Management of Hepatocellular Carcinoma: A Review

CDCA8 and its multifaceted role in tumorigenesis

Human cell division cycle-associated 8 (CDCA8), also known as Borealin or Dasra-B, is a critical component of the vertebrate Chromosomal Passenger Complex (CPC). It plays a pivotal role in the segregation of sister chromatids during the cell cycle and is essential for preventing the formation of aneuploid chromosomes and ensuring successful cytokinesis. Numerous studies have demonstrated that CDCA8 is upregulated in various cancers, including hepatocellular carcinoma, lung cancer, glioma, and bladder cancer. By influencing key biological processes such as cell proliferation, apoptosis, invasion, and metastasis, CDCA8 drives tumor progression. Clinically, the expression of CDCA8 correlates closely with tumor staging and histological grading, providing significant prognostic value for patients with diverse cancers. Moreover, CDCA8 modulates tumor biology through multiple signaling pathways, including P53, PI3K/Akt, E2F/Rb, and mTOR. In summary, CDCA8 represents a promising diagnostic and therapeutic target across multiple cancer types and serves as a potential prognostic biomarker. This review highlights the critical roles of CDCA8 in cancer diagnosis, treatment, and prognosis, as well as the underlying mechanisms through which it exerts its effects. These insights offer a theoretical basis and research direction for early cancer diagnosis, targeted therapy, and prognostic evaluation.

BAIAP2L2 facilitates hepatocellular carcinoma progression and immune evasion of via targeting JAK1-mediated pathway and PD-L1 expression

Hepatocellular carcinoma (HCC) poses a serious threat to human health due to its high mortality rate. Recently, breakthrough progress has been made in immunotherapy field. However, the mechanisms underlying HCC progression and immune escape are still unclear. This study aimed to investigate the impact of brain-specific angiogenesis inhibitor 1-associated protein 2-like 2 (BAIAP2L2) in HCC and elucidate its potential mechanisms in this context. Clinical data revealed that the overexpression of BAIAP2L2 correlated with tumor progression and poor prognosis in HCC patients. Functional assays demonstrated that BAIAP2L2 facilitates HCC proliferation, metastasis, invasion, and PD-L1-mediated immune evasion both in vitro and in vivo. Mechanistically, we observed co-localization and interaction between BAIAP2L2 and JAK1 within HCC cells, in turn enhancing the activation of the JAK1/STAT3 signaling pathway. Utilizing the JAK1 inhibitor Ruxolitinib effectively reversed BAIAP2L2-induced cellular processes such as proliferation, migration, invasion, and PD-L1 upregulation. Overall, our results emphasize that BAIAP2L2 plays a crucial role in driving tumor progression and immune evasion in HCC through the JAK1-mediated signaling pathway, thus proposing BAIAP2L2 as a promising therapeutic target for HCC treatment.

Spatial immune scoring system predicts hepatocellular carcinoma recurrence

Given the high recurrence rates of hepatocellular carcinoma (HCC) post-resection1-3, improved early identification of patients at high risk for post-resection recurrence would help to improve patient outcomes and prioritize healthcare resources4-6. Here we observed a spatial and HCC recurrence-associated distribution of natural killer (NK) cells in the invasive front and tumour centre from 61 patients. Using extreme gradient boosting and inverse-variance weighting, we developed the tumour immune microenvironment spatial (TIMES) score based on the spatial expression patterns of five biomarkers (SPON2, ZFP36L2, ZFP36, VIM and HLA-DRB1) to predict HCC recurrence risk. The TIMES score (hazard ratio = 88.2, P < 0.001) outperformed current standard tools for patient risk stratification including the TNM and BCLC systems. We validated the model in 231 patients from five multicentred cohorts, achieving a real-world accuracy of 82.2% and specificity of 85.7%. The predictive power of these biomarkers emerged through the integration of their spatial distributions, rather than individual marker expression levels alone. In vivo models, including NK cell-specific Spon2-knockout mice, revealed that SPON2 enhances IFNγ secretion and NK cell infiltration at the invasive front. Our study introduces TIMES, a publicly accessible tool for predicting HCC recurrence risk, offering insights into its potential to inform treatment decisions for early-stage HCC.

Synthetic RIG-I-Agonist RNA Induces Death of Hepatocellular Carcinoma Cells

Retinoic acid-inducible gene I (RIG-I) is a critical sensor of viral RNA and is activated in response to binding to RNA containing exposed 5'-triphosphate (5'ppp) and poly-uridine to trigger innate immune activation and response including induction of type I and III interferons (IFNs). RIG-I signaling plays a key role in not only restricting RNA virus infection but also suppressing tumor progression via oncolytic signaling. We evaluated the actions of a specific RIG-I agonist RNA (RAR) as a potential therapeutic against model tumor cell lines representing hepatocellular carcinoma (HCC). RAR constitutes a synthetic-modified RNA motif derived from the hepatitis C virus genome that is specifically recognized by RIG-I and induces innate immune activation when delivered to cells. We found that RAR directs RIG-I-dependent signaling to drive HCC cell death. Analysis of knockout cell lines lacking RIG-I, mitochondrial activator of virus signaling, or IRF3 confirmed that RAR-induced cell death signaling propagates through the RIG-I-like receptor (RLR) pathway to mediate caspase activation and HCC cell death. RAR-induced cell death is potentiated by type I IFN. Thus, RAR actions trigger HCC cell death through RIG-I linkage of RLR, caspase, and IFN signaling programs. RAR offers a potent application in antitumor therapeutic strategies leveraging innate immunity against liver cancer.

Gd-EOB-DTPA-enhanced MRI radiomics and deep learning models to predict microvascular invasion in hepatocellular carcinoma: a multicenter study

BACKGROUND

Microvascular invasion (MVI) is an important risk factor for early postoperative recurrence of hepatocellular carcinoma (HCC). Based on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) images, we developed a novel radiomics model. It combined bi-regional features and two machine learning algorithms. The aim of this study was to validate its potential value for preoperative prediction of MVI.

METHODS

This retrospective study included 304 HCC patients (training cohort, 216 patients; testing cohort, 88 patients) from three hospitals. Intratumoral and peritumoral volumes of interest were delineated in arterial phase, portal venous phase, and hepatobiliary phase images. Conventional radiomics (CR) and deep learning radiomics (DLR) features were extracted based on FeAture Explorer software and the 3D ResNet-18 extractor, respectively. Clinical variables were selected using univariate and multivariate analyses. Clinical, CR, DLR, CR-DLR, and clinical-radiomics (Clin-R) models were built using support vector machines. The predictive capacity of the models was assessed by the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity.

RESULTS

The bi-regional CR-DLR model showed more gains and gave better predictive performance than the single-regional models or single-machine learning models. Its AUC, accuracy, sensitivity, and specificity were 0.844, 76.9%, 87.8%, and 69.1% in the training cohort and 0.740, 73.9%, 50%, and 84.5% in the testing cohort. Alpha-fetoprotein (odds ratio was 0.32) and maximum tumor diameter (odds ratio was 1.270) were independent predictors. The AUCs of the clinical model and the Clin-R model were 0.655 and 0.672, respectively. There was no significant difference in the AUCs between all the models (P > 0.005).

CONCLUSION

Based on Gd-EOB-DTPA-enhanced MRI images, we focused on developing a radiomics model that combines bi-regional features and two machine learning algorithms (CR and DLR). The application of the new model will provide a more accurate and non-invasive diagnostic solution for medical imaging. It will provide valuable information for clinical personalized treatment, thereby improving patient prognosis.

CLINICAL TRIAL NUMBER

Not applicable.

AEBP1 inhibition reduces cell growth and PI3K/AKT pathway while less regulates cell mobility in hepatocellular carcinoma

BACKGROUND

Adipocyte enhancer-binding protein 1 (AEBP1) regulates collagen fibrosis, extracellular matrix, and important oncogene pathways, but its regulation on hepatocellular carcinoma (HCC) is not known. This study aimed to investigate the effect of AEBP1 knockdown on HCC cell proliferation, apoptosis, migration, invasion and PI3K/AKT pathway.

METHODS

MHCC-97 H and Huh7 cell lines were applied. Negative control or AEBP1 siRNA (siAEBP1) were transfected into cells, and cells without transfection were set as blank control. Quantitative polymerase chain reaction (qPCR), western blot, Cell Counting Kit-8 (CCK-8), 5-Ethynyl-2'-deoxyuridine (EdU) staining, Terminal-deoxynucleotidyl Transferase Mediated Nick End Labeling (TUNEL) staining, Transwell invasion, and cell scratch assays were performed.

RESULTS

AEBP1 mRNA and protein expressions were lower after siAEBP1 transfection in MHCC-97 H and Huh7 cells. OD value of CCK-8 and EdU positive cell percentage were decreased, while TUNEL reflected cell apoptosis rate was increased, after siAEBP1 transfection in MHCC-97 H and Huh7 cells. However, invasive cell number and cell migration rate were only reduced after siAEBP1 transfection in Huh7 cells but not in MHCC-97 H cells. Expressions of p-PI3K/PI3K and p-AKT/AKT were downregulated after siAEBP1 transfection in MHCC-97 H and Huh7 cells. Subsequent rescue experiment revealed that th activation of PI3K/AKT pathway by 740Y-P attenuated the effect of siAEBP1 transfection in MHCC-97 H and Huh7 cells.

CONCLUSION

AEBP1 exhibits the potency to be a target for HCC treatment, reflected by its regulation on HCC proliferation, apoptosis and PI3K/AKT pathway, but its effect on HCC invasion and migration seems limited.

PD-1 inhibitors improve the efficacy of transcatheter arterial chemoembolization combined with apatinib in advanced hepatocellular carcinoma: a meta-analysis and trial sequential analysis

BACKGROUND

The efficacy of adding programmed death-1 (PD-1) inhibitors to transcatheter arterial chemoembolization (TACE) combined with apatinib for advanced hepatocellular carcinoma (HCC) remains controversial. This study aimed to evaluate the efficacy of incorporating PD-1 inhibitors into TACE combined with apatinib.

METHODS

Relevant literature on TACE combined with apatinib plus PD-1 inhibitors for advanced HCC was searched in PubMed, Cochrane Library, Embase, and Web of Science databases. Trial sequential analysis (TSA) was conducted to minimize randomization errors and assess whether the meta-analysis provided conclusive evidence.

RESULTS

Six studies involving 1,452 patients were included. Compared with the TACE combined with apatinib treatment group (T-A), TACE combined with apatinib plus PD-1 inhibitors (T-A-P) significantly prolonged overall survival (OS) (Hazard Ratio [HR] 2.22, 95% Confidence Interval [CI] 1.93-2.56; p < 0.001) and progression-free survival (PFS) (HR 2.36, 95% CI 2.01-2.77; p < 0.001), while also improving the objective response rate (ORR) (risk ratios [RR] 1.60, 95% CI 1.20-2.14; p < 0.001) and disease control rate (DCR) (RR 1.06, 95% CI 1.00-1.12; p < 0.001). TSA results indicated that additional studies were required to confirm the significance of DCR. Prognostic analysis identified treatment regimen and extrahepatic metastasis as common independent risk factors for OS and PFS. The incidence of adverse events in the T-A-P treatment group was comparable to that in the T-A treatment group.

CONCLUSION

Adding PD-1 inhibitors to TACE combined with apatinib significantly prolonged OS and PFS, particularly in patients without extrahepatic metastases. It also improved ORR and DCR in patients with HCC.

Radiomic features at contrast-enhanced CT predict proliferative hepatocellular carcinoma and its prognosis after transarterial chemoembolization

Proliferative hepatocellular carcinoma (HCC) is an aggressive phenotype associated with unfavorable clinical outcomes. Predicting the preoperative subtype of HCC can aid in the development of individualized treatment. We retrospectively recruited 180 HCC patients who underwent hepatic resection and established a CT-based radiomics model for predicting proliferative HCCs. The evaluation of tumor response to transarterial chemoembolization therapy and progression-free survival (PFS) according to the radiomics model was further performed in internal (n = 54) and external (n = 80) outcome cohorts. In our study, 98 of 180 (54%) patients were confirmed to have proliferative HCCs. The radiomics model comprising 9 radiomic features and exhibited good performance for predicting proliferative HCCs. The nomogram integrated radiomics and serum α-fetoprotein level showed good calibration and discrimination in both the training cohort (AUC = 0.848) and the validation cohort (AUC = 0.825). Predicted proliferative HCCs (high radiomics scores) were associated with lower response rate (P < 0.05) and worse PFS (P < 0.05) compared to predicted non-proliferative HCCs in outcomes cohorts. We linked radiomics model to gene expression, unveiling that activated/immature B cells and tertiary lymphoid structures were downregulated in the high radiomics group. The proposed CT radiomics model exhibited good performance for identifying proliferative HCCs, which may facilitate clinical decision-making. Our findings suggest a potential correlation between proliferative HCC and immunosuppressive tumor microenvironment.

ESR1-dependent suppression of LCN2 transcription reverses autophagy-linked ferroptosis and enhances sorafenib sensitivity in hepatocellular carcinoma

Sorafenib resistance is a significant hurdle in the treatment landscape of hepatocellular carcinoma (HCC). Lipocalin 2 (LCN2), a secretory glycoprotein that transports lipophilic molecules across cell membranes, is thought to affect the s therapeutic efficacy of sorafenib. Despite its importance, the detailed regulatory pathways involving LCN2 are still being deciphered. We probed the correlation between LCN2 expression and sorafenib resistance in HCC cells. Through the modulation of LCN2 levels, we investigated its role in cell proliferation, apoptosis, and its regulatory effects on autophagy-driven ferroptosis. With the aid of hTFtarget and JASPAR databases, ESR1 was pinpointed as a transcriptional inhibitor of LCN2. The impact of the ESR1-LCN2 axis on sorafenib resistance in HCC was then examined in vitro and validated in a xenograft tumor mouse model. In HCC cells, elevated LCN2 levels were found to be associated with resistance to sorafenib. Depletion of LCN2 resulted in attenuated HCC cell growth and elevated rates of apoptosis and ferroptosis. Overexpression of LCN2 had the opposite effect, promoting cell proliferation and suppressing cell death pathways, a response that could be overridden by autophagy agonists. ESR1 suppressed LCN2 transcription, which in turn activated autophagy-mediated ferroptosis, mitigating sorafenib tolerance in HCC and enhancing the therapeutic index. ESR1 targets LCN2 transcription to initiate autophagy-driven ferroptosis, thereby reducing sorafenib resistance in HCC cells.

The Role of the Gut-Biliary-Liver Axis in Primary Hepatobiliary Liver Cancers: From Molecular Insights to Clinical Applications

Background: Hepatobiliary liver cancers (HBLCs) represent the sixth most common neoplasm in the world. Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) constitute the main HBLC types, with alarming epidemiological projections. Methods: In recent decades, alterations in gut microbiota, with mutual implications on the gut-liver axis and gut-biliary axis permeability status, have been massively investigated and proposed as HBLC pathogenetic deus ex machina. Results: In the HCC setting, elevated intestinal levels of Escherichia coli and other Gram-negative bacteria have been demonstrated, resulting in a close association with increased lipopolysaccharide (LPS) serum levels and, consequently, chronic systemic inflammation. In contrast, the intestinal microbiota of HCC individuals feature reduced levels of Lactobacillus spp., Bifidobacterium spp., and Enterococcus spp. In the CC setting, evidence has revealed an increased expression of Lactobacillus spp., with enhanced levels of Actynomices spp. and Alloscardovia spp. Besides impaired strains/species representation, gut-derived metabolites, including bile acids (BAs), short-chain fatty acids (SCFAs), and oxidative-stress-derived products, configure a network severely impacting the progression of HBLC. Conclusions: In the era of Precision Medicine, the clarification of microbiota composition and functioning in HCC and CC settings can contribute to the identification of individual signatures, potentially providing novel diagnostic markers, therapeutic approaches, and prognostic/predictive tools.

Highly expressed GCN1 is associated with cancer progression and poor prognosis in hepatocellular carcinoma patients

BACKGROUND

General control non-derepressible protein 1 (GCN1), a ribosome-binding protein, has been implicated in the development and progression of multiple cancers. However, the potential role of GCN1 in hepatocellular carcinoma (HCC) has not yet been investigated.

METHODS

The expression of GCN1 in HCC was analyzed using multiple databases. Bioinformatics analysis was employed to investigate the correlation of GCN1 expression with clinical significance and immune infiltration in HCC. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, gene set enrichment analysis (GSEA), and in vitro experiments were conducted to study the function and potential mechanisms of GCN1 in HCC.

RESULTS

GCN1 was significantly upregulated in HCC, which was associated with worse clinicopathological features and poorer prognosis of the patients. GCN1 expression was closely associated with immune cell infiltration in HCC. GSEA analysis showed that GCN1 was involved in several tumor-related signaling pathways, including cell cycle, DNA replication, and Wnt signaling pathway. Knockdown of GCN1 inhibited the proliferation, invasion and migration of HCC cells, and also down-regulated the expression levels of cell cycle protein cyclin B1 (CCNB1), cyclin D1 (CCND1), and Wnt signaling pathway-related proteins Wnt3A and β-catenin.

CONCLUSION

GCN1 overexpression was associated with HCC progression and poor prognosis, and GCN1 knockdown could suppress the proliferation, migration and invasion ability of HCC cells by regulating Wnt signaling pathway, suggesting the potential of GCN1 as a prognostic and therapeutic target for HCC.

Hypericin Nanoparticles-Associated Photodynamic Therapy Modulates the Biological Behavior of Hepatocellular Carcinoma by SERPINE1

Background

In recent years, photodynamic therapy (PDT) has gradually attracted the attention of researchers due to its therapeutic potential for treating malignant tumors. Hypericin (HC) is anticipated to enhance the therapeutic effect on tumors as an efficient photosensitizer (PS) for PDT. However, the role and mechanism of PDT in hepatocellular carcinoma (HCC) remain unclear.

Methods

In this study, we investigated the efficacy of hypericin nanoparticles (HC-NPs)-associated PDT (HC-NPs-PDT) on HCC to explore its anti-HCC mechanism both in vitro and in vivo. Cellular molecular experiments, as well as HCC mouse tumor models, were utilized to validate the impact of HC-NPs-PDT on HCC. Additionally, molecular docking and related experiments were employed to investigate its potential mechanism.

Results

Our findings demonstrated that HC-NPs-PDT effectively inhibits the viability, migration, and invasion abilities of HCC cells, as well as suppresses the growth of subcutaneous HCC tumors in BALB/C-nu nude mice. SERPINE1 (also known as PAI, PAI-1, PAI1, PLANH1) may be a key target of HC, as its mRNA and protein levels were significantly up-regulated following HC-NPs-PDT. This upregulation led to a decrease in mitochondrial membrane potential and promoted apoptosis of HCC cells. Additionally, inhibition of SERPINE1 partially restored changes in mitochondrial membrane potential.

Conclusion

These results suggest that HC-NPs-PDT may regulate the biological behavior of HCC by upregulating SERPINE1 expression, offering a new perspective for treating HCC.

Liver transplantation for NASH-related hepatocellular carcinoma versus non-NASH etiologies of hepatocellular carcinoma: A systematic review and meta-analysis

BACKGROUND

Non-alcoholic steatohepatitis (NASH)-associated hepatocellular carcinoma (HCC) has been emerging a predominant reason for liver transplantation (LT). The complexity of comorbidities in this population increases the possibility of poor transplant outcomes. The purpose of this study was to evaluate the differences in survival after transplantation among patients with NASH HCC and those with non-NASH HCC.

METHOD

We conducted systematic searches of the PubMed, Embase, Web of Science, and Cochrane Library databases. To analyze the data, both fixed and random-effects models were employed to aggregate hazard ratios (HRs) along with 95% confidence intervals (CIs) for recurrence-free survival (RFS) and overall survival (OS) outcomes. This study is registered with PROSPERO as CRD42024578441.

RESULTS

A total of seven studies were included in this study. This study revealed that there was no significant difference in OS between liver transplant recipients with NASH HCC and those with non-NASH HCC. The RFS of NASH HCC patients were significantly longer. The HRs were 0.70 (95% CI: 0.51-0.97, P = 0.03) for RFS and 0.88 (95% CI: 0.72-1.07, P = 0.21) for OS, respectively.

CONCLUSION

This study indicates that patients with NASH HCC who undergo LT have comparable OS as those with non-NASH HCC, while NASH HCC was associated with increased RFS. However, further research in randomized trials is necessary to verify these results and address potential selection biases.

Redefining hepatocellular carcinoma treatment: nanotechnology meets tumor immune microenvironment

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide, characterised by its complex pathogenesis and poor therapeutic outcomes. Despite recent advances in targeted molecular therapies, immune checkpoint inhibitors (ICIs), radiotherapy and conventional chemotherapy, the 5-year survival rate for this neoplasm remains dismally low. The progress in nanotechnology has revolutionised cancer treatment in recent years. These advances provide unprecedented opportunities to overcome the current limitations of different therapeutic modalities. This review provides a comprehensive analysis of how nanotechnology interfaces with the tumour immune microenvironment (TIME) in HCC and can present a new frontier in therapeutic interventions for HCC. We critically overview the latest developments in nanoparticle-based delivery systems for various drugs and also other antitumor agents like thermal therapy and radiotherapy. We also highlight the unique ability of nanoparticles to modulate the immunosuppressive tumour microenvironment (TME) and enhance therapeutic efficacy. Furthermore, we analyse emerging strategies that exploit nanoformulations to overcome biological barriers and enhance drug bioavailability in HCC treatment.

Cystic artery embolism after transarterial chemoembolization for hepatocellular carcinoma: A case report and review of the literature

BACKGROUND

Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma. Usually, conservative management is sufficient for complete recovery of patients who develop this complication. If conservative treatment is ineffective, urgent surgical intervention may be required to prevent the progression of complications.

CASE SUMMARY

This article reports a rare and serious case of acute cholecystitis complicated by gallbladder necrosis and biliary peritonitis, which was initially treated conservatively but eventually necessitated emergency laparotomy. The patient initially presented with equivocal symptoms of fever and upper abdominal pain and distention, which worsened at the two weeks mark along with emergence of signs of peritonitis. This was managed by emergency laparotomy and cholecystostomy, allowing rapid symptom relief. The patient ultimately discharged and succumbed to advanced liver cancer 11 months after diagnosis.

CONCLUSION

After cholecystostomy, the patient showed symptom relief and was discharged, surviving 11 months post-stage IIIB liver cancer diagnosis.

Two treatment methods for hepatocellular carcinoma: Lenvatinib or bevacizumab combined with sintilimab and interventional therapy

In their study, Han et al compared the efficacy of bevacizumab plus sindilizumab plus interventional therapy with that of lenvatinib plus sindilizumab plus interventional therapy for patients with intermediate and advanced hepatocellular carcinoma. The triple therapy, which integrates interventional therapy, targeted therapy, and immunotherapy, has emerged as a promising research focus in the treatment of liver cancer. Consequently, it is of utmost significance to select an appropriate combination of interventional therapy, targeted therapy, and immunotherapy for patients suffering from intermediate and advanced liver cancer.

USP39/SMC4 promotes hepatoma cell proliferation and 5-FU resistance

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, characterized by a high rate of postoperative recurrence and poor long-term survival outcomes. Structural maintenance of chromosome 4 (SMC4) is frequently overexpressed in various types of cancer and plays a pivotal role in tumor cell growth, migration, and invasion. Bioinformatics analysis has revealed a significant correlation between the tumor-node metastasis (TNM) stage (P < 0.01) and SMC4 expression (P < 0.05), and SMC4 was associated with poor prognosis in HCC. Furthermore, SMC4 was identified as an independent prognostic factor for HCC. Ubiquitin-specific peptidase 39 (USP39) was found whether the regulation was observed to affect protein synthesis or stability through bioinformatics analysis and immunoprecipitation. The expression levels and cellular localization of SMC4 and USP39 in hepatoma cells were evaluated using quantitative real-time PCR (qPCR), western blotting, and immunohistochemistry (IHC), all of which indicated significantly elevated expression of USP39 and SMC4 in HCC. The roles of the SMC4/USP39 were further investigated through several assays, including the 3-(4,5-Dimethylthiazol-2-yl) -2,5- diphenyltetrazolium bromide (MTT) assay, 5-ethynyl-2'-deoxyuridine (EdU) incorporation assay, and wound healing assay. The results demonstrated that USP39/SMC4 plays a crucial role in enhancing the viability and proliferation of HepG2 cells. Additionally, bioinformatics analysis identified ZNF207 and TIAL1 as potential target proteins of SMC4. Drug-resistant hepatoma cell lines were established, and both MTT and EdU assays were performed to assess cell viability and proliferation. The results demonstrated that HepG2/5-FU cells regained their sensitivity to 5-FU following the knockdown of SMC4. Additionally, the knockdown of either TIAL1 or ZNF207 also restored 5-FU sensitivity in HepG2/5-FU cells, effectively inhibiting cell viability and proliferation. Our study underscores the significant role of the USP39/SMC4 in HCC development and suggests that SMC4 may contribute to the regulation of drug resistance in hepatoma cell lines, potentially through interactions with TIAL1 and ZNF207.

Melatonin suppresses PD-L1 expression and exerts antitumor activity in hepatocellular carcinoma

Melatonin, also known as the pineal hormone, is secreted by the pineal gland and primarily regulates circadian rhythms. Additionally, it possesses immunomodulatory properties and anticancer effects. However, its specific mechanism in hepatocellular carcinoma (HCC) remains unclear, particularly regarding its effect on HCC-mediated immune escape through PD-L1 expression.In this study, in vitro experiments were conducted using Huh7 and HepG2 HCC cells. Melatonin treatment was applied to both cell types to observe changes in malignant phenotypes. Additionally, melatonin-pretreated Huh7 or HepG2 cells were co-cultured with T cells to simulate the tumor microenvironment. The results showed that melatonin inhibited cancer cell proliferation, migration, and invasion, as well as reduced PD-L1 expression in cancer cells, exhibiting similar anti-cancer effects in the co-culture system. In vivo experiments involved establishing ascitic HCC mouse models using H22 cells, followed by subcutaneous tumor models in Balb/c nude and Balb/c wild-type mice. Melatonin inhibited tumor growth and suppressed PD-L1 expression in cancer tissues in both subcutaneous tumor models, and it increased T lymphocyte activity in the spleen of Balb/c wild-type mice. Overall, the in vitro and in vivo experiments demonstrated that melatonin has dual anti-cancer effects in HCC: direct intrinsic anti-cancer activity and enhancement of anti-tumor immunity by reducing PD-L1 expression thereby inhibiting cancer immune escape. Furthermore, a decrease in the expression of the upstream molecule HIF-1α of PD-L1 and an increase in the expression levels of JNK, P38, and their phosphorylated forms were detected. Thus, the mechanism by which melatonin reduces PD-L1 may involve the downregulation of HIF-1α expression or the activation of the MAPK-JNK and MAPK-P38 pathways. This provides new insights and strategies for HCC treatment.

Pathological roles of lncRNA HOTAIR in liver cancer: An updated review

Liver cancer ranks as the sixth most prevalent form of cancer and stands as the fourth leading cause of cancer-related fatalities on a global scale. The two primary types of liver cancer are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). While ICC originates from the bile ducts, HCC develops from hepatocytes, which are the primary functional cells of the liver. In cases where liver cancer is detected in its early stages, it can be effectively treated through locoregional interventions such as surgical resection, Radiofrequency Ablation, Transarterial chemoembolization, or liver transplantation. However, HCC is typically diagnosed at advanced stages, rendering these treatment options ineffective due to the unresectable nature of the tumor. LncRNAs, a novel class of RNA molecules and epigenetic regulators, have emerged as key players in the development and advancement of different types of tumors. They exert their influence by regulating the expression of downstream genes in cancer-related signaling pathways, thereby promoting the proliferation, migration, and invasion of tumor cells. Additionally, these transcripts have the ability to modify the activity and expression of tumor suppressors and oncogenes, further contributing to tumorigenesis. Recently, growing numbers of experiments have demonstrated the elevated expression of HOX antisense intergenic RNA (HOTAIR), a spliced and poly-adenylated lncRNA, in liver cancers and its association with cancer patient's prognosis and overall survival, as well as tumor cells' growth, metastasis, and resistance to therapies. This updated review will summarize molecular pathways by which lncRNA HOTAIR promotes liver cancer development, and highlight its diagnostic and therapeutic potential, though.

Analysis of a modified surgical desirability of outcome ranking (mDOOR) among patients undergoing surgery for Hepatocellular carcinoma

BACKGROUND

Composite measures represent a validated method for evaluating surgical care quality. We defined a modified Desirability Of Outcome Ranking (mDOOR) and compared it with textbook outcome (TO).

METHODS

In this cohort study, patients undergoing curative-intent surgery for HCC were identified from an international cohort. The performance and agreement of mDOOR, TO, and other measures of postoperative course with respect to overall survival (OS) were compared using Harrell's Concordance-index (C-index) and Cohen's kappa.

RESULTS

Among 2181 patients, 77.6 % (n = 1692) achieved the most desirable outcome (i.e., DOOR1), whereas roughly one-half of patients achieved TO (n = 1,171, 53.7 %). Patients with lower mDOOR had a better 5-year OS compared with patients with higher mDOOR (64.7 % vs. 51.9 %; p < 0.001). On multivariable analysis, higher mDOOR was associated with worse OS (HR 1.35, 95%CI 1.28-1.44; p < 0.001). The mDOOR demonstrated improved performance compared with the comprehensive complication index (C-index: 0.696 vs. 0.649; p < 0.001) and the Accordion score (C-index: 0.696 vs. 0.653; p = 0.002).

CONCLUSION

Roughly 4 out of 5 patients achieved the most desirable outcome. Higher mDOOR was associated with worse long-term outcomes. A composite outcome ranking may provide more insight on surgical outcomes, complementing traditional metrics.

Folate receptor 1 is a stemness trait-associated diagnostic and prognostic marker for hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) can be classified into several subtypes based on molecular traits, aiding in prognostic stratification. The subtype with a poor prognosis is often associated with stem/progenitor features. This study focused on identifying circulating biomarkers for aggressive HCC.

METHODS

We searched for secretory proteins whose expression was positively associated with the stem/progenitor markers KRT19, EPCAM, and PROM1 in 2 independent HCC cohorts. Serum folate receptor 1 (FOLR1) levels were measured in 238 chronic liver disease and 247 HCC patients, evaluating their diagnostic and prognostic capabilities.

RESULTS

FOLR1 was identified as a secretory protein that was positively correlated with all 3 stem/progenitor markers and a poor prognosis in both the discovery and validation cohorts. Higher FOLR1 expression was detected in tumor than nontumor tissues and was associated with aggressive subtypes, and activation of p53, DNA repair, Myc, E2F, and PI3K/AKT/mTOR pathways. Serum FOLR1 levels correlated with tumoral FOLR1 expression in HCC patients and were significantly elevated compared with those in patients with chronic hepatitis or nonliver disease. Serum FOLR1 levels demonstrated diagnostic performance for HCC comparable to that of alpha-fetoprotein (AFP), and their combination increased the diagnostic accuracy. Elevated serum FOLR1 levels were associated with poor prognosis in HCC patients, regardless of treatment, especially in patients with early-stage disease. The multivariate analysis revealed that the serum FOLR1 level and the Gender, Age, AFP-L3, AFP, and Des-gamma-carboxy prothrombin (GALAD) score were independent predictors of a poor prognosis with their combination further stratifying prognosis.

CONCLUSIONS

FOLR1 is a stemness-associated biomarker for HCC, with serum levels serving as a diagnostic marker for HCC and a prognostic indicator for early-stage disease.

Predicting the complexity of minimally invasive liver resection for hepatocellular carcinoma using machine learning

BACKGROUND

Despite technical advancements, minimally invasive liver surgery (MILS) for hepatocellular carcinoma (HCC) remains challenging. Nonetheless, effective tools to assess MILS complexity are still lacking. Machine learning (ML) models could improve the accuracy of such tools.

METHODS

Patients who underwent curative-intent MILS for HCC were identified using an international database. An XGBoost ML model was developed to predict surgical complexity using clinical and radiological characteristics.

RESULTS

Among 845 patients, 186 (22.0 %) were classified as high-risk patients. In this subgroup, median Charlson Comorbidity Index (CCI) (5.0, IQR 3.0-7.0 vs. 2.0, IQR 2.0-5.0, p < 0.001) and tumor burden score (TBS) (median 4.12, IQR 3.0-5.1 vs. 4.22, IQR 3.2-7.1, p < 0.001) were higher. The model was able to effectively predict complexity of surgery in both the training and testing cohorts with high discriminating power (ROC-AUC: 0.86, 95%CI 0.82-0.89 vs. 0.73, 95%CI 0.65-0.81). The most influential variables were CCI, TBS, BMI, extent of resection, and sex. Patients predicted to have a complex surgery were more likely to develop severe complications (OR 4.77, 95%CI 1.82-13.9, p = 0.002). An easy-to-use calculator was developed.

CONCLUSION

Preoperative ML-prediction of complex MILS for HCC may improve preoperative planning, resource allocation, and patient outcomes.

The Role of Chemokine (C-C Motif) Ligand 7 (CCL7) in Hepatocellular Carcinoma: Expression, Function, and Mechanisms

AIM

AHepatocellular carcinoma (HCC) is a malignant neoplasm characterized by a poor prognosis, with its incidence rising globally. Chemokine (C-C motif) ligand 7 (CCL7), a chemokine protein, has been implicated in the progression of various cancers. Nonetheless, the specific role of CCL7 in HCC has yet to be elucidated. This study seeks to examine the expression and functional role of CCL7 in the context of HCC.

MATERIALS & METHODS

Western blot and immunohistochemistry were used to detect the expression of CCL7 in HCC tissues and cell lines. Cell Counting Kit 8 (CCK8) assay, clonogenic assay, and transwell assay were performed to examine the effects of CCL7 on SNU-878 cells. Immunofluorescence was used to analyze the expression of proteins associated with epithelial interstitial transformation (EMT). Western blot was used to detect the activation of the PI3K/AKT pathway. In vivo tumorigenesis experiments were performed to assess the role of CCL7 in HCC tumorigenesis.

RESULTS

The results showed that the expression of CCL7 was up-regulated in HCC tissues, and exogenous CCL7 promoted the proliferation, migration, invasion, and EMT of SNU-878 cells and VEGF secretion by SNU-878 cells. Furthermore, CCL7 stimulated the activation of the PI3K/AKT pathway. Further analysis revealed that CCL7 targeted CCR1 and CCR2 to enhance the growth, and metastasis of SNU-878 cells and VEGF secretion by SNU-878 cells. CCR1/CCR2 silencing prevented CCL7 from activating the PI3K/AKT signaling pathway in SNU-878 cells. Moreover, CCL7 facilitated HCC tumorigenesis and VEGF expression in vivo.

CONCLUSION

Our findings indicate that CCL7 plays a promoting role in HCC growth and tumorigenesis, potentially via targeting CCR1 and CCR2 and activating the PI3K/AKT pathway.

Microwave ablation versus radiofrequency ablation for hepatocellular carcinoma in patients with decompensated cirrhosis

BACKGROUND

The efficacy of microwave ablation (MWA) and radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients with decompensated cirrhosis remains unclear.

METHODS

A total of 315 patients with decompensated cirrhosis and HCC who underwent MWA or RFA were recruited. Recurrence beyond the Milan criteria (RBM), local tumor progression (LTP), overall survival (OS), and complications were evaluated and compared.

RESULTS

After propensity score matching, the overall liver-related complication rates were 12.1 % in the current study. The cumulative RBM rates were lower in patients treated with MWA compared to those treated with RFA (21.9 % vs. 23.4 % at 1 year; 42.3 % vs. 66.8 % at 5 years; p = 0.016). In addition, lower cumulative rates of LTP were found in patients treated with MWA compared to those treated with RFA (6.2 % vs. 19.9 % at 1 year; 14.7 % vs. 27.8 % at 3 years; p = 0.032). The OS rates at 1 and 5 years were 89.9 % and 58.9 % in the MWA group, and 80.7 %, and 38.9 % in the RFA group, respectively (p = 0.105).

CONCLUSION

HCC patients with decompensated cirrhosis can undergo MWA or RFA with acceptable mortality, morbidity and liver-rated complications rates. MWA demonstrates superiority over RFA in tumor control.

Tumor exosomal RNPEP promotes lung metastasis of liver cancer via inducing cancer-associated fibroblast activation

Cancer-associated fibroblasts (CAFs) are essential players in the tumor microenvironment (TME) due to their roles in facilitating tumor progression and metastasis. It is worth noting that the high-metastatic hepatocellular carcinoma (HCC) cell-derived exosomes have exhibited the ability to transform normal fibroblasts into CAFs, which further fosters the lung metastasis of low-metastatic HCC cells. Yet, the mechanisms underlying this tumor exosome-induced metastatic niche formation are poorly explored. In this study, the secreted protein arginyl aminopeptidase (RNPEP) was highly expressed in the plasma of patients with HCC. In addition, high-metastatic HCC cells showed augmented RNPEP expression levels in their exosomes. These exosomes induced obvious CAF-like properties in the human fibroblast cell line MRC-5, as evidenced by the increased CAF marker expression, and enhanced migratory ability. More strikingly, the secretions from high-metastatic tumor exosome-educated MRC-5 cells increased tumor stemness and promoted epithelial-mesenchymal transition (EMT) in MHCC-97L cells, a low-metastatic HCC cell line. However, the knockdown of RNPEP in exosomes from high-metastatic HCC cells abated the changes described above. Animal studies in vivo highlighted the pro-tumor and pro-metastatic effects of exosomal RNPEP on MHCC-97L cells by inducing CAF activation. Furthermore, tumor-derived exosomal RNPEP induced the activation of NF-κB signaling in MRC-5 cells, a critical pathway associated with CAF activation. Collectively, these results provide novel insight into tumor-derived exosomal RNPEP for its crosstalk with CAFs during HCC lung metastasis.

Integrated transcriptomics and proteomics analysis of the impact of iodine‑125 in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a common cause of cancer‑related mortality and morbidity worldwide. While iodine‑125 (125I) particle brachytherapy has been extensively used in the clinical treatment of various types of cancer, the precise mechanism underlying its effectiveness in treating HCC remains unclear. In the present study, MHCC‑97H cells were treated with 125I, after which, cell viability and proliferation were assessed using Cell Counting Kit‑8, 5‑ethynyl‑2'‑deoxyuridine and colony formation assays, cell invasion and migration were evaluated using wound healing and Transwell assays, and cell apoptosis was determined using flow cytometry. Omics data were analyzed using Kyoto Encyclopedia of Genes and Genomes, Gene Ontology and STRING analyses to observe the key genes that exhibited significant changes at the transcriptional and protein levels in MHCC‑97H cells treated with 125I particles. Finally, the expression levels of key genes (GPNMB, C4BPA, CTH, H1‑0 and MT2A) were verified through reverse transcription quantitative PCR. Following treatment with 125I, the proliferation, invasion and migration of MHCC‑97H cells were inhibited, and apoptosis was enhanced. The results of omics data analysis indicated that the biological behavior of MHCC‑97H cells treated with 125I was related to the expression levels of CTH and MT2A genes. These findings indicated that intervention with 125I radiation particles may induce changes in gene expression, potentially influencing alterations in biological characteristics. In conclusion, these insights may shed light on the underlying mechanisms of 125I radiation particle therapy in HCC and offer novel targets for HCC treatment.

Albumin-Butyrylcholinesterase as a Novel Prognostic Biomarker for Hepatocellular Carcinoma Post-hepatectomy: A Retrospective Cohort Study with the Hiroshima Surgical Study Group of Clinical Oncology

BACKGROUND

This study aimed to investigate the association between a new biomarker that incorporates albumin (Alb) and butyrylcholinesterase (BCHE) levels, as well as the prognosis of hepatocellular carcinoma (HCC) after hepatectomy.

METHODS

The study enrolled 1712 patients who underwent primary hepatectomy for HCC between January 2003 and December 2019 at seven institutions belonging to the Hiroshima Surgical Study Group of Clinical Oncology. The entire dataset was randomly split into discovery and validation cohorts in a 7:3 ratio. The product of the preoperative Alb and BCHE levels was defined as the ABC. In the discovery cohort, the patients in the high-ABC group (≥ 951) were compared with those in the low-ABC group (< 951). These findings then were confirmed in the validation cohort.

RESULTS

In the discovery cohort, a significant difference was observed in the 5-year survival rate between the high- and low-ABC groups (p < 0.001), and ABC was identified as an independent prognostic factor for HCC. Similarly, in the validation cohort, a significant difference was observed in the 5-year survival rate between the high- and low-ABC groups (p < 0.001), and ABC was identified as an independent prognostic factor for HCC. Furthermore, in the discovery and validation cohorts, significant differences in the early recurrence rate between the two groups were observed (p < 0.001 and p = 0.020, respectively).

CONCLUSIONS

For patients with HCC, ABC is a useful predictive biomarker because it can be calculated in a simple manner and because it provides accurate prognostic information.

Levels of Bile Acid Metabolism Are Associated With Alterations of Gut Microbes in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is viewed as a metabolism associated disease, and bile acid metabolism is reported to occupy a significant role in the progression of HCC. However, little is known about the association between gut microbes and bile acid metabolism in HCC. Our study was designed to clarify the role of bile acid metabolism and microbiome in the progression of HCC. We investigated the relationship between bile acid metabolism and prognosis and immune cells by mining GSE14520. We studied the microbial profiles and metabolic alterations between the low bile acid group and high bile acid group using 16S rRNA sequencing and metabolomics. HCC patients in the high bile acid metabolism group showed better survival outcome compared with those in the low bile acid metabolism. Immune analysis displayed the close correlation between low bile acid metabolism and infiltration of CD4 + T cells, and the close relationship between high bile acid metabolism and infiltration of CD8 + T cells, macrophage cells in HCC. 16S rRNA sequencing results demonstrated that Blautia, Ruminococcus_gnavus_group, Erysipelotrichaceae_UCG-003 were mostly enriched in the low bile acid group. Metabolomics of the 109 fecal samples showed that the most enriched metabolites in the low total bile acid group were dihydrocytochalasin B, cucurbic acid and 27-Norcholestanehexol. Finally, KEGG enrichment analysis identified secondary bile acid biosynthesis and endocrine resistance as the most significant metabolic pathways. High bile acid metabolism was associated with more infiltration of CD8 + T cells, macrophage cells, and better prognosis in HCC. Levels of bile acid were significantly associated with altered gut microbes and metabolites in HCC. Further research related to gut microbes and bile acid metabolism may provide a novel insight into the pathogenesis and therapeutic strategy of HCC.

Next-generation sequencing demonstrates racial and sex differences in genomic profiling of hepatocellular carcinoma patients: an AACR GENIE project analysis

BACKGROUND

Genomic variations related to racial and sex differences among patients with hepatocellular carcinoma (HCC) have not been investigated. We sought to characterize the mutational landscape of patients with HCC relative to race and sex.

METHODS

The American Association for Cancer Research GENIE project (v16.0) was used to assess data on genomic variations among adult patients (>18 years) with HCC who underwent next-generation sequencing. Variations in 787 genes were identified and characterized relative to race and sex.

RESULTS

Among 832 patients, 60.8 % of individuals were White, 7.7 % Black, and 12.4 % Asian (other/unknown:19.1 %). Most patients had genetic data from the primary tumor (71.2 %), whereas 17.2 % had metastatic disease sequenced (unknown:11.6 %). TERT mutations occurred more frequently in White (48.0 %) and Black (46.7 %) versus Asian (23.4 %) patients (q = 0.003), while TP53 mutations were more common in Asian (48.6 %) versus Black (45.5 %) or White (33.1 %) individuals (q = 0.03). TERT (46.1 % vs. 28.6 %) and CTNNB1 mutations (47.7 % vs. 29.3 %) were more likely to occur in males than females (both q < 0.05). Marked variations in prevalence of other common genetic HCC mutations were noted across different races and sexes.

CONCLUSIONS

Differences in mutational profiles of HCC patients highlight the importance of accruing diverse populations of patients to clinical trials.

Development models to predict complication and prognosis following liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension

BACKGROUND

Postoperative complications are potential factors influencing the prognosis of patients with HCC combined with CSPH. This study aims to explore the risk factors affecting the occurrence of postoperative complications, investigate potential factors influencing long-term prognosis in these patients, and establish predictive models.

METHODS

From April 2018 to December 2021, a total of 190 patients with HCC combined with CSPH who underwent curative liver resection in our hospital were included, comprising 69 cases in the complication group and 121 cases in the non-complication group. LASSO-Logistic regression was employed to identify risk factors influencing postoperative complications and establish a predictive model. LASSO-Cox regression was used to determine prognostic factors for long-term outcomes in patients with HCC combined with CSPH and establish a predictive model.

RESULTS

LASSO regression selected variables including ALBI grade, preoperative ascites, major hepatectomy, and portal vein occlusion time >15 ​min. These variables were incorporated into logistic regression (P ​< ​0.05) to establish a nomogram for predicting postoperative complications, with a C-index of 0.723. Results from the multivariable Cox regression analysis showed that postoperative complications, maximum tumor diameter, and microvascular invasion were risk factors for recurrence, while postoperative complications, maximum tumor diameter, microvascular invasion, and prealbumin were risk factors for overall survival. The C-index values for the respective nomograms were 0.635 and 0.734. The calibration curves and ROC curves demonstrated good performance for all three nomograms.

CONCLUSIONS

The three nomograms achieved optimal predictive performance for postoperative complications, recurrence, and overall survival in patients with HCC combined with CSPH undergoing curative resection.

Impact of microwave ablation on survival rates and recurrence in hepatic malignant tumors

PURPOSE

This study aimed to evaluate the efficacy of percutaneous microwave ablation (MWA) for treating hepatic malignant tumors and to identify factors influencing tumor recurrence post-treatment.

METHODS

A total of 249 patients with hepatic malignant tumors treated at the Shandong Cancer Hospital and Institute were included, and 101 patients were analyzed. Disease-free and overall survival rates were assessed at 1, 2, and 3 years post-MWA. Correlations between tumor recurrence and factors such as Child-Pugh B classification and lesion count were examined, and a meta-analysis was conducted to identify independent risk factors for recurrence.

RESULTS

The study found disease-free survival rates of 80.2%, 72.3%, and 70.3% at 1, 2, and 3 years post-MWA, with overall survival rates at 99%, 97%, and 96%. Significant correlations were observed between tumor recurrence, Child-Pugh B classification, and the number of lesions. Meta-analysis confirmed lesion count and Child-Pugh B classification as independent risk factors for recurrence following MWA treatment.

CONCLUSION

The study underscores the importance of considering Child-Pugh B classification and lesion count in predicting tumor recurrence after MWA for hepatic malignant tumors. These findings offer valuable insights for clinicians in decision-making and post-treatment monitoring.

Protein regulator of cytokinesis 1 regulates autophagy in hepatitis B virus‑associated liver cancer development

Hepatitis B protein x (HBx) is considered a critical contributor to hepatitis B virus (HBV)‑associated liver cancer development. Protein regulator of cytokinesis 1 (PRC1) has been implicated in hepatocarcinogenesis. However, the clinical relevance, biological functions and related regulatory mechanisms of PRC1 in HBV‑associated liver cancer have not yet been clarified. PRC1 expression profiles in liver cancer were obtained from The Cancer Genome Atlas and Gene Expression Profiling Interactive Analysis database and through reverse transcription‑quantitative polymerase chain reaction and immunohistochemistry assays. A series of in vitro and in vivo assays were used to explore the function of the PRC1 gene and the possible mechanisms through which it affects HBV‑associated liver cancer. PRC1 was overexpressed in HBV‑positive liver cancer tissues. Functional studies in vitro demonstrated that HBx induced the expression of the PRC1 gene, which promoted cell autophagy and enhanced viability, invasion and migration. Furthermore, the knockdown of the PRC1 gene or treatment with the autophagosome inhibitor 3‑methyladenine blocked the HBx‑induced autophagic flux, disrupted the formation of autophagosomes, and promoted cell apoptosis. Liver cancer xenograft animal model experiments revealed that inhibition of autophagy by 3‑methyladenine or silencing of the PRC1 gene attenuated HBx‑induced malignant behavior in vivo. The absence of autophagy inhibited the expression of Bcl‑2, induced the expression of Bax, and regulated the levels of Th1 and Th2 cytokines. These results elucidate a mechanism wherein the PRC1 gene participates in the occurrence and development of HBV‑associated liver cancer by modulating autophagy. PRC1 could be a potential therapeutic target for liver cancer.

Upper gastrointestinal cancers: Trends and determinants of location of death

BACKGROUND

Patients diagnosed with upper gastrointestinal cancers often require extensive end-of-life care. We sought to investigate social determinants of health associated with disparities in the location of death among patients who died of upper gastrointestinal cancers.

METHODS

Patients who died between 2003 and 2020 from esophageal cancer, gastric cancer, hepatobiliary cancer, and pancreatic cancer were identified using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Social determinants of health were assessed using the Social Vulnerability Index. Patients were categorized on the basis of location of death: inpatient hospital, home, nursing home, hospice, and outpatient medical facility/emergency department. Multivariable regression and mediation analyses defined the association of patient race as well as social determinants of health with location of death.

RESULTS

Among 815,780 decedents (esophageal cancer: 15.3%; gastric cancer: 3.6%; hepatobiliary cancer: 36.6%; pancreatic cancer: 54.5%), most were male (60.8%), aged 55-74 years (52.3%), and White (89.1%). Most decedents died at home (55.7%), followed by inpatient hospital (24.8%), hospice (9.0%), nursing home (8.1%), and outpatient medical facility/emergency department (2.5%). During the study period, location of death shifted notably from inpatient hospital (36.8% to 21.3%) to home (45.8% to 56.3%). Residents of high Social Vulnerability Index areas were more likely to die at inpatient hospital compared with home (31.8% vs 24.3%) (P < .001). Black race (reference: White; odds ratio; 0.41, 95% confidence interval, 0.40-0.42) and social vulnerability (reference: low Social Vulnerability Index; odds ratio, 0.64, 95% confidence interval, 0.63-0.65) remained independently associated with lower odds of dying at home compared with an inpatient hospital. Notably, 65% of the overall race-based association with death at inpatient hospital was driven indirectly through social determinants of health.

CONCLUSION

Social determinants are important drivers of end-of-life care and impact the potential ability of patients with cancer to die at home.

MFSD2A Overexpression Inhibits Hepatocellular Carcinoma Through TGF-β/Smad Signaling

Hepatocellular carcinoma (HCC) is a common primary malignancy of the liver and has a high mortality. Major facilitator superfamily domain containing 2 (MFSD2A) was previously demonstrated to inhibit tumor progression in several cancers. Here, we elucidated the association between MFSD2A expression and HCC progression and also investigated the underlying mechanism. The online tools were utilized to evaluate MFSD2A expression in HCC samples and predict the prognostic significance of MFSD2A in HCC patients. The biological role of MFSD2A in HCC cellular processes was examined by colony formation, wound healing, transwell, and western blotting. The in vivo role of MFSD2A in HCC was investigated in a xenograft tumor model. The miRNAs and RNA-binding proteins potentially targeting MFSD2A were identified using bioinformatics prediction tools. Luciferase reporter, RNA immunoprecipitation, actinomycin D, and immunofluorescence assays were performed to investigate the molecule mechanisms of MFSD2A. Transforming growth factor (TGF)-β1/Small mothers against decapentaplegic (Smad) signaling was detected using western blot analysis. We found that MFSD2A expression was significantly downregulated in HCC patients and cells and its downregulation predicted a poor prognosis. MFSD2A overexpression repressed HCC cell proliferation, migration, invasion, the epithelial-to-mesenchymal transition in vitro, as well as inhibited HCC tumor growth in vivo. MFSD2A was targeted by miR-3189-3p. High-density lipoprotein binding protein (HDLBP) inhibited MFSD2A expression by binding to and destabilizing MFSD2A mRNA. MFSD2A significantly suppressed activation of TGF-β/Smad signaling in HCC cells. Knockdown of MFSD2A abrogated the inhibitory effect of miR-3189-3p inhibitor on HCC cellular processes, and overexpression of MFSD2A reversed the tumor-promoting effect of HDLBP overexpression. Overall, MFSD2A exerts a tumor-inhibiting effect in HCC via suppression of TGF-β/Smad signaling, suggesting that MFSD2A may be a promising target for HCC therapy.

Mixture of Expert-Based SoftMax-Weighted Box Fusion for Robust Lesion Detection in Ultrasound Imaging

Background/Objectives: Ultrasound (US) imaging plays a crucial role in the early detection and treatment of hepatocellular carcinoma (HCC). However, challenges such as speckle noise, low contrast, and diverse lesion morphology hinder its diagnostic accuracy. Methods: To address these issues, we propose CSM-FusionNet, a novel framework that integrates clustering, SoftMax-weighted Box Fusion (SM-WBF), and padding. Using raw US images from a leading hospital, Samsung Medical Center (SMC), we applied intensity adjustment, adaptive histogram equalization, low-pass, and high-pass filters to reduce noise and enhance resolution. Data augmentation generated ten images per one raw US image, allowing the training of 10 YOLOv8 networks. The mAP@0.5 of each network was used as SoftMax-derived weights in SM-WBF. Threshold-lowered bounding boxes were clustered using Density-Based Spatial Clustering of Applications with Noise (DBSCAN), and outliers were managed within clusters. SM-WBF reduced redundant boxes, and padding enriched features, improving classification accuracy. Results: The accuracy improved from 82.48% to 97.58% with sensitivity reaching 100%. The framework increased lesion detection accuracy from 56.11% to 95.56% after clustering and SM-WBF. Conclusions: CSM-FusionNet demonstrates the potential to significantly improve diagnostic reliability in US-based lesion detection, aiding precise clinical decision-making.

Lactoferrin-functionalized PEGylation liposomes loaded with norcantharidin acid for targeted therapy of hepatocellular carcinoma

Norcantharidin (NCTD), an antitumor agent with an increased leukocyte function, has been used for the treatment of hepatocellular carcinoma (HCC) in clinical. However, the clinical application of NCTD is limited due to its inadequate hydrophilicity and lipophilicity, short half-life (t1/2), as well as adverse effects such as vascular irritation, cardiotoxicity, and nephrotoxicity. Herein, a lactoferrin (Lf) and DSPE-mPEG2000 functionalized liposomes loaded with norcantharidic acid (NCA), an active metabolite of NCTD, was constructed for the targeted therapy of HCC. In this study, blank PEGylated liposomes were prepared using the film hydration method, and the NCA was loaded by calcium acetate active loading method to increase the encapsulation efficiency (EE). Subsequently, lactoferrin was covalently coupled to DSPE-PEG2000-COOH activated by EDC and NHS. In addition, the in vivo pharmacokinetics and pharmacodynamics were investigated in Sprague-Dawley (SD) rats and H22 tumor-bearing BALB/c mice, respectively. As expected, the encapsulation efficiency measurement showed that the encapsulation efficiency of the NCA liposomes was 89.3±1.25 %, and the coupling efficiency of lactoferrin was more than 65.97 %. Additionally, the variations in both the dynamic size and encapsulation efficiency of norcantharidic acid liposomes in long-term storage stability and serum stability studies did not exceed 10 %. Furthermore, the pharmacokinetics and pharmacodynamics results showed that, the NCA-Lips-Lf were able to significantly improve antitumor activity by enhancing tumor-targeting accumulation and prolonging circulation time in the body compared to the sodium demethylcantharidate for injection (Na2DCA). Notably, the AUC0-48 and the t1/2 of NCA-Lips-Lf increased 4.28-time and 5.17-time in comparison to those of NCA-sol, respectively. The tumor inhibition rate of NCA-Lips-Lf (85.29 %) was significantly higher than that of sodium demethylcantharidate for injection (Na2DCA) (59.13 %), without obvious vascular irritation, cardiotoxicity and nephrotoxicity. In conclusion, NCA-Lips-Lf have the potential to eliminate hepatocellular carcinoma more effectively with fewer side effects than Na2DCA, which further advances the clinical application of norcantharidin-related drugs.

Enhanced efficacy of immune checkpoint inhibitors combined locoregional therapy and tyrosine kinase inhibitors in the treatment of unresectable hepatocellular carcinoma: A single - center retrospective study

Background

Unresectable hepatocellular carcinoma (HCC) presents significant treatment challenges. While locoregional therapies (LT) and tyrosine kinase inhibitors (TKI) offer some benefits, prognosis remains poor. Immune checkpoint inhibitors (ICI) have shown promise in other oncological settings, suggesting potential benefits in HCC treatment regimens.

Methods

This retrospective study analyzed 232 patients diagnosed with unresectable HCC at West China Hospital from January 2019 to December 2023. Patients were categorized into two treatment groups: LT+TKI and LT+TKI+ICI. All patients underwent standardized locoregional treatments and first-line TKIs, with the latter group also receiving ICIs. The primary endpoints measured were overall survival (OS) and progression-free survival (PFS). Survival analysis utilized Kaplan-Meier estimates and Cox regression models.

Results

The LT+TKI+ICI group demonstrated significantly improved survival outcomes compared to the LT+TKI group. Median OS was 28 ± 3.9 months in the LT+TKI+ICI group versus 21 ± 3.0 months in the LT+TKI group, with corresponding 6-, 12-, and 24-month OS rates of 96.8%, 79.3%, and 59.4% versus 85.8%, 71.5%, and 44.1%, respectively (HR, 0.64; 95% CI, 0.449-0.913; P = 0.014). Median PFS also favored the LT+TKI+ICI group (11 ± 1.1 months vs. 7 ± 0.76 months; HR, 0.60; 95% CI, 0.452-0.805; P<0.001). Multivariable analysis identified LT+TKI, vascular invasion, and metastasis as independent risk factors for poorer survival outcomes.

Conclusions

Adding ICI to LT and TKI significantly extends both OS and PFS in patients with unresectable HCC. These findings suggest that integrating ICI into treatment protocols could be beneficial in managing unresectable HCC, particularly for patients with vascular invasion.

Minimalistic Implant for Percutaneous Magnetic Hyperthermia-Based Combination Therapy of Hepatocellular Carcinoma

Percutaneous local thermal therapy, containing radio frequency and microwave ablation, is widely utilized in the clinical management of hepatocellular carcinoma (HCC) due to its minimal invasiveness and favorable therapeutic outcomes. However, its further development is limited by a prolonged ablation duration and the risk of excessive heating. Magnetic hyperthermia therapy (MHT) provides a new perspective for percutaneous tumor thermal ablation due to its superior tissue penetration capability and safety. Herein, an iron foam-agarose gel-drug (IF-Aga-drug) implant is prepared using a minimalistic method for percutaneous combination therapy of HCC. The excellent conductivity of IF endows it with strong heating capability owing to eddy current loss in an alternating magnetic field (AMF), while the abundant pores provide ample space for drug loading. Agarose gel imparts the IF platform with universal and efficient drug-loading capacity and controlled drug-release capability that is responsive to magnetic hyperthermia. Doxorubicin (DOX) is utilized as a representative drug to construct the IF-Aga-DOX implant, which is successfully employed in ultrasound-guided, magnetic hyperthermia-based combination chemotherapy for orthotopic HCC in rabbits under ultralow-power magnetic field intensities (Happl·fappl = 2.25 × 108 A m-1 s-1). The developed IF-Aga-drug implant platform offers a convenient and versatile strategy for percutaneous tumor therapy.

Machine Learning Prognostic Model for Post-Radical Resection Hepatocellular Carcinoma in Hepatitis B Patients

Purpose

Primary liver cancer, predominantly hepatocellular carcinoma (HCC), constitutes a substantial global health challenge, characterized by a poor prognosis, particularly in regions with high prevalence of hepatitis B virus (HBV) infection, such as China. This study sought to develop and validate a machine learning-based prognostic model to predict survival outcomes in patients with HBV-related HCC following radical resection, with the potential to inform personalized treatment strategies.

Patients and Methods

This study retrospectively analyzed clinical data from 146 patients at Xinjiang Medical University and 75 patients from The Cancer Genome Atlas (TCGA) database. A prognostic model was developed using a machine learning algorithm and evaluated for predictive performance using the concordance index (C-index), calibration curve, decision curve analysis (DCA), and receiver operating characteristic (ROC) curves.

Results

Key predictors for constructing the best model included body mass index (BMI), albumin (ALB) levels, surgical resection method (SRM), and the American Joint Committee on Cancer (AJCC) stage. The model achieved a C-index of 0.736 in the training set and performed well in both training and validation datasets. It accurately predicted 1-, 3-, and 5-year survival rates, with Area Under the Curve (AUC) values of 0.843, 0.797, and 0.758, respectively. Calibration curve analysis and Decision Curve Analysis (DCA) further validated the model's predictive capability, suggesting its potential use in clinical decision-making.

Conclusion

The study highlights the importance of BMI, ALB, SRM, and AJCC staging in predicting HBV-related HCC outcomes. The machine learning model aids clinicians in making better treatment decisions, potentially enhancing patient outcomes.

Post-translational modifications in hepatocellular carcinoma: unlocking new frontiers in immunotherapy

Liver cancer, particularly hepatocellular carcinoma (HCC), is one of the most common and aggressive malignancies worldwide. Immunotherapy has shown promising results in treating HCC, but its efficacy is often limited by complex mechanisms of immune evasion. Post-translational modifications (PTMs) of proteins play a critical role in regulating the immune responses within the tumor microenvironment (TME). These modifications influence protein function, stability, and interactions, which either promote or inhibit immune cell activity in cancer. In this mini-review, we explore the diverse PTMs that impact immune evasion in liver cancer, including glycosylation, phosphorylation, acetylation, and ubiquitination. We focus on how these PTMs regulate key immune checkpoint molecules such as PD-L1, CTLA-4, and the TCR complex. Furthermore, we discuss the potential of targeting PTMs in combination with existing immunotherapies to enhance the effectiveness of treatment in HCC. Understanding the role of PTMs in immune regulation may lead to the development of novel therapeutic strategies to overcome resistance to immunotherapy in liver cancer.

Survival path model outperforms conventional static machine learning models in long-term dynamic prognosis prediction for patients with intermediate stage hepatocellular carcinoma

Motivation

Patients with intermediate stage hepatocellular carcinoma (HCC) require repeated disease monitoring, prognosis assessment, and treatment planning. A novel machine learning model called survival path mapping (SP) model was developed, while its performance as compared with conventional machine learning models remains unknown. Between January 2007 and December 2018, the time-series data of 2644 intermediate stage HCC patients from four medical centers in China were reviewed and included. Static machine learning models by Gaussian Naive Bayes (GNB), support vector machine (SVM), and random forest (RF) for the prediction of survivorship were built based on data at initial admission. Longitudinal data divided into different time slices were utilized for the construction of the SP model. The time-dependent c-index was compared between models.

Results

The training set, internal testing set, and external testing set consisted of 1560, 670, and 414 HCC patients, respectively. The survival path model had superior or non-inferior performance in prognosis prediction compared to GNB and RF models since the 12th month after initial diagnosis in the training set and the external testing set. The survival path model had higher time-dependent c-index over all conventional ML models since the 6th month in the external testing cohort. In conclusion, the survival path model had superior performance in long-term dynamic prognosis prediction compared to conventional static machine learning models for intermediate stage HCC.

Availability and implementation

The parameters of models are provided in the manuscript.

METTL14 suppresses the migration and invasion of hepatocellular carcinoma cells by m6A methylation of RPLP2

Fluctuating N(6)-methyladenosine (m6A) levels affect the progression of hepatocellular carcinoma (HCC). METTL14, a m6A methyltransferase, acts as a tumor suppressor in HCC; however, its underlying mechanisms need further clarification. This study aimed to clarify the role of METTL14 in HCC and the underlying molecular mechanism. Cellular behaviors were evaluated using cell counting kit-8, EdU, and Transwell assays. The molecular mechanism was analyzed using methylated RNA binding protein immunoprecipitation, dual-luciferase reporter assay, and RNA stability determination. The results demonstrated that METTL14 expression was decreased in HCC tissues and cells, and its overexpression suppressed cellular proliferation, migration, and invasion. Moreover, RPLP2 was negatively correlated to METTL14, and it was highly expressed in HCC tissues and cells. METTL14 promoted the m6A modification of RPLP2 and reduced its stability, thereby inhibiting malignant behaviors. Besides, YTHDC2 decreased RPLP2 expression and reversed the stability induced by METTL14. In conclusion, METTL14 inhibits HCC progression by regulating the YTHDC2-m6A-RPLP2 axis.

Enhanced antitumor activity of combined hepatic arterial infusion chemotherapy with Lenvatinib and PD-1 inhibitors in unresectable hepatocellular carcinoma: a meta-analysis

Background

Hepatic arterial infusion chemotherapy (HAIC) is increasingly recognized as a primary treatment option for patients with unresectable hepatocellular carcinoma (uHCC), providing a focused treatment for localized tumors. The combination of lenvatinib, a multikinase inhibitor, with PD-1 inhibitors has demonstrated significant survival benefits in HCC. This meta-analysis aims to assess whether the integration of HAIC with lenvatinib and PD-1 inhibitors (referred to as the HAIC-L-P group) leads to better treatment effectiveness and security compared to lenvatinib and PD-1 inhibitors alone (L-P group) in uHCC.

Methods

An exhaustive search of the literature was conducted, including PubMed, the Cochrane Library, Embase, ClinicalTrials.gov, and Web of Science, from the start of each database until September 2024, to ensure a thorough and up-to-date compilation of relevant studies. Extract data on outcome measures such as overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Subsequently, meta-analyses were performed using RevMan 5.4 to quantitatively evaluate the aggregated effect of the HAIC-L-P regimen versus the L-P regimen alone.

Results

In our systematic meta-analysis of eight retrospective cohort studies, the HAIC-L-P regimen demonstrated markedly enhanced OS, with an HR of 0.54 (95% CI: 0.45-0.64; p < 0.00001), and enhanced 1-year and 2-year OS rates. Superior PFS was also observed in the HAIC-L-P group, with an HR of 0.64 (95% CI: 0.55-0.75; p < 0.0001), and higher 1-year and 2-year PFS rates. Response rates were markedly higher in the HAIC-L-P group, with an ORR risk ratio of 2.15 (95% CI: 1.84-2.50; p < 0.00001) and a DCR risk ratio of 1.28 (95% CI: 1.20-1.43; p < 0.0001). The AEs classified as grade 3 or above were elevated in the HAIC-L-P group, with notable risk ratios for vomiting, elevated AST, elevated ALT, thrombocytopenia, neutropenia, and hyperbilirubinemia. No life-threatening AEs were reported.

Conclusion

The HAIC-L-P regimen correlated with enhanced tumor responses and prolonged survival, alongside manageable adverse effects, indicating its potential as a viable therapeutic strategy for individuals afflicted with uHCC.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024594109.

ATF3-SLC7A7 Axis Regulates mTORC1 Signaling to Suppress Lipogenesis and Tumorigenesis in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) poses a substantial global health burden, with poor prognosis and high mortality rates. Dysregulated lipid metabolism has emerged as a critical driver of HCC progression. While mTORC1 signaling is known to promote lipid synthesis in HCC, the regulatory mechanisms governing mTORC1 remain largely unclear. Here, we demonstrate that mTORC1 inhibition significantly reduces lipogenesis in HCC and uncover a regulatory axis involving the transcription factor ATF3 and the leucine-arginine transporter SLC7A7. Transcriptomic analysis of HCC patients reveals an inverse correlation between ATF3 expression and lipid synthesis, a finding corroborated by experimental validation. Mechanistically, ATF3 suppresses mTORC1 signaling, thereby inhibiting lipid biosynthesis, with SLC7A7 identified as a key intermediary in this process. Specifically, ATF3 binds to the enhancer region of SLC7A7, driving its transcriptional activation and subsequently restraining mTORC1 activity. Functional assays in ATF3-overexpressing and -knockdown HCC cell lines further confirm ATF3's role as a tumor suppressor. Our study identifies a novel ATF3-SLC7A7-mTORC1 regulatory axis that attenuates lipogenesis and tumorigenesis in HCC, establishing a critical link between lipid metabolism and hepatocarcinogenesis. These findings offer new insights into potential therapeutic targets for the treatment of HCC.

The anti-PD-L1/CTLA-4 bispecific antibody KN046 plus lenvatinib in advanced unresectable or metastatic hepatocellular carcinoma: a phase II trial

This open-label phase II trial (NCT04542837) aimed to evaluate the efficacy and safety of KN046 combined with lenvatinib in patients with advanced hepatocellular carcinoma (HCC), and explore the potential response biomarkers. Participants received KN046 5 mg/kg every 3 weeks and lenvatinib 12 or 8 mg once daily. The primary endpoints were safety, tolerability, dose-limiting toxicity (DLT), and objective response rate (ORR) according to RECIST v1.1. A total of fifty-five participants were enrolled. The results meet the pre-specified primary endpoints. No DLT was observed in the safety run-in period. The incidence of serious adverse events and grade ≥3 treatment-related adverse events (TRAEs) was 30.9% and 47.3%, respectively. Grade ≥3 immunotherapy-related adverse events occurred in 3 (5.5%) participants. Five (9.1%) participants discontinued treatment due to TRAEs, all of which were grade 1-2. The ORR was 45.5% (95% CI, 31.97-59.45). The median progression-free survival was 11.0 (95% CI, 8.21-15.24) months. The median overall survival (OS) was 16.4 (95% CI, 11.20-not estimable) months, and 12-month OS rate was 60.0% (95% CI, 45.87-71.55). Circulating tumor DNA status before the third cycle of treatment was associated with prognosis. In conclusion, First-line KN046 plus lenvatinib shows promising efficacy for advanced unresectable or metastatic HCC.

Single-cell landscape of dynamic changes in CD8+ T cells, CD4+ T cells and exhausted T cells in hepatocellular carcinoma

Hepatocellular carcinoma has a high incidence and poor prognosis. In this study, we investigated the value of T-cell-related genes in prognosis by single-cell sequencing data in hepatocellular carcinoma. Twelve cases of hepatocellular carcinoma single-cell sequencing were included in the study. The high dimensional weighted gene co-expression network analysis (hdWGCNA) was used to identify gene modules associated with CD4+ T cells, CD8+ T cells and exhausted T cells. Altered signaling pathway activity in exhausted T cells was uncovered by the AUCell algorithm. xCELL, TIMER, QUANTISEQ, CIBERSORT and CIBERSORT-abs were performed to explore immune cell infiltration. Immune checkpoint inhibitor genes and TIDE methods were used to predict immunotherapy response. Finally, immunohistochemistry and real-time PCR were used to verify gene expression. The hdWGCNA algorithm identified 40 genes strongly associated with CD4+ T cells, CD8+ T cells and exhausted T cells. Seven genes were finally selected for transcriptome data modeling. The results of the three independent datasets suggested that the model had strong prognostic value. Model genes were critical factors influencing CD4+ T cell and CD8+ T cell infiltration in patients. The efficacy of PD-1 immunotherapy was higher in patients belonging to the low-risk group. Alterations in signaling pathways' activity within exhausted T cells were crucial factors contributing to the decline in immune function. Differential expression of seven genes in CD8+ T cells, CD4+ T cells and exhausted T cells were key targets for improving immunotherapy response in HCC.

Criteria and prognostic models for patients with hepatocellular carcinoma undergoing liver transplantation

Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated death globally. Liver transplantation (LT) has emerged as a key treatment for patients with HCC, and the Milan criteria have been adopted as the cornerstone of the selection policy. To allow more patients to benefit from LT, a number of expanded criteria have been proposed, many of which use radiologic morphological characteristics with larger and more tumors as surrogates to predict outcomes. Other groups developed indices incorporating biological variables and dynamic markers of response to locoregional treatment. These expanded selection criteria achieved satisfactory results with limited liver supplies. In addition, a number of prognostic models have been developed using clinicopathological characteristics, imaging radiomics features, genetic data, and advanced techniques such as artificial intelligence. These models could improve prognostic estimation, establish surveillance strategies, and bolster long-term outcomes in patients with HCC. In this study, we reviewed the latest findings and achievements regarding the selection criteria and post-transplant prognostic models for LT in patients with HCC.

Conversion therapy strategy: A novel GPC3-targeted multimodal organic phototheranostics platform for mid-late-stage hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is typically diagnosed at intermediate to advanced stage, making surgical treatment unfeasible. Conversion therapy aims to reduce tumor stage, improve hepatic resection feasibility, and lower recurrence rates. Since traditional therapies are often accompanied by uncertainty of efficacy, there is an urgent need to explore new treatment strategies. Near-infrared phototheranostics technology provides a new way for HCC diagnosis and treatment by its excellent optical properties. However, complex preparation and poor biocompatibility of phototheranostics probes limit clinical application. In this study, we developed a fluorescence/magnetic resonance dual-modality imaging (FLI/MRI) as well as photothermal/photodynamic therapy (PTT/PDT) GPC3-targeted multifunctional phototheranostics probe, IR820-GPC3-Gd NPs (IGD NPs), to improve the efficiency of conversion therapy for HCC. The IGD NPs were simply prepared with the IR820 as the core. Conjugating the HCC-specific targeting molecule GPC3 peptide and the MRI agent DOTA-Gd through click chemistry. IGD NPs target HCC cells through GPC3, releasing heat and reactive oxygen species (ROS) under noninvasive 808 nm laser irradiation to reduce tumor size and achieve downstaging. High-sensitivity FLI/MRI precisely delineates tumor boundaries, providing real-time surgical navigation and prognosis assessment. This novel probe offers a feasible and effective treatment option for advanced HCC.

Imaging-Based Prediction of Ki-67 Expression in Hepatocellular Carcinoma: A Retrospective Study

AIM

This study aims to develop a non-invasive, preoperative predictive model for Ki-67 expression in HCC patients using enhanced computed tomography (CT) and clinical indicators to improve patient outcomes.

METHODS

This retrospective study analyzed 595 post-curative hepatectomy HCC patients. Patients were categorized into high (> 20%) and low (≤ 20%) Ki-67 expression groups based on cellular proliferation levels. Radiomic features were extracted from enhanced CT scans and combined with clinical parameters to develop a predictive model for Ki-67 expression.

RESULTS

Key clinical factors impacting Ki-67 expression in HCC included alpha-fetoprotein (AFP), non-smooth tumor margin, ill-defined pseudo-capsule, and peritumoral star node. From 1441 initially extracted radiomic features, 16 key features were selected using Lasso regression. These features were used to develop a radiomics model, which, when combined with clinical data, yielded an integrated predictive model with high accuracy. The combined model achieved an area under the curve (AUC) of 0.854 in the training group and 0.839 in the validation group. A nomogram based on this model was constructed, and its predictive accuracy was validated through calibration curves and decision curve analysis. A risk scorecard model was also constructed as a practical tool for clinicians to assess the risk level of high Ki-67 expression, facilitating personalized treatment planning. Survival analysis demonstrated significant differences in 3-year overall survival (OS) and progression-free survival (PFS) rates between patients with high and low Ki-67 expression, indicating the model's strong prognostic capability.

CONCLUSIONS

This study successfully developed a comprehensive model that integrates radiomic and clinical data for the preoperative prediction of Ki-67 expression in HCC patients.