Journal of Hepatocellular Carcinoma最新文献

{"title":"Balloon-Occluded Transarterial Chemoembolization for Hepatocellular Carcinoma: Technical Rationale, Current Evidence, and Future Directions.","authors":"Xiaoli Jia, Yuanyi Chen, Xiaomeng Cui, Yan Tian, Dandan Feng, Wenjun Wang","doi":"10.2147/JHC.S622393","DOIUrl":"10.2147/JHC.S622393","url":null,"abstract":"<p><p>Balloon-occluded transarterial chemoembolization (B-TACE) uses temporary microballoon occlusion to reduce distal arterial pressure and promote dense, selective deposition of chemoembolic material within the tumor and its drainage territory. Observational comparative studies and a meta-analysis suggest higher complete response and objective response rates than conventional TACE (C-TACE), especially in 3-5 cm tumors. However, randomized evidence and a proven survival advantage are lacking. Clinical benefit is therefore most plausible in carefully selected patients with preserved liver function, a limited tumor burden amenable to segmental treatment, and anatomy in which collateral inflow does not prevent a meaningful pressure reduction. Measurement of balloon-occluded arterial stump pressure may help characterize hemodynamics, but the proposed <64 mmHg threshold is not universally reproducible or routinely available. B-TACE has a broadly comparable overall safety profile to C-TACE, while non-target or excessive peripheral embolization can injure the peribiliary plexus and cause biloma or hepatic abscess. Future priorities include standardized technical endpoints, prospective randomized comparisons, validated selection criteria, imaging-based hemodynamic prediction, and rigorously designed combinations with systemic or other locoregional therapies.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"622393"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Survival Advantage of Prior Curative Hepatectomy in Patients with Hepatocellular Carcinoma Receiving First-Line Multikinase Inhibitors: A Propensity Score-Adjusted Study.","authors":"Jia-Min Wu, Guan-Hua Li, Cheng-Chun Lee, Jie-Ying Chen, Shun-Fa Yang, Kuan-Chun Hsueh","doi":"10.2147/JHC.S620001","DOIUrl":"10.2147/JHC.S620001","url":null,"abstract":"<p><strong>Background: </strong>Curative hepatectomy is the treatment of choice for resectable hepatocellular carcinoma (HCC). For recurrence or progression beyond locoregional therapy (LRT), multikinase inhibitors (MKIs) remain established first-line options. However, whether prior curative resection is associated with a survival benefit after MKI initiation remains unclear. We employed inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) to compare survival in MKI-treated patients with and without prior hepatectomy.</p><p><strong>Methods: </strong>This retrospective cohort study enrolled 203 patients with unresectable HCC receiving first-line sorafenib or lenvatinib at a single Taiwanese referral hospital (2018-2023). Patients were classified into recurrent HCC (rHCC, n = 58; with prior curative resection) and primary unresectable HCC (uHCC, n = 145; without prior resection) groups. Overall survival (OS) and progression-free survival (PFS) were evaluated using stabilized IPTW with multivariable Cox regression, and PSM as a sensitivity analysis.</p><p><strong>Results: </strong>Over a 13.2-month median follow-up, median OS was longer in the rHCC group (27.0 vs 11.8 months; P = 0.027). After IPTW adjustment, prior resection was independently associated with longer OS (HR: 0.54; 95% CI: 0.36-0.81; P = 0.003) and PFS (HR: 0.61; 95% CI: 0.42-0.89; P = 0.010). PSM yielded concordant results (OS HR: 0.42; 95% CI: 0.26-0.70; P < 0.001; PFS HR: 0.55; 95% CI: 0.35-0.86; P = 0.010). This survival advantage was primarily observed in patients with late recurrence (≥24 months from hepatectomy). High tumor burden was an independent adverse prognostic factor for OS (HR: 1.58; 95% CI: 1.08-2.30; P = 0.017).</p><p><strong>Conclusion: </strong>In patients receiving first-line MKIs, prior curative resection was associated with longer OS and PFS. The better liver reserve and more favorable tumor biology that made these patients suitable candidates for surgery may persist into the systemic therapy phase. Therefore, future clinical trials might consider prespecifying prior resection as a stratification factor.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"620001"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectory-Based Integration of Biomarker Dynamics and Clinical Features for Prognostic Prediction in Hepatocellular Carcinoma: A Retrospective Cohort Study.","authors":"Cineng Xu, Yun Yang, Dongmei Gou, Xiafei Wei, Qichao Yu, Jianguo Huang, Qingxian Cai, Hongzhong Zhou, Yong Xu","doi":"10.2147/JHC.S622498","DOIUrl":"10.2147/JHC.S622498","url":null,"abstract":"<p><strong>Purpose: </strong>Dynamic changes in circulating biomarkers may reflect tumor biology and host responses more accurately than static measurements. This study aimed to develop and internally validate a dynamic prognostic model for progression-free survival (PFS) and overall survival (OS) in patients with hepatocellular carcinoma (HCC) by integrating longitudinal biomarker trajectories with clinical variables.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed 379 patients with HCC treated at a single center in China. Latent class mixed models were used to identify circulating biomarker trajectories, which were integrated with clinical variables to construct the Integrated Multi-Biomarker Trajectory (IMBT) model. The model was compared with BCLC stage, a baseline biomarker model, and an AFP trajectory model. Discrimination, calibration, and clinical utility were assessed using C-indices and time-dependent AUCs, calibration plots, calibration slopes and Brier scores, and decision curve analysis (DCA), respectively. Internal subgroup validation was performed in a treatment-defined subset of 327 patients from the same center and source cohort who received PD-(L)1 inhibitor plus molecular targeted therapy. A predefined AFP-negative subgroup analysis was performed using baseline/cycle-0 AFP <20 ng/mL, which was used only to define the subgroup.</p><p><strong>Results: </strong>AFP, D-dimer, and absolute lymphocyte count (ALC) trajectories independently predicted PFS and OS. Sharp-falling AFP trajectories were associated with favorable outcomes, whereas persistently high or rising AFP and D-dimer trajectories and lower ALC trajectories indicated poorer prognosis. The IMBT model achieved C-indices of 0.741 for PFS and 0.728 for OS. For PFS, the C-index exceeded those of the BCLC, baseline biomarker, and AFP trajectory models by 0.108, 0.124, and 0.039, respectively. The corresponding C-indices were 0.730 and 0.724 in the internal PD-(L)1 plus MTT subgroup. Calibration slopes at 12 and 24 months were 1.176 and 1.509 for PFS and 0.898 and 1.014 for OS, respectively, while DCA demonstrated positive net benefit across clinically relevant thresholds. In AFP-negative patients, the PFS/OS C-indices were 0.647/0.634 in the full cohort and 0.692/0.683 in the PD-(L)1 plus MTT subgroup.</p><p><strong>Conclusion: </strong>Longitudinal trajectories of AFP, D-dimer, and ALC provide independent and complementary prognostic information. By integrating dynamic biomarker patterns with clinical features, the IMBT model improved risk stratification compared with conventional staging, baseline biomarker, and AFP-only trajectory models. These findings support further prospective external validation of the model for dynamic prognostic assessment and risk-adapted monitoring in HCC.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"622498"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Omics and Molecular Simulation Identify KIF11 as a Candidate Direct Target of Resveratrol in Hepatocellular Carcinoma.","authors":"Yeying Wang, Shun Wan, Wanjia Qiao, Renpeng Li, Jinyu Zhao, Wenbo Meng","doi":"10.2147/JHC.S615781","DOIUrl":"10.2147/JHC.S615781","url":null,"abstract":"<p><strong>Objective: </strong>Hepatocellular carcinoma (HCC) has poor prognosis and variable immunotherapy response. Resveratrol exhibits anti-HCC activity, but its direct targets and association with immunotherapy response are unclear. This study identifies core resveratrol targets in HCC and evaluates their prognostic and predictive value.</p><p><strong>Methods: </strong>Resveratrol targets were intersected with TCGA-LIHC differentially expressed genes. A prognostic risk model was built using LASSO-Cox regression. Drug-target binding was assessed by molecular dynamics simulations and qRT-PCR. Single-cell and spatial transcriptomics, cell-cell communication, and a pan-immunotherapy cohort were used to investigate KIF11. An HCC mouse model validated immunomodulatory effects via flow cytometry.</p><p><strong>Results: </strong>Thirty-four resveratrol-associated targets were identified, enriched in metabolism pathways. A nine-gene risk model showed robust prognostic performance. Resveratrol stably binds to KIF11's ATP-binding pocket. KIF11 is overexpressed in malignant hepatocytes and proliferating T cells; KIF11⁺ cells orchestrate VEGF-mediated microenvironment remodeling. High KIF11 expression correlated with poor prognosis but predicted superior survival in the immunotherapy cohort, a phenomenon attributed to the observation that KIF11-high tumors exhibit both enhanced immunogenicity and active immunosuppression. In vivo, resveratrol enhanced CD8⁺ T cell infiltration, proliferation, effector function, and central memory T cells, while reducing Tregs.</p><p><strong>Conclusion: </strong>KIF11 drives HCC progression and predicts immunotherapy response. It is a candidate direct resveratrol target and a potential biomarker for patient stratification in immune checkpoint therapy, although further experimental validation is warranted.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"615781"},"PeriodicalIF":3.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of Inflammation-Driven Hepatocarcinogenesis: The Hepatic Immune Microenvironment, Gut-Liver Axis, and Neuroregulation.","authors":"Weichen Yu, Kai Yin, Chenna Liu, Jin Ding, Yihai Shi","doi":"10.2147/JHC.S626893","DOIUrl":"10.2147/JHC.S626893","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is a highly malignant cancer closely related to the chronic inflammation induced by persistent liver damage. Various risk factors, including chronic hepatitis B/C virus infections, alcoholic liver disease, metabolic dysfunction-associated steatotic liver disease, aflatoxins exposure, and metabolic disorders, contribute to genetic mutations in hepatocytes, leading to sustained cellular damage and apoptosis. These processes foster a chronic inflammatory microenvironment that activates hepatic stellate cells, promotes extracellular matrix deposition, and triggers aberrant regenerative repair, ultimately advancing liver fibrosis, cirrhosis, and HCC. The transition from chronic liver injury to HCC is governed by two interconnected mechanistic layers: initiating triggers-viral infection and hepatocyte death-that provide the substrate for malignant transformation, and modulatory systems that determine the trajectory of this process. Recent studies have revealed that diverse cell types and molecular signaling pathways form an intercellular regulatory network that fosters an inflammatory and carcinogenic microenvironment. This review focuses on three such modulatory systems-the hepatic immune microenvironment, the gut-liver axis, and neuroregulation-and examines how their interplay influences malignant behaviors including cell transformation, proliferation, and apoptosis. We systematically overview the key cellular constituents, fundamental molecular mechanisms, and core signaling pathways governing inflammation-induced hepatocarcinogenesis, and discuss potential therapeutic targets emerging from current research. A deeper understanding of these fundamental pathological mechanisms provides a conceptual framework for elucidating the initiation and progression of HCC. It also offers a theoretical basis for the future development of preventive and targeted therapeutic strategies, although the translation of these mechanistic insights into clinically effective interventions-particularly for cancer prevention-will require rigorous validation in large-scale, prospective human studies.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"626893"},"PeriodicalIF":3.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathologic Complete Response to Neoadjuvant Dual Checkpoint Blockade with Durvalumab Plus Tremelimumab in Advanced-Stage HCC: A Case Report.","authors":"Leonard Bopp, Meinrad Beer, Stefan Andreas Schmidt, Thomas Seufferlein, Thomas Ettrich, Nuh N Rahbari, Emrullah Birgin","doi":"10.2147/JHC.S616393","DOIUrl":"10.2147/JHC.S616393","url":null,"abstract":"<p><p>Current guidelines recommend systemic therapy for patients with Barcelona Clinic Liver Cancer (BCLC) Stage C hepatocellular carcinoma (HCC). However, this population is highly heterogeneous regarding tumor burden, vascular invasion, liver function, and performance status, enabling opportunities for individualized, multimodal strategies. We report the case of a 72-year-old male with a 10 × 7.5 cm HCC and portal vein infiltration involving both the right anterior and left portal branches, in the setting of a past hepatitis C. Due to extensive vascular invasion, the tumor board advised primary systemic therapy with dual immune checkpoint inhibition using Durvalumab and Tremelimumab. After four months of neoadjuvant immunotherapy, restaging showed a partial response with stable liver function. Due to this favorable outcome, the tumor board reassessed resectability and recommended secondary resection. The patient underwent a robotic two-stage hepatectomy with ligation of the right anterior and left portal branches (ALPPS), followed by completion left trisectionectomy 14 days later. Final pathology revealed a complete pathologic response to immunotherapy. At twelve months, the patient remained recurrence-free, with preserved liver function and improved quality of life. This case highlights the potential of neoadjuvant dual checkpoint blockade to induce tumor regression in selected patients with BCLC-C HCC, thereby expanding surgical candidacy even in the presence of macroscopic vascular invasion. Combined with advances in robotic hepatectomy, such multimodal approaches may redefine resectability criteria.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"616393"},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Interpretable MRI-Based Machine Learning Model for Preoperative Identification of the Vascular Dissemination Phenotype in Hepatocellular Carcinoma: A Dual-Center Study.","authors":"Junhan Pan, Cong Zhang, Yitian Wu, Yanyan Zhu, Yan-Ci Zhao, Shuzhen Wu, Wuyue Chen, Wenbin Ji, Feng Chen","doi":"10.2147/JHC.S612379","DOIUrl":"10.2147/JHC.S612379","url":null,"abstract":"<p><strong>Objective: </strong>To develop and externally validate an interpretable MRI-based machine-learning model for preoperative identification of the vascular dissemination phenotype in hepatocellular carcinoma (HCC), defined by vessels encapsulating tumor clusters (VETC) and/or microvascular invasion (MVI).</p><p><strong>Materials and methods: </strong>This dual-center retrospective study included 642 patients with surgically confirmed HCC who underwent preoperative contrast-enhanced MRI. Patients from Institution I (n = 435) and Institution II (n = 207) formed the training and independent external validation cohorts, respectively. Clinical and conventional MRI predictors were selected using univariable logistic regression, collinearity assessment, and recursive feature elimination. Nine machine-learning models were developed and externally validated. Performance was assessed using area under the curve (AUC), sensitivity, specificity, calibration, decision-curve analysis, and subgroup analyses. SHAP was used for model interpretation, and transcriptomic analysis was performed in 30 patients.</p><p><strong>Results: </strong>Among the nine machine-learning models, XGBoost achieved the highest observed AUCs in the training cohort (0.85; 95% CI: 0.81, 0.88) and external validation cohort (0.82; 95% CI: 0.75, 0.88), with higher AUCs than logistic regression in both cohorts (<i>p</i> < 0.001 and <i>p</i> = 0.047, respectively). In external validation, sensitivity and specificity were 71.1% and 85.5%, respectively. Calibration and decision-curve analyses supported model performance. Subgroup discrimination remained acceptable for tumors ≤ 5.0 cm and BCLC stage 0 or A disease, although sensitivity was lower for tumors ≤ 5.0 cm. SHAP identified intratumoral artery, nonsimple nodular growth type, and necrosis or severe ischemia as leading contributors. Transcriptomic analysis suggested exploratory enrichment of cell-cycle and metabolic pathways.</p><p><strong>Conclusion: </strong>The interpretable MRI-based XGBoost model showed favorable performance for identifying the vascular dissemination phenotype in HCC, with SHAP-based interpretability and exploratory transcriptomic context.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"612379"},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PUM1 Promotes HCC Cell Proliferation and Inhibits Mitochondria‑mediated Apoptosis, Accompanied by Activation of the PI3K-AKT Pathway.","authors":"Junhao Liu, Kejun Liu, Yongxue Lv, Yang Bu, Peng Yuan","doi":"10.2147/JHC.S622310","DOIUrl":"10.2147/JHC.S622310","url":null,"abstract":"<p><strong>Background: </strong>Belonging to the RNA-binding protein family, Pumilio RNA binding family member 1 (PUM1) modulates gene expression post-transcriptionally through the recognition of particular motifs within the 3' untranslated region of its target transcripts. The present investigation seeks to elucidate PUM1's contribution to HCC pathogenesis and advancement, while also probing the molecular mechanisms that underpin its function.</p><p><strong>Methods: </strong>Publicly available datasets were employed to examine PUM1 transcript abundance in hepatocellular carcinoma, along with its relationship to clinicopathological parameters and prognostic outcomes. PUM1 protein levels were subsequently corroborated in clinical HCC specimens via immunoblotting and immunohistochemical staining. To explore the biological functions of PUM1, we established HCCLM3 cell lines with PUM1 overexpression and knockdown. We then evaluated proliferation via EdU, colony formation, and CCK‑8 assays; apoptosis via TUNEL and flow cytometry; mitochondrial membrane integrity and calcium balance using JC‑1, Mito‑Tracker, and Rhod‑2; and oxygen species (ROS) accumulation via MitoSOX and DCFH‑DA. The downstream molecular pathways were further examined by Western blotting.</p><p><strong>Results: </strong>HCC tissues exhibit markedly upregulated PUM1 levels, a feature tightly correlated with poor prognosis. In vitro, PUM1 preserved mitochondrial membrane integrity and calcium homeostasis in HCC cells, while suppressing the accumulation of reactive oxygen species (ROS). Additionally, PUM1 inhibited programmed cell death and promoted cell proliferation. These biological activities were closely associated with the PI3K-AKT signaling pathway. Conversely, knockdown of PUM1 significantly impaired HCC cell proliferation and induced apoptosis.</p><p><strong>Conclusion: </strong>PUM1 promotes HCC cell proliferation and suppresses mitochondria‑mediated apoptosis, effects that are closely associated with activation of the PI3K-AKT pathway.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"622310"},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Preoperative TACE vs Upfront Hepatectomy in Hepatocellular Carcinoma: A Single-Center Retrospective Study in Vietnam.","authors":"Anh Gia Pham, Nghia Trung Bui, Thau Manh Cao, Son Hong Trinh, Huyen Trang Thi Vo, Lam Thanh Phan, Thu Hang Thi Nguyen, Tung Thanh Pham, Hang Thu Nong, Ngoc Thi Tran, Cong Tien Bui","doi":"10.2147/JHC.S619293","DOIUrl":"10.2147/JHC.S619293","url":null,"abstract":"<p><strong>Purpose: </strong>This propensity score-matched study aimed to compare survival outcomes between preoperative TACE followed by hepatectomy and upfront hepatectomy in patients with resectable hepatocellular carcinoma.</p><p><strong>Patients and methods: </strong>In this single-center retrospective cohort study at Viet Duc University Hospital, 304 consecutive patients with resectable HCC treated between January 2015 and October 2024 were analyzed: 168 underwent upfront hepatectomy and 136 received preoperative TACE followed by hepatectomy. Propensity score matching (PSM; 1:1 nearest-neighbor, caliper 0.01) was performed to balance pre-treatment covariates between groups. Overall survival (OS) and disease-free survival (DFS) were compared using Kaplan-Meier analysis and the Log rank test. Independent prognostic factors were identified using multivariable Cox regression.</p><p><strong>Results: </strong>Median follow-up was 58.9 months. After PSM (113 matched pairs), median OS was not reached in the upfront hepatectomy group versus 62.5 months in the preoperative TACE group (P = 0.322), and median DFS was 32.0 versus 29.2 months (P = 0.056). In multivariable Cox analysis of the matched cohort, preoperative TACE was not independently associated with OS (HR 1.15, 95% CI 0.74-1.79; P = 0.526) or DFS (HR 1.19, 95% CI 0.92-1.75; P = 0.130), whereas advanced TNM stage (OS: HR 2.45, 95% CI 1.08-5.52, P = 0.032; DFS: HR 2.26, 95% CI 1.14-4.46, P = 0.019) and microvascular invasion (OS: HR 1.48, 95% CI 1.09-2.40, P = 0.007; DFS: HR 1.52, 95% CI 1.01-2.29, P = 0.035) remained independent prognostic factors. Within the TACE group, patients achieving complete pathological necrosis (n = 26) had OS and DFS comparable to upfront hepatectomy, whereas incomplete or partial necrosis was associated with significantly worse survival (P = 0.05 for OS and P = 0.01 for DFS).</p><p><strong>Conclusion: </strong>In this retrospective, propensity score-matched cohort, preoperative TACE was not associated with improved overall or disease-free survival in patients with resectable HCC and does not appear justified as a routine strategy in patients who are already surgical candidates. Because the analysis was retrospective and residual confounding cannot be excluded, these findings should be regarded as hypothesis-generating. Any role for preoperative TACE in selected settings, such as borderline resectability or when complete tumor necrosis is achieved, requires prospective confirmation.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"619293"},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized Risk Stratification for Early Recurrence of Hepatocellular Carcinoma: A Clinical Tool Derived from a Large-Scale (n=3084) Cohort Study.","authors":"Xuanyi Zhu, Yiteng Zhao, Muyan Li, Shugeng Zhang","doi":"10.2147/JHC.S623497","DOIUrl":"10.2147/JHC.S623497","url":null,"abstract":"<p><strong>Introduction: </strong>Early recurrence (typically within 2 years) following curative liver resection remains the primary obstacle to long-term survival in patients with hepatocellular carcinoma (HCC). Traditional linear staging systems frequently fail to capture the non-linear clinical and biological interactions driving early relapse. This study aimed to develop and validate a methodologically rigorous machine learning framework for precision post-hepatectomy risk stratification, and to deploy an interactive clinical tool.</p><p><strong>Patients and methods: </strong>In this large-scale retrospective cohort study, we analyzed 3084 HCC patients who underwent curative resection. To strictly prevent data leakage and ensure generalizability, the cohort was partitioned into training (60%), validation (20%), and independent test (20%) sets prior to any preprocessing. Six ML algorithms were evaluated, and SHapley Additive exPlanations (SHAP) were employed to decode model transparency. A web-based calculator was subsequently deployed for clinical use.</p><p><strong>Results: </strong>XGBoost emerged as the optimal model, achieving an area under the curve (AUC) of 0.891 (95% CI: 0.865-0.915) on the independent test set, significantly outperforming traditional logistic regression (P < 0.0001). Using a rigorously optimized probability threshold of 0.310, the model yielded a sensitivity of 87.6% (95% CI: 83.5%-91.4%) and a specificity of 70.3% (95% CI: 65.4%-75.2%), with all confidence intervals derived from 2,000 bootstrap resamples. SHAP analysis identified tumor capsule integrity, neutrophil-to-eosinophil ratio (NER), and alpha-fetoprotein (AFP) as the most critical predictors of recurrence.</p><p><strong>Conclusion: </strong>This methodologically rigorous ML framework provides a highly sensitive, data-driven tool for individual risk stratification. By identifying high-risk patients, the web-based calculator can guide clinicians in implementing intensified postoperative surveillance and selecting candidates for targeted adjuvant interventions, ultimately improving oncological outcomes in HCC.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"13 ","pages":"623497"},"PeriodicalIF":3.9,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}