Liver Cancer最新文献

{"title":"Consensus Guideline of Ablation for Metastatic Liver Tumors by Taiwan Academy of Tumor Ablation.","authors":"Ming Shun Wu, Wei-Yu Kao, Ming-Feng Chiang, Po-Heng Chuang, Shih-Jer Hsu, Shen-Yung Wang, Ching-Wei Chang, Chen-Chun Lin, Chao-Hung Hung, Chih Horng Wu, San-Chi Chen, Hsin-Lun Lee, Jen-I Hwang, Po-Chin Liang, Shi-Ming Lin, Chia-Chi Wang","doi":"10.1159/000546765","DOIUrl":"https://doi.org/10.1159/000546765","url":null,"abstract":"<p><p>Metastatic liver tumors (MLTs) are the most common type of malignant liver tumors, primarily because the liver is a frequent target organ for metastasis. Metastatic cancer is generally considered a systemic disease, so the mainstay of treatment should be systemic therapies, including chemotherapy, targeted therapies, and immunotherapy. Currently, it is believed that a multimodal approach, combining local and systemic treatments, can improve tumor control and potentially prolong patient survival. Local treatments, in addition to surgery, include ablation therapy as one of the options. Ablation therapy has its limitations and advantages for local tumor control but can also be combined with other locoregional treatments such as surgical resection, transarterial embolization, and stereotactic body radiotherapy to manage appropriate subsets of patients. Ablation of hepatocellular carcinoma has been performed for many years. In recent years, the number of MLTs cases treated with ablation has been increasing. However, the characteristics of primary liver tumors and MLTs, as well as their responses to ablation therapy, are distinct. At present, there is no established international guideline specifically for the ablation treatment of MLTs. The consensus guidelines developed by the Taiwan Academy of Tumor Ablation (TATA) represent evidence-based medical statements. These guidelines are created and reviewed by an expert team including hepatologists, medical oncologists, radiation oncologists, and intervention radiologists through comprehensive medical literature searches, discussions, and voting. The process adheres to evidence-based standards, such as evaluating levels of evidence and grading recommendations. Furthermore, the guidelines are finalized through thorough discussions among all experts and by calculating voting consistency. In cases where clinical evidence is unclear or lacking, expert opinions are also incorporated. Additionally, the guidelines provide recommendations on the future development of ablation therapy for MLTs.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fever following Treatment with Atezolizumab plus Bevacizumab Predicts Liver Injury in Patients with Unresectable Hepatocellular Carcinoma: A Prospective Observational Analysis.","authors":"Takanori Ito, Takafumi Yamamoto, Kazuki Nishida, Yumiko Kobayashi, Kazuyuki Mizuno, Takaya Suzuki, Shinya Yokoyama, Kenta Yamamoto, Norihiro Imai, Yoji Ishizu, Takashi Honda, Masatoshi Ishigami, Toshinari Koya, Sayori Nakashima, Takehito Naito, Satoshi Yasuda, Teiji Kuzuya, Hidenori Toyoda, Yuichi Ando, Sachiyo Yoshio, Hiroki Kawashima","doi":"10.1159/000546967","DOIUrl":"10.1159/000546967","url":null,"abstract":"<p><strong>Introduction: </strong>Liver injury is a treatment-related adverse event (liver-TRAE), one of the most common complications of atezolizumab plus bevacizumab (Atez/Bev) therapy, when treating unresectable hepatocellular carcinoma (uHCC). Fever following immune checkpoint inhibitor (ICI) therapy may predict ICI-induced liver injury in various malignancy types. However, the association between fever and liver-TRAEs in patients with uHCC treated with Atez/Bev has not been investigated. We prospectively evaluated the relationship between the onset of liver-TRAEs and preceding fever and sought to identify circulating biomarkers that predict liver injury in patients with Atez/Bev-treated uHCC.</p><p><strong>Methods: </strong>The primary outcome of this prospective, multicenter study was the association between liver-TRAEs (grade ≥2) and the presence of ICI-induced fever before the onset of liver injury. We used a multiplex bead-based immunoassay to evaluate 40 circulating proteins in the serum before and at 1, 3, and 6 weeks after initial Atez/Bev treatment.</p><p><strong>Results: </strong>Among 99 patients receiving Atez/Bev, grade ≥2 liver-TRAEs occurred in 10 (10.1%) during the follow-up period (median, 14.7 months). The incidences of liver-TRAEs associated with fever before liver injury were 27.8% (<i>n</i> = 5/18) and 6.2% (<i>n</i> = 5/81) in the fever and non-fever groups, respectively. Multivariable analysis showed that the presence of fever was a significant risk factor for liver-TRAEs (odds ratio 7.57; 95% confidence interval, 1.83-33.89; <i>p</i> = 0.006). Furthermore, the prognosis was worse in the liver-TRAE (grade ≥2) group (<i>p</i> = 0.065 for progression-free survival and <i>p</i> = 0.074 for overall survival). Among patients with preceding fever, the liver-TRAE group had significantly lower CXCL-5 levels before treatment, higher IL-6 levels at 1 and 3 weeks, and lower CXCL-5, IFN-γ, and IL-10 levels at 6 weeks (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Fever during Atez/Bev treatment may predict liver-TRAEs, which leads to poor prognosis in patients with uHCC. Altered inflammatory cytokine and chemokine levels may help predict liver-TRAEs in patients with fever after Atez/Bev therapy.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updated Network Meta-Analysis of First-Line Systemic Treatments for Advanced HCC: Consistent Role of TACE.","authors":"Ye Rim Kim, Euichang Kim, Ha Il Kim, Seungbong Han, Jihyun An, Ju Hyun Shim","doi":"10.1159/000546697","DOIUrl":"10.1159/000546697","url":null,"abstract":"<p><strong>Background and aims: </strong>We conducted an updated network meta-analysis to evaluate and identify the optimal first-line treatment for advanced hepatocellular carcinoma (HCC) among all relevant interventional and targeted therapies.</p><p><strong>Methods: </strong>We analyzed 16 phase 2 or 3 randomized controlled trials involving 9,482 patients with metastatic or unresectable HCC published between 2018 and 2024. The trials evaluated 11 systemic agents and 5 interventional treatments in combination with systemic therapy, using either sorafenib or lenvatinib as the control. The primary outcome was overall survival (OS), and secondary outcomes included progression-free survival (PFS) and grade 3-4 adverse events. Subgroup analyses were conducted to assess individual treatment efficacies in specific clinical settings.</p><p><strong>Results: </strong>Transarterial chemoembolization (TACE) combined with lenvatinib provided the greatest improvement in OS over sorafenib, with a hazard ratio of 0.41 (95% confidence interval, 0.30-0.58), followed by sintilimab + IBI305 (0.57; 0.43-0.75), camrelizumab + rivoceranib (0.62; 0.48-0.80), atezolizumab + bevacizumab (0.66; 0.51-0.85), lenvatinib + pembrolizumab (0.77; 0.62-0.97), and tremelimumab + durvalumab (0.78; 0.64-0.95). These combinations, except for tremelimumab + durvalumab, also showed significantly superior PFS to sorafenib. TACE + lenvatinib was ranked first in OS analyses with the other current standard-of-care regimens (lenvatinib, atezolizumab + bevacizumab, and tremelimumab + durvalumab) as controls. TACE + lenvatinib, sintilimab + IBI305, and atezolizumab + bevacizumab demonstrated consistently significant extension of OS over sorafenib in subsets with portal invasion, extrahepatic metastasis, and hepatitis B. All immunotherapy-based combinations were significantly associated with a higher risk of adverse events than sorafenib.</p><p><strong>Conclusions: </strong>For advanced HCC, our first-line analysis consistently scored TACE + lenvatinib the best for survival outcomes, followed by various immunotherapy-based combinations. However, the superior efficacy of TACE + lenvatinib should be interpreted with consideration of its derivation from a region with high hepatitis B virus prevalence.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis of Hepatectomy versus Systemic Chemotherapy Based on Oncological Resectability Criteria for Borderline Resectable Hepatocellular Carcinoma.","authors":"Shohei Komatsu, Toshifumi Tada, Takashi Nishimura, Motofumi Tanaka, Atsushi Takebe, Saeko Kushida, Yoshimi Fujishima, Nobuaki Ishihara, Takanori Matsuura, Ikuo Nakamura, Taro Okazaki, Masahiro Tsuda, Jun Ishida, Ippei Matsumoto, Seiko Hirono, Hirayuki Enomoto, Yuzo Kodama, Takumi Fukumoto","doi":"10.1159/000546830","DOIUrl":"10.1159/000546830","url":null,"abstract":"<p><strong>Introduction: </strong>Oncological resectability criteria for hepatocellular carcinoma have been defined (resectable [R]/borderline resectable 1 [BR1]/borderline resectable 2 [BR2]); however, their validation is necessary.</p><p><strong>Methods: </strong>A total of 1,469 patients who underwent hepatectomy and 525 patients who received systemic chemotherapy, including lenvatinib, atezolizumab plus bevacizumab, and durvalumab plus tremelimumab, as first-line treatment were analyzed.</p><p><strong>Results: </strong>In the BR1 group, the median survival times (MSTs) of patients who underwent hepatectomy and systemic chemotherapy were 52.7 and 34.6 months, respectively, without a significant difference (<i>p</i> = 0.075). In the propensity score matching (PSM) analysis of the BR1 group, the MSTs of hepatectomy and systemic chemotherapy were 42.4 and 35.1 months, respectively, without a significant difference (<i>p</i> = 0.772). Hepatitis virus infection, modified albumin-bilirubin (mALBI) grade 2b + 3, and the presence of extrahepatic metastasis were identified as poor prognostic factors for hepatectomy, whereas mALBI grade 2b + 3 was the only poor prognostic factor for systemic chemotherapy. In the BR2 group, the MSTs of hepatectomy and systemic chemotherapy were 20.1 and 19.5 months, respectively, with significantly better survival for hepatectomy than for systemic chemotherapy (<i>p</i> = 0.017). In the PSM analysis of the BR2 group, the MSTs of hepatectomy and systemic chemotherapy were 20.1 and 21.0 months, respectively, without a significant difference (<i>p</i> = 0.375). Serum alpha-fetoprotein levels≥100, intrahepatic tumor number ≥6, and the presence of extrahepatic metastasis were identified as poor prognostic factors for hepatectomy, whereas female, serum alpha-fetoprotein levels ≥100, mALBI grade 2b + 3, intrahepatic maximal tumor size >5 cm, and the presence of extrahepatic metastasis were identified as poor prognostic factors for systemic chemotherapy.</p><p><strong>Conclusion: </strong>In the PSM analysis, no significant differences were observed between the BR1 and BR2 groups for hepatectomy and systemic chemotherapy. The intrahepatic tumor number for hepatectomy and the intrahepatic maximal tumor size for systemic chemotherapy are significant risk factors for BR2 patients, highlighting the characteristics of each treatment and the potential for selecting the optimal modality.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the Letter regarding \"Combination Assay of Methylated <i>HOXA1</i> with Tumor Markers for Detection of Early-Stage Hepatocellular Carcinoma\".","authors":"Yuki Kunimune, Yutaka Suehiro, Issei Saeki, Kiyoshi Ichihara, Teppei Yamashita, Taro Takami, Takahiro Yamasaki","doi":"10.1159/000546560","DOIUrl":"10.1159/000546560","url":null,"abstract":"","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etiology of Hepatocellular Carcinoma May Influence the Pattern of Progression under Atezolizumab-Bevacizumab.","authors":"Bernardo Stefanini, Fabio Piscaglia, Fabio Marra, Massimo Iavarone, Caterina Vivaldi, Giuseppe Cabibbo, Andrea Palloni, Tiziana Pressiani, Andrea Dalbeni, Benedetta Stefanini, Leonardo Stella, Piera Federico, Gianluca Svegliati-Baroni, Sara Lonardi, Caterina Soldà, Luca Ielasi, Stefania De Lorenzo, Ingrid Garajova, Claudia Campani, Mariangela Bruccoleri, Gianluca Masi, Ciro Celsa, Giovanni Brandi, Alessandra Auriemma, Bruno Daniele, Francesca Romana Ponziani, Lorenzo Lani, Rusi Chen, Maria Boe, Alessandro Granito, Lorenza Rimassa, Francesco Tovoli","doi":"10.1159/000545494","DOIUrl":"10.1159/000545494","url":null,"abstract":"<p><strong>Background: </strong>Preclinical models have shown that metabolic dysfunction-associated steatotic liver disease (MASLD)-related hepatocellular carcinoma (HCC) may exhibit reduced responsiveness to immunotherapy, especially for intrahepatic lesions due to liver tumor microenvironment. Radiological pattern of progression has been validated in clinical studies as a useful tool for predicting outcomes in HCC undergoing systemic treatments.</p><p><strong>Aims: </strong>The aim of this study was to determine whether MASLD influences the pattern of progression in patients treated with atezolizumab-bevacizumab.</p><p><strong>Methods: </strong>This multicenter, prospective study included patients with unresectable HCC receiving atezolizumab-bevacizumab. Progression patterns were defined as previously proposed. Patients were categorized as either MASLD or controls based on a recent multisocietal Delphi consensus statement. Multivariable models analyzed the risk of specific progression patterns and their impacts on post-progression survival (PPS) and overall survival (OS). A historical cohort treated with sorafenib was also analyzed to determine whether observed patterns were specific for atezolizumab-bevacizumab.</p><p><strong>Results: </strong>Four-hundred twenty patients were included (MASLD: <i>n</i> = 88, 21.0%). Time to progression (TTP) was shorter in MASLD compared to controls, due to an increased risk of intrahepatic growth (IHG - hazard ratio [HR] 1.739, 95% confidence interval [CI] 1.206-2.507, <i>p</i> = 0.003]). Neither etiology nor IHG predicted a different PPS. No differences between etiologies were found in OS. Etiology did not influence the pattern of progression under sorafenib in the historical cohort.</p><p><strong>Conclusion: </strong>IHG was more frequently associated with MASLD-HCC compared to controls, confirming preclinical data and suggesting biological differences between tumors, with potential implications for future research. MASLD should not be seen as a contraindication to immunotherapy.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":"1-14"},"PeriodicalIF":11.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Camrelizumab Combined with Lenvatinib and RALOX-Hepatic Arterial Infusion Chemotherapy for Unresectable Hepatocellular Carcinoma (Cal Era): A Prospective, Single-Arm, Phase II Trial.","authors":"Mengya Zang, Qi Li, Xiaoyun Hu, Huajin Pang, Rong Li, Wenli Li, Yongru Chen, Peilin Zhu, Kaiyan Su, Guosheng Yuan, Yuan Li, Yuanfeng Li, Jinzhang Chen","doi":"10.1159/000546575","DOIUrl":"10.1159/000546575","url":null,"abstract":"<p><strong>Introduction: </strong>Combining systemic agents with hepatic arterial infusion chemotherapy (HAIC) has produced promising outcomes in advanced hepatocellular carcinoma (HCC). Raltitrexed, an antimetabolite recognized for its extended plasma half-life, enables shorter infusion schedules. This study aimed to assess the efficacy, safety, and potential predictive biomarkers of a therapeutic approach incorporating camrelizumab, lenvatinib, and a HAIC protocol using raltitrexed plus oxaliplatin (RALOX) in patients with intermediate-to-advanced HCC.</p><p><strong>Methods: </strong>Participants in this single-arm phase II study (NCT05003700) had Barcelona Clinic Liver Cancer (BCLC) stage B or C HCC. They received RALOX-HAIC in tandem with camrelizumab and lenvatinib for a maximum of 6 cycles, continuing until either disease progression or unacceptable toxicity. The primary outcome measure was the objective response rate (ORR).</p><p><strong>Results: </strong>Thirty-nine individuals underwent at least one tumor review after baseline. The confirmed ORR was 66.7% (95% CI, 49.8-80.9). The median progression-free survival was 13.8 months (95% CI, 10.5-20.5), and the median overall survival was 21.2 months (95% CI, 14.3-21.2). Grade 3-4 treatment-related adverse events occurred in 79.5% of the subjects, with the most common being decreased neutrophil count (41%), decreased platelet count (30.8%), and increased aspartate aminotransferase (23.1%). All side effects were, as anticipated, controllable, and no treatment-related deaths were reported. Serum IL-2, CXCL13, and CCL19 levels significantly differed between stable disease and partial response patients (<i>p</i> < 0.05 and |fold change| >1.5). Furthermore, risk stratification based on these three biomarkers revealed shorter progression-free survival and overall survival in high-risk versus low-risk subgroups (<i>p</i> < 0.05). These results suggested that the serum concentrations of IL-2, CXCL13, and CCL19 emerged as potential predictors of clinical benefits under this triple-combination protocol.</p><p><strong>Conclusion: </strong>The triple regimen of camrelizumab, lenvatinib, and RALOX-HAIC exhibited notable antitumor capabilities and acceptable tolerability in patients with advanced HCC. Moreover, baseline levels of IL-2, CXCL13, and CCL19 may function as predictive indicators of the response to this first-line therapeutic strategy.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":"1-12"},"PeriodicalIF":11.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transarterial Chemoembolization plus Sorafenib versus Sorafenib Alone in Advanced Hepatocellular Carcinoma (SELECT): A Multicenter, Phase 3, Randomized, Controlled Trial.","authors":"Yan Zhao, Wei Bai, Rong Ding, Nan You, Lin Zheng, Lei Li, Jianbing Wu, Peng Zhang, Wukui Huang, Hui Zhang, Yongjin Zhang, Diwen Zhu, Haiping Li, Dongdong Xia, Jie Yuan, Xiaomei Li, Zhengyu Wang, Bohan Luo, Wengang Guo, Zhanxin Yin, Wei Mu, Ming Huang, Jing Li, Weixin Ren, Daiming Fan, Yong Lv, Guohong Han","doi":"10.1159/000546530","DOIUrl":"10.1159/000546530","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with advanced hepatocellular carcinoma (HCC) face an extremely poor prognosis. Sorafenib, a multikinase inhibitor, remains an essential treatment for advanced HCC in certain clinical settings where immunotherapy is either contraindicated or unavailable. However, the survival benefit of transarterial chemoembolization (TACE) plus sorafenib remains under investigation.</p><p><strong>Methods: </strong>The SELECT trial was a multicenter, randomized, controlled study conducted across twelve centers in China. From September 7, 2013, to December 4, 2019, 199 patients with advanced-stage HCC were randomly assigned in a 1:1 ratio to receive either TACE plus sorafenib or sorafenib monotherapy.</p><p><strong>Results: </strong>The median age of the study population was 55 years (IQR 46-63), with hepatic virus infection being the predominant cause of HCC. In the intention-to-treat (ITT) population, the overall survival (OS) analysis did not show a statistically significant difference between the combination and sorafenib monotherapy groups (14.9 months [95% CI: 10.5-19.3] vs. 11.9 months [95% CI: 9.0-14.8], HR 0.862, <i>p</i> = 0.312). However, the combination therapy group demonstrated significantly improved time to progression (TTP) (10.0 months [95% CI: 6.4-13.6] vs. 5.9 months [95% CI: 3.1-8.7]; <i>p</i> = 0.016) and post hoc progression-free survival (PFS) (8.5 months [95% CI: 6.7-10.3] vs. 5.6 months [95% CI: 4.1-7.1]; <i>p</i> = 0.034). In predefined per-protocol analysis, the combination therapy group showed a significantly longer median OS compared to the monotherapy group (14.6 months [11.3-17.9] vs. 7.4 months [95% CI: 4.3-10.5], HR 0.539, <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>Although the combination of TACE and sorafenib did not demonstrate a significant improvement in OS in the ITT analysis, it met the secondary endpoints, including TTP and post hoc PFS. These findings provide valuable insights for the design of future trials and highlight the importance of integrating locoregional interventions with systemic therapies in the management of advanced-stage HCC.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":"1-14"},"PeriodicalIF":11.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12201953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Risk of Decompensation in Steatotic Liver Disease-Related Hepatocellular Carcinoma: A Comparison with Viral-Controlled Cases.","authors":"Yuki Matsushita, Tatsuya Minami, Yoshikuni Kawaguchi, Akihiko Ichida, Ryo Oikawa, Keisuke Mabuchi, Makoto Moriyama, Tomoharu Yamada, Kazuya Okushin, Takuma Nakatsuka, Masaya Sato, Yotaro Kudo, Mitsuhiro Fujishiro, Kiyoshi Hasegawa, Ryosuke Tateishi","doi":"10.1159/000546492","DOIUrl":"10.1159/000546492","url":null,"abstract":"<p><strong>Background and aims: </strong>Treatment options for steatotic liver disease (SLD) are limited compared to those for viral hepatitis, which may affect the prognosis of patients with hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>This retrospective cohort study included 255 and 125 patients with SLD-related HCC and viral-controlled HCC (80 hepatitis C and 45 hepatitis B) who underwent curative radiofrequency ablation (RFA) for primary HCC (maximum tumor diameter ≤3 cm and ≤3 lesions). Viral control was defined as a sustained virological response to hepatitis C and undetectable hepatitis B viruses on a nucleos(t)ide analog before HCC diagnosis. Overall survival, recurrence rates, and hepatic decompensation rates were evaluated using the Kaplan-Meier method and Cox proportional hazard models between the two groups. Validation was performed in a surgical cohort of 120 patients (70 with SLD and 50 controls).</p><p><strong>Results: </strong>The 1-, 3-, and 5-year survival rates were 97%, 81%, and 62% for patients with SLD-related HCC, and 100%, 94%, and 89% for viral-controlled patients in the RFA cohort, respectively (<i>p</i> < 0.001, log-rank test). Multivariate analysis showed no significant difference in recurrence between the two groups (adjusted hazard ratio [aHR] 1.06, <i>p</i> = 0.75); however, a higher risk of hepatic decompensation was observed in patients with SLD-related HCC (aHR 6.17; <i>p</i> < 0.001) and a worse overall survival (aHR 2.04; <i>p</i> = 0.003). Similar results were observed in the surgical cohort.</p><p><strong>Conclusion: </strong>Patients with SLD-related HCC have a higher risk of decompensation than viral-controlled patients with HCC, which leads to a worse overall survival.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":"1-13"},"PeriodicalIF":11.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Concept of \"Converse Therapeutic Hierarchy\" for Patients with Hepatocellular Carcinoma.","authors":"Alessandro Vitale, Giuseppe Cabibbo, Lorenza Rimassa, Massimo Iavarone, Agostino Colli, Laura Crocetti, Timothy M Pawlik, Andrea Casadei-Gardini, Francesca Romana Ponziani, Irene Bargellini, Francesco Tovoli, Umberto Cillo, Edoardo G Giannini","doi":"10.1159/000546360","DOIUrl":"10.1159/000546360","url":null,"abstract":"<p><strong>Background: </strong>The clinical complexity of patients with hepatocellular carcinoma (HCC), the availability of multiple therapeutic options, and clinical therapeutic intents could make it challenging to identify an unequivocal limit between conversion, downstaging/downsizing, and neoadjuvant therapies and curative or palliative intent treatments and to dimension the most proper sequential therapeutic strategy for each patient.</p><p><strong>Summary: </strong>The concept of converse therapeutic hierarchy could rationally embrace all the different sequential treatment options (e.g., from surgery to systemic therapy) and the different therapeutic clinical intents (e.g., curative, neoadjuvant, downstaging/downsizing, conversion, and palliative), sharing the common goal of converting the patient with HCC from a less to a more favourable condition to improve the chance (higher applicability - conversion or downstaging intent) or the effectiveness (better postoperative outcome - neoadjuvant intent) of \"intent-to-cure treatments.\" This narrative review aims to introduce and explain the umbrella concept of the converse therapeutic hierarchy as a valuable framework for everyday clinical practice, enabling clinicians to better define ideal candidates and good responders for each sequential strategy. Furthermore, the converse therapeutic hierarchy concept represents a flexible container that should be continuously filled with new scientific evidence to build different sequential treatment strategies in the multidisciplinary and multi-step management of patients with HCC. An operative and pragmatic definition of the various sequential treatment strategies, based on the initial probability of intent to cure therapy for patients with HCC, has also been proposed. This probability varies from very high to low. It is related to the initial treatment choice and the multiparametric patient evaluation (e.g., patient's fitness, tumour features, liver function, and technical aspects) done by an expert multidisciplinary tumour board.</p><p><strong>Key messages: </strong>The converse therapeutic hierarchy concept represents a valuable and pragmatic framework for everyday clinical practice. It also serves as a flexible container that must be filled with new high-quality evidence and expert consensus to better define the clinical boundaries between the different HCC sequential treatment strategies (e.g., neoadjuvant, downstaging/downsizing, and conversion).</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":" ","pages":"1-15"},"PeriodicalIF":11.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}