and compare predictive performance.The results showed that the MSE score had superior discriminatory power compared to m VI/S in predicting recurrence and overall survival.Kaplan-Meier analysis indicated a significantly better separation of low-and high-risk groups with the MSE score(P<0.001),while ROC analysis revealed higher AUC values for the MSE score at 1,3,and 5 years.Multivariate Cox analysis demonstrated higher predictive power for the MSE score(HR=2.900(1.808-4.652))compared to m VI/S(HR=2.134(1.567-3.043)).Additionally,logistic regression confirmed that the MSE score had stronger predictive power for aggressive recurrence(OR=2.992(1.816-4.862)vs.m VI/S OR=1.847(1.105-3.470)).SHAP analysis highlighted that the MSE score was more significant than m VI/S.The MSE score also outperformed traditional BCLC staging,TNM staging,and preoperative serum AFP levels in predicting recurrence.In conclusion,the MSE score provides reliable predictions for postoperative aggressive recurrence and survival in BCLC stage 0-A HCC,offering superior risk stratification compared to m VI/S and promising utility in guiding postoperative management.
基金supported by grants from You’an Liver disease/AIDS funding(2011)the National Science&Technology Pillar Program during the 12th Five-year Plan Period(2013BAI13B04)
文摘BACKGROUND： The Barcelona Clinic Liver Cancer（BCLC）staging system for hepatocellular carcinoma（HCC） recommends transarterial chemoembolization（TACE） as the first line therapy for stage B patients and sorafenib treatment for stage C patients.However, stage C patients exhibit variations in terms of tumor burden, liver function, and extrahepatic metastasis, which could potentially affect disease outcome. Here, we assessed whether the Cancer of the Liver Italian Program（CLIP） scores can help identify stage C patients likely to benefit from TACE.METHODS： Out of 295 BCLC stage C HCC patients enrolled between January 2009 and December 2011, those with platelet counts 〉30×10~9 cells/L, total bilirubin 〈51 μmo L/L, and an unobstructed main portal vein were scheduled for TACE（n=195）. The remaining patients received best supportive care（BSC, n=100）.All the patients were followed up for symptoms, performance status, and Child-Pugh classification scores every 4 weeks until death or December 2013. The prognosis of each group was evaluated by using the log-rank test and Cox-Mantel test.RESULTS： The median overall survival（OS） was 6 months [95% confidence interval（CI）： 4.64-7.36]. The OS was 9 months for the TACE group and 4 months for the BSC group. The TACE group had a longer OS than the BSC subgroup for CLIP scores 0-2 [13 months（95% CI： 8.55-17.45） vs 4 months（95% CI：0.00-10.96）, P=0.001]. No significant differences were found between the TACE and BSC groups for CLIP scores 3-5. The CLIP score and treatment methods were found to be independent prognostic factors.CONCLUSIONS： BCLC stage C HCC patients exhibit definite disease heterogeneity and can be reclassified by using the CLIP scoring system. Moreover, patients with CLIP scores 0-2 are likely to benefit from TACE. However, additional studies with long-term follow-up will be required to validate these findings.
文摘Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of effectiveness and safety, as reported in recent research articles, systematic reviews and meta-analyses. In this report, we summarized for the first time the results of proton therapy treatment for HCC according with respect to the Barcelona Clinic Liver Cancer Staging System, the most adopted classification system for HCC which provides information on both prognostic prediction and treatment allocation.
文摘Hepatocellular carcinoma(HCC)is the third-leading cause of cancer-related mortality worldwide(1).While upfront surgical resection has been established as an effective curative treatment for early-stage disease,up to 53.6%of patients present with moderate-to-advanced stage disease(2).Traditional recommendations as per the latest Barcelona Clinic Liver Cancer(BCLC)2022 update have advised for palliative transarterial chemoembolization(TACE)or systemic treatment(3),leaving this patient group with only modest response rates of 5%to 40%(4).However,with oncological advancements in recent years,conversion therapy has emerged as an effective strategy to change the therapeutic trajectory of patients with BCLC stage B and BCLC stage C HCC,showing significantly improved long-term outcomes compared to systemic therapy alone(5).
基金This work was supported by grants from the Health and Welfare Surcharge of Tobacco Products,Ministry of Health and Welfare,Taiwan(Nos.MOHW107-TDU-B-212-114022,MOHW108-TDU-B-212-124022,MOHW109-TDU-B-212-134022 to Chen CL).
文摘Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a significant clinical challenge.However,transarterial chemoembolization(TACE)is the only recommended treatment option.Therefore,we aimed to investigate the patient characteristics and outcomes of living donor liver transplantation(LDLT)for BCLC stage B HCC.Methods:A total of 516 patients with BCLC stage B HCC who underwent LDLT(n=104)or did not undergo LDLT(non-LDLT;n=412)between 2004 to 2018 were analyzed by propensity score matching(PSM;1:4)analysis.Factors influencing overall survival(OS)and recurrence were analyzed using Cox’s proportional hazards models.Results:Patients treated with LDLT achieved better OS than the non-LDLT group,including liver-and non-liver related survival(all P<0.001).Multivariate Cox regression analysis showed age>60 years(P=0.006),a neutrophil-lymphocyte ratio(NLR)>4(P=0.016)and>3 locoregional therapies(LRT)before LDLT(P<0.001)were independent risk factors for HCC recurrence.In addition,age>60 years(P<0.001)and>3 LRT before LDLT(P=0.001)were independent risk factors for OS.Using a combination of age,NLR,and LRT before liver transplantation(LT),the patients can be divided into low-risk(none of risk),intermediate-risk(one of risk),and high risk(more than two of risk)groups.There were significant differences in the cumulative HCC recurrence(P<0.001)and mortality(P<0.001)rates among the three groups.Conclusions:LDLT may represent a valuable therapeutic option for selected patients with BCLC stage B HCC.
