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Jaber F, El-Serag HB. HES V2.0 surpasses GALAD for HCC detection: a review of multi-dimensional biomarker scores and studies. Hepat Oncol 2025; 12:2494446. [PMID: 40308043 PMCID: PMC12051611 DOI: 10.1080/20450923.2025.2494446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 04/14/2025] [Indexed: 05/02/2025] Open
Abstract
This was a narrative review of select studies published through September of 2024. We review the shift toward multi-dimensional scores such as HCC early detection screening (HES), GALAD, ASAP, and mt-HBT represents a significant advancement in biomarker research for hepatocellular carcinoma (HCC) detection. Unlike single biomarker approaches, these scores integrate various clinical and biochemical factors to enhance predictive accuracy by reflecting different complementary aspects of disease progression and HCC oncogenesis. Proper testing and validation of biomarker scores in phase 3 biomarker studies is essential before wide use can be recommended. We also review the comparative performance of biomarker scores in phase 3 studies. The new version of HES (HES V2.0) which includes AFP, AFP L3, DCP, and changes in their levels the past one year, if available, in addition to age, platelets, albumin, ALT and underlying liver disease etiology outperforms GALAD in detecting early-stage HCC with overall 6.7% higher sensitivity, and ASAP with 13.4%-18.0% higher sensitivity, both at fixed 90% specificity. HES V2.0 is a leading candidate biomarker score for prospective testing in clinical studies of early HCC detection.
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Affiliation(s)
- Fouad Jaber
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Hashem B. El-Serag
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
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2
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Kow AWC. Postoperative regular follow-up in hepatocellular carcinoma: Transforming early detection into survival gains. Hepatobiliary Pancreat Dis Int 2025; 24:237-238. [PMID: 40253287 DOI: 10.1016/j.hbpd.2025.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2025] [Accepted: 04/03/2025] [Indexed: 04/21/2025]
Affiliation(s)
- Alfred Wei Chieh Kow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore 119228, Singapore.
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Aldecoa KAT, Macaraeg CSL, Abougergi MS, Krishnamoorthy G, Arsene C. Palliative Care Utilization Among Hospitalized Patients With Hepatocellular Cancer: A Nationwide Study in the Pandemic Era (2019-2021). Am J Hosp Palliat Care 2025; 42:571-579. [PMID: 39138972 DOI: 10.1177/10499091241271371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
Background: Palliative care addresses a range of needs, from symptom management to providing support to patients with hepatocellular cancer (HCC) and their families throughout the illness. However, research on palliative care in HCC remains limited, particularly during the COVID-19 pandemic. This study investigates the healthcare utilization associated with palliative care referral among patients with HCC. Methods: This is a retrospective cross-sectional analysis conducted using the National Inpatient Sample (NIS) database from 2019 to 2021 among patients with HCC age ≥18 years. Results: Among the 35,220 hospitalizations with HCC as the principal diagnosis, 18.7% received inpatient palliative care referrals. Factors associated with increased palliative care referrals included age ≥65 years, Midwest region, Charlson Comorbidity Index (CCI) score ≥3, and end-of-life care, as reflected by discharge resulting in death. No racial or insurance disparities were observed. Palliative care consultations were associated with lower total hospital costs ($20,573 vs $26,035, <0.0001). A higher prevalence of "do-not-resuscitate" status was also found among patients with palliative care referrals. Conclusion: The study provides an understanding of palliative care utilization across pre-pandemic and pandemic periods. Factors such as advanced age, hospital region, and underlying comorbidities influenced the likelihood of referral, with no discernible racial or insurance disparities identified. Palliative care involvement has also been shown to provide cost-effective supportive care with lower hospital costs. These findings provide invaluable guidance for optimizing the integration of palliative care alongside HCC management.
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Affiliation(s)
- Kim Abbegail Tan Aldecoa
- Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA
- Wayne State University, Detroit, MI, USA
| | | | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, INOVA Fairfax Medical Campus, Great Falls, VA
- Catalyst Medical Consulting, Huntington Valley, PA, USA
| | - Geetha Krishnamoorthy
- Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA
- Wayne State University, Detroit, MI, USA
| | - Camelia Arsene
- Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA
- Wayne State University, Detroit, MI, USA
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Rodgers SK, Fetzer DT, Seow JH, McGillen K, Burrowes DP, Fung C, Udare AS, Wilson SR, Kamaya A. Optimizing US for HCC surveillance. Abdom Radiol (NY) 2025; 50:2453-2463. [PMID: 39585379 PMCID: PMC12069441 DOI: 10.1007/s00261-024-04631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 10/02/2024] [Accepted: 10/04/2024] [Indexed: 11/26/2024]
Abstract
Ultrasound is the primary imaging modality used for surveillance of patients at risk for HCC. In 2017, the American College of Radiology Liver Imaging Reporting and Data Systems (ACR LI-RADS) introduced US LI-RADS to standardize the performance, interpretation, and reporting of US for HCC surveillance, with the algorithm recently updated as LI-RADS US Surveillance v2024. The American Association for the Study of Liver Diseases (AASLD) recommends reporting both the examination-level LI-RADS US Category as well as the US Visualization Score. The US Category conveys the overall findings of the exam and primarily determines follow up recommendations. The US Visualization Score conveys the expected sensitivity of the test and stratifies patients into appropriate surveillance pathways. One of the goals of routine surveillance is the detection of HCC at an early, potentially curable stage. Therefore, optimizing US technique is of critical importance. Increasing North American and worldwide utilization of LI-RADS US Surveillance, which includes technical recommendations, through education and outreach will undoubtedly benefit patients undergoing US HCC surveillance.
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Affiliation(s)
| | - David T Fetzer
- The University of Texas Southwestern Medical Center, Dallas, USA
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Rhee H, Kim MJ, Kim DY, An C, Kang W, Han K, Roh YH, Han KH, Ahn SH, Choi JY, Park JY, Chung YE, Kim SU, Kim BK, Lee S, Lee HW, Lee JS. Noncontrast Magnetic Resonance Imaging vs Ultrasonography for Hepatocellular Carcinoma Surveillance: A Randomized, Single-Center Trial. Gastroenterology 2025; 168:1170-1177.e12. [PMID: 39855314 DOI: 10.1053/j.gastro.2024.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 12/19/2024] [Accepted: 12/26/2024] [Indexed: 01/27/2025]
Abstract
BACKGROUND & AIMS This study aimed to compare ultrasonography (US) and noncontrast magnetic resonance imaging (MRI) in the surveillance of hepatic malignancy. METHODS We conducted a randomized, nonblinded trial at a single center in South Korea. Eligible individuals were aged 20 to 70 years with liver cirrhosis, Child-Pugh class A, and no history of liver cancer or other recent malignancy. Participants were randomized 1:1 to receive up to 10 semiannual surveillance using US or noncontrast MRI with serum alpha-fetoprotein testing. The primary endpoints were the detection rates of Barcelona Clinic Liver Cancer (BCLC) stage 0 or A tumors, stage distribution at initial diagnosis, and false-positive referral rates. RESULTS From June 2015 to November 2017, 416 patients were screened, and 414 were enrolled and assigned to the US (n = 207) or MRI (n = 207) group. In total, 23 participants in the US group and 25 in the MRI group were diagnosed with liver cancer by November 2022. The detection rates of BCLC stage 0 or A tumors were not different between the US and MRI groups (7% [95% confidence interval (CI), 4%-11%] vs 12% [8%-17%]). BCLC stage 0 tumors were more frequently detected in the MRI group than in the US group (8% vs 2%). The MRI group had earlier BCLC stage (P = .014) and lower false-positive referral rate (0.7% [95% CI, 0.4%-1.2%] vs 3.1% [2.3%-4.1%], P < .001) compared with the US group. CONCLUSIONS Noncontrast MRI is a better alternative to US for the surveillance of cirrhotic patients offering earlier stage at initial diagnosis and lower false-positive referral rate. (ClincalTrials.gov, Number: NCT02514434.).
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Affiliation(s)
- Hyungjin Rhee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong-Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| | - Do Young Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| | - Chansik An
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Wonseok Kang
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin-Young Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Yong Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Eun Chung
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Up Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sunyoung Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Won Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Seung Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Wu Y, Cheng G, Han J, Yang Q. Myosteatosis and the survival of patients with hepatocellular carcinoma: a meta-analysis. Clin Exp Med 2025; 25:164. [PMID: 40377729 PMCID: PMC12084174 DOI: 10.1007/s10238-025-01671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Accepted: 04/04/2025] [Indexed: 05/18/2025]
Abstract
Myosteatosis, characterized by fat infiltration into skeletal muscle, is increasingly recognized as a prognostic factor in hepatocellular carcinoma (HCC), although the results were not consistent. This meta-analysis aimed to summarize impact on overall survival (OS) and progression-free survival (PFS) in patients with HCC.A systematic search of PubMed, Embase, and Web of Science was conducted to identify observational studies reporting survival outcomes in HCC patients with and without myosteatosis. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. A total of 24 retrospective cohort studies involving 7436 HCC patients were included. Myosteatosis was significantly associated with poorer OS (HR: 1.60, 95% CI: 1.40-1.83, p < 0.001, I2 = 65%) and PFS (HR: 1.53, 95% CI: 1.33-1.76, p < 0.001, I2 = 36%). Subgroup analysis revealed a stronger association in Asian studies (HR: 1.74 for OS; 1.57 for PFS) compared to European studies (HR: 1.08 for OS; 1.05 for PFS). The prognostic impact remained significant regardless of anticancer treatment type, myosteatosis assessment method, sex-specific or universal cutoff values, and follow-up duration (p for subgroup differences all > 0.05). The results remained significant in studies adjusting for sarcopenia (HR: 1.89 for OS; 1.50 for PFS). Meta-regression analyses did not suggest any of the following variables may affect the results, including sample size, mean ages of the patients, proportions of men, follow-up durations, and study quality scores (p all > 0.05).Myosteatosis is independently associated with worse survival in HCC patients, particularly in Asian populations. These findings highlight the significance of assessing muscle quality as a prognostic factor in HCC.
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Affiliation(s)
- Yongjuan Wu
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136 Jingzhou Street, Xiangcheng District, Xiangyang, 441021, Hubei Province, China
| | - Guangyuan Cheng
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136 Jingzhou Street, Xiangcheng District, Xiangyang, 441021, Hubei Province, China
| | - Jun Han
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136 Jingzhou Street, Xiangcheng District, Xiangyang, 441021, Hubei Province, China
| | - Qingsong Yang
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136 Jingzhou Street, Xiangcheng District, Xiangyang, 441021, Hubei Province, China.
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Burciu C, Miutescu B, Bende R, Burciu D, Moga TV, Popescu A, Popa A, Bende F, Gadour E, Burdan A, Iovanescu D, Danila M, Sirli R. Effects of the COVID-19 Pandemic and Post-Pandemic Changes on the Diagnosis, Treatment, and Mortality of Hepatocellular Carcinoma in a Tertiary Center in Western Romania. Cancers (Basel) 2025; 17:1660. [PMID: 40427157 PMCID: PMC12110651 DOI: 10.3390/cancers17101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2025] [Revised: 05/08/2025] [Accepted: 05/13/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND/OBJECTIVES Access to healthcare services was significantly restricted during the COVID-19 pandemic, leading to changes in the management of hepatocellular carcinoma (HCC). However, limited research has examined how these changes evolved post-pandemic. This study evaluated the impact of the pandemic at a tertiary center in Romania, focusing on diagnosis rates, treatments, and survival outcomes. METHODS A retrospective study conducted at Timișoara County Hospital divided patients into three equal cohorts of 23 months each: the pre-pandemic period (PreP: 1 May 2018-31 March 2020), the pandemic period (PandP: 1 April 2020-28 February 2022), and the post-pandemic period (PostP: 1 March 2022-31 January 2024). Newly diagnosed HCC cases were evaluated for the tumor stage, biological markers, and treatment received during each period. A survival census was conducted nine months after the diagnosis. RESULTS During the PandP and PostP periods, the numbers of newly diagnosed HCC cases decreased to 58 cases (p < 0.001) and 64 cases (p < 0.005), respectively, representing reductions of 38.3% and 31.9% compared to the PreP period, which had 94 cases. The proportion of patients in the BCLC-B stage increased from 31.9% in the PreP period to 50% during the PandP period (p = 0.0401), with fewer BCLC-A-0 cases (17% vs 5.1%; p = 0.059) during PandP. The tumor characteristics, BCLC classification, and TNM staging showed no significant differences between the PreP and PostP periods. Systemic therapy was the most commonly used treatment (39.7-50%). No significant differences were observed across treatment types when comparing all three periods (p > 0.05). The median follow-up times in the PreP, PandP, and PostP periods were 157.5, 159.5, and 183.5 days, respectively, with no statistically significant differences. The survival curve showed no statistically significant differences in survival between the groups at the nine-month follow-up (p > 0.05). CONCLUSIONS The COVID-19 pandemic decreased HCC diagnoses, with only a partial rebound in the PostP period that did not reach PreP levels. While the PandP period showed worsening BCLC staging and an increase in tumor numbers, the tumor stage and treatment in the PostP period were similar to those in the PreP period. Similarly, the nine-month survival rates remained similar across all three periods.
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Affiliation(s)
- Calin Burciu
- Department of Gastroenterology, Faculty of Medicine, Pharmacy and Dental Medicine, “Vasile Goldis” West University of Arad, 310414 Arad, Romania; (C.B.); (D.I.)
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Bogdan Miutescu
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
| | - Renata Bende
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
| | - Deiana Burciu
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
| | - Tudor Voicu Moga
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
| | - Alina Popescu
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
| | - Alexandru Popa
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
| | - Felix Bende
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
| | - Eyad Gadour
- Multi-Organ Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia;
- Department of Medicine, Faculty of Medicine, Zamzam University College, Khartoum 11113, Sudan
| | - Adrian Burdan
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
| | - Dana Iovanescu
- Department of Gastroenterology, Faculty of Medicine, Pharmacy and Dental Medicine, “Vasile Goldis” West University of Arad, 310414 Arad, Romania; (C.B.); (D.I.)
| | - Mirela Danila
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
| | - Roxana Sirli
- Center for Advanced Research in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (R.B.); (D.B.); (T.V.M.); (A.P.); (A.P.); (F.B.); (A.B.); (M.D.); (R.S.)
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Pius Brinzeu” County Emergency Clinical Hospital, 300723 Timisoara, Romania
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Liu M, Qiu Y, Xie E, Qian P, Yang S, Zhao S, Yan W, Huang X, Han S. Development of a chitosanase 3-like protein 1 assay kit and study of its application in patients with hepatocellular carcinoma. BMC Biotechnol 2025; 25:35. [PMID: 40355912 PMCID: PMC12070687 DOI: 10.1186/s12896-025-00970-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Accepted: 04/28/2025] [Indexed: 05/15/2025] Open
Abstract
OBJECTIVE The detection kit for plasma Chitinase-3-like Protein 1 was developed using the magnetic bead chemiluminescence method, in order to investigate the diagnostic value of DD, FDP, CHI3L1, AFP-L3 and PIVKA-II in hepatocellular carcinoma. METHOD The CHI3L1 detection kit was developed using the chemiluminescence method. The luminescence value obtained from the chemiluminescence analyzer was utilized for sensitive detection of CHI3L1, and the performance of the kit was evaluated accordingly. Moreover, this study enrolled 200 patients with hepatocellular carcinoma who were treated at the Oncology Department of the Affiliated Hospital of Jiangnan University between August 2022 and November 2023 as study subjects, while 100 healthy individuals undergoing physical examinations during the same period served as a control group. The plasma CHI3L1 levels in these subjects were measured using our institute's developed kit. Simultaneously, DD, FDP, AFP-L3, and PIVKA-II levels were assessed in all subjects to investigate their relationship with general pathology in patients with hepatocellular carcinoma. Additionally, ROC curves were generated to evaluate both single and combined detections' diagnostic efficacy for hepatocellular carcinoma. RESULT The serological index changes of DD, FDP, AFP-L3, PIVKA-II, and CHI3L1 were not associated with patient gender. The concentrations of AFP-L3 and PIVKA-II in the 45-59 age group were significantly higher than in other groups (P < 0.05). Additionally, DD, CHI3L1, and PIVKA-II levels were markedly elevated in patients with tumors > 5 cm, medium-to-high differentiation, nerve invasion, lymph node metastasis, or distant metastasis. In advanced liver cancer (stages III-IV), DD, FDP, and CHI3L1 concentrations were significantly higher than in early-stage patients (stages I-II). For single diagnostic analysis, the AUC for CHI3L1 was 0.923, while the combined AUC for all five indices was 0.961, indicating greater diagnostic value when used together. The CHI3L1 chemiluminescence detection kit had a minimum detection limit of 1.50 ng/mL, with precision and accuracy within 10%, and R > 0.99. Compared to a clinical reference kit, the correlation coefficient (R) was 0.994, meeting clinical performance evaluation criteria. CONCLUSION The CHI3L1 chemiluminescence kit developed meets clinical requirements. CHI3L1 can be used as an indicator for early screening of liver cancer, and the detection value of combined five indicators DD, FDP, AFP-L3, PIVKA-II and CHI3L1 is higher than that of single detection.
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Affiliation(s)
- Min Liu
- Department of Laboratory Medicine, Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi City, Jiangsu Province, 214122, China
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Yanru Qiu
- Department of Laboratory Medicine, Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi City, Jiangsu Province, 214122, China
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Erfu Xie
- Department of Laboratory Medicine, The First Afiliated Hospital with Nanjing Medical University, Nanjing City, Jiangsu, China
| | - Pu Qian
- Department of Laboratory Medicine, Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi City, Jiangsu Province, 214122, China
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Shuxian Yang
- Department of Laboratory Medicine, The First Afiliated Hospital with Nanjing Medical University, Nanjing City, Jiangsu, China
| | - Simin Zhao
- Department of Laboratory Medicine, Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi City, Jiangsu Province, 214122, China
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Wenjun Yan
- Department of Laboratory Medicine, Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi City, Jiangsu Province, 214122, China
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Xuan Huang
- Department of Laboratory Medicine, Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi City, Jiangsu Province, 214122, China.
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China.
| | - Shuang Han
- Department of Pathology, Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi City, Jiangsu Province, 214122, China.
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China.
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9
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Cornberg M, Sandmann L, Jaroszewicz J, Kennedy P, Lampertico P, Lemoine M, Lens S, Testoni B, Lai-Hung Wong G, Russo FP. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2025:S0168-8278(25)00174-6. [PMID: 40348683 DOI: 10.1016/j.jhep.2025.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2025] [Accepted: 03/20/2025] [Indexed: 05/14/2025]
Abstract
The updated EASL Clinical Practice Guidelines on the management of hepatitis B virus (HBV) infection provide comprehensive, evidence-based recommendations for its management. Spanning ten thematic sections, the guidelines address diagnostics, treatment goals, treatment indications, therapeutic options, hepatocellular carcinoma surveillance, management of special populations, HBV reactivation prophylaxis, post-transplant care, HBV prevention strategies, and finally address open questions and future research directions. Chronic HBV remains a global health challenge, with over 250 million individuals affected and significant mortality due to cirrhosis and hepatocellular carcinoma. These guidelines emphasise the importance of early diagnosis, risk stratification based on viral and host factors, and tailored antiviral therapy. Attention is given to simplified algorithms, vaccination, and screening to support global HBV elimination targets. The guidelines also discuss emerging biomarkers and evolving definitions of functional and partial cure. Developed through literature review, expert consensus, and a Delphi process, the guidelines aim to equip healthcare providers across disciplines with practical tools to optimise HBV care and outcomes worldwide.
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10
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Tillakeratne S, Valerio H, Alavi M, Hajarizadeh B, Martinello M, George J, Matthews G, Grebely J, Pearson SA, Dore GJ. Trends in cause-specific mortality among people with hepatitis C virus in New South Wales, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2025; 139:104790. [PMID: 40168800 DOI: 10.1016/j.drugpo.2025.104790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 02/25/2025] [Accepted: 03/20/2025] [Indexed: 04/03/2025]
Abstract
BACKGROUND Monitoring of HCV-related morbidity and mortality is crucial to evaluate direct-acting antiviral (DAA) therapy impact and HCV elimination progress. This population-based study examined mortality among individuals with an HCV notification in New South Wales (NSW), Australia, including cause-specific mortality prior to and during the viral hepatitis elimination era (2015-2021). METHODS HCV notifications in NSW, Australia (1995-2021) were linked to hospitalisation records and cause-specific mortality records. Over the period 2002-2021, all-cause and cause-specific mortality rates were examined. Cox proportional hazard models were used to assess factors associated with mortality during the viral hepatitis elimination era. RESULTS Among people with HCV notifications in 1995-2021, 112,046 were alive during 2002-2021 and contributed to mortality analyses. All-cause mortality per 100,000 population increased from 5.5 in 2002 to 13.4 in 2015 and plateaued at 12.9 in 2021. Liver-related mortality per 100,000 population increased from 2.0 in 2002 to 5.9 in 2015, before declining to 4.6 in 2021. Drug-related mortality per 100,000 population increased from 0.7 in 2002 to 1.8 in 2015, before declining to 1.2 in 2021. Factors associated with increased mortality risk during 2015-2021 included: recent injecting drug use (adjusted Hazard Ratio [aHR] 7.22, 95 % CI 6.84-7.62) and recent alcohol use disorder (aHR 3.17, 95 % CI 2.97-3.37). Recent opioid agonist therapy (aHR 0.47, 95 % CI 0.43-0.51) and recent incarceration (aHR 0.32, 95 % CI 0.23-0.45) were associated with lower mortality risk. CONCLUSION During the HCV elimination era, both liver-related and drug-related mortality have declined, suggesting direct and indirect impacts of DAA therapy, respectively. Expanded opioid agonist therapy coverage and enhanced alcohol use disorder management could further reduce mortality.
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Affiliation(s)
| | | | - Maryam Alavi
- The Kirby Institute, UNSW, Sydney, NSW, Australia
| | | | | | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
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11
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Vaz J, Hagström H, Eilard MS, Rizell M, Strömberg U. Socioeconomic inequalities in diagnostics, care and survival outcomes for hepatocellular carcinoma in Sweden: a nationwide cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2025; 52:101273. [PMID: 40224376 PMCID: PMC11987686 DOI: 10.1016/j.lanepe.2025.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 03/05/2025] [Accepted: 03/05/2025] [Indexed: 04/15/2025]
Abstract
Background Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. This study evaluates how strongly socioeconomic factors associate with diagnostics, treatment, and survival among patients with HCC in Sweden. Methods All adult patients registered with a diagnosis of HCC in the Swedish quality register for liver cancer between 2011 and 2021 were included. Household income was classified as low (first quartile; poorest), medium (second or third quartile), or high (in fourth quartile; wealthiest) based on the overall distribution of household income across all household in Sweden. Outcomes included likelihood of diagnosis under surveillance, early-stage diagnosis (Barcelona Clinic Liver Cancer [BCLC] staging 0-A), and receipt of curative treatment (ablation, resection or liver transplantation), as well as mortality risk. Findings Among 5490 patients, a significant association was found between low household income and decreased likelihood of diagnosis while under surveillance (adjusted odds ratio [aOR] 0·63; 95% confidence interval [CI]: 0·50-0·80), early-stage diagnosis (aOR 0·58; 95% CI: 0·51-0·67), and curative treatment receipt (aOR 0·65; 95% CI: 0·50-0·85). After adjustments for all variables in the BCLC, other sociodemographic variables, comorbidities, and cirrhosis status, patients with low household income had an adjusted hazard ratio for mortality of 1·29 (95% CI: 1·15-1·45) compared to patients with high household income. Interpretation Socioeconomic disparities associate markedly with more advanced stage at HCC diagnosis, less curative treatment, and poorer survival in Sweden. Addressing these disparities through targeted public health interventions may improve HCC care and outcomes in socioeconomically disadvantaged populations. Funding The Swedish Cancer Society-Cancerfonden.
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Affiliation(s)
- Juan Vaz
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Halland Hospital Halmstad, Halmstad, Sweden
| | - Hannes Hagström
- Department of Medicine, Halland Hospital Halmstad, Halmstad, Sweden
- Unit of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Sternby Eilard
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Transplantation, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Magnus Rizell
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Transplantation, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Ulf Strömberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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12
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Rao S, Prince SP, Gaddipati S, Feun L, Ezenwajiaku N, Martin P, Jones PD. Looking Toward the Future: Emerging Therapies for Hepatocellular Carcinoma. Gastroenterol Hepatol (N Y) 2025; 21:286-297. [PMID: 40416920 PMCID: PMC12100529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2025]
Abstract
Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related deaths worldwide. Despite the decreasing prevalence of hepatitis C, the burden of HCC is expected to rise owing to the increasing prevalence of metabolic syndrome and increased global alcohol consumption. Guideline-concordant screening with ultrasound every 6 months has been associated with increased rates of early-stage detection and receipt of curative treatment. However, most patients with cirrhosis do not undergo screening, with HCC often diagnosed only at an advanced stage when curative resection or ablation is not feasible. Systemic medical therapy is indicated in patients diagnosed with infiltrative or advanced HCC, or when early-stage disease progresses or recurs after resection, transplant, or other locoregional therapy. Sorafenib was approved as first-line therapy for HCC in 2007. Since 2017, there has been an exponential rate of approval of novel agents targeting HCC, including lenvatinib, regorafenib, and cabozantinib. Checkpoint inhibitors, including pembrolizumab, nivolumab, ipilimumab, and combination therapy with atezolizumab plus bevacizumab and durvalumab plus tremelimumab, have expanded treatment options. This article describes treatment for all HCC stages, with a brief discussion of locoregional therapy for context, as some emerging treatment regimens combine locoregional and systemic therapies. The article highlights approved systemic therapies that are guideline-endorsed and emerging therapies for advanced HCC.
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Affiliation(s)
- Sanjana Rao
- University of Miami/Jackson Health System Internal Medicine Residency, University of Miami Miller School of Medicine, Miami, Florida
| | - Sean-Patrick Prince
- University of Miami/Holy Cross Health Internal Medicine Program, Fort Lauderdale, Florida
| | - Sirisha Gaddipati
- University of Miami/Jackson Health System Internal Medicine Residency, University of Miami Miller School of Medicine, Miami, Florida
| | - Lynn Feun
- Department of Medicine, Division of Medical Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Nkiruka Ezenwajiaku
- Department of Medicine, Division of Medical Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Paul Martin
- Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Patricia D. Jones
- Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
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13
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Sala M, Pascual S, Rota Roca MR, Matilla AM, Campos M, Delgado M, Ferrer MT, Montero JL, González-Santiago JM, Guerrero A, Aracil C, Rodríguez-Lope C, Romero-Gutiérrez M, Sogbe M, Vázquez-Rodríguez S, Olmo JF, Mínguez B, Cortés-García L, Vallejo-Senra N, Unceta PR, Clos A, Díaz-Bethencourt D, Sánchez AG, Castro RQ, Bustamante J, Perelló C, Urquijo Ponce JJ, Serra HA, Llamoza-Torres CJ, Montoliu S, Fernández-Marcos C, Guiberteau A, Hernández-Guerra M, Vergara M, Fernández-López AM, Valer López-Fando MP, Gutiérrez-García ML, Hernáez-Alsina T, Coll S, Cuyás B, Morillas MJ, Olmedo SR, Fernández-Bermejo M, Roget M, Ramos IC, Pacheco del Río G, Rifà R, Gacho PC, Barrio ML, Gómez-Rubio M, Peñas I, Serra I, Cachero A, Reig M, Giraldez Á, Guerrero M, Segarra JX, Lledó JL, Díaz-González Á, Delgado C, Iñarrairaegui M, Rodríguez-González MM, Lázaro M, Bermúdez-Ramos M, Lué A, Molina E, Macías-Rodríguez MA, Rodríguez M, Chiminazzo V, Varela M. Evolving epidemiology of HCC in Spain. JHEP Rep 2025; 7:101336. [PMID: 40248605 PMCID: PMC12005282 DOI: 10.1016/j.jhepr.2025.101336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 01/20/2025] [Accepted: 01/22/2025] [Indexed: 04/19/2025] Open
Abstract
Background & Aims The epidemiological landscape of hepatocellular carcinoma (HCC) in Europe is evolving. This study aims to provide an updated description of the current epidemiology of liver cancer in Spain. Methods This multicenter prospective study collected demographic and clinical data on primary liver cancer between October 2022 and January 2023. We conducted descriptive and comparative analyses with data collected in 2008 and 2014. Results Of the 767 cases of primary liver cancer collected from 52 centers, 91% were diagnosed as HCC. The majority of patients were male (83.3%), average age 68 years, 80.7% had cirrhosis. The primary causes were alcohol (29.9% alone, 55% combined with other etiologies), liver disease related to metabolic syndrome (LDrMS, 23%) and hepatitis C (17.3%). Treatments included ablation (15.7%), systemic therapy (14.7%), and chemoembolization (14.6%). Data from 29 centers (n = 1,351) across three registries revealed a significant increase in LDrMS (from 4.9% to 24%) and HCC in non-cirrhotic livers (from 4.2% to 7.9%). Meanwhile, hepatitis C decreased sharply (from 43% to 17.5%). Alcohol-related cases remained stable. There was a slight increase in male patients and hypertension, diabetes, and obesity. Patients with cirrhosis diagnosed outside of screening programs presented with larger tumors and more advanced disease. This led to fewer evaluations for curative treatments. Conclusions Alcohol accounts for 30% of HCC cases and is the main etiology. The registry shows a decrease in hepatitis C-related HCC, an increase in LDrMS and HCC in non-cirrhotic livers. Surveillance was implemented in ∼80% of the recommended population. There is a need for improved screening and prevention strategies, particularly for alcohol abuse and LDrMS, to enhance HCC management. Impact and implications Our study showcases the involvement of numerous reference centers across Spain and examines over 1,300 patients to track the changing epidemiology of hepatocellular carcinoma (HCC) over 14 years. In patients with known liver cirrhosis, more than 80% of HCC diagnoses were made through screening leading to early-stage identification and curative treatment opportunities. Notably, there has been a shift in HCC etiology within the registries from hepatitis C to liver disease related to metabolic syndrome, with an increase in cases without cirrhosis. Findings indicate a need for the prevention and early detection of HCC, particularly focusing on alcohol and liver disease related to metabolic syndrome, along with greater involvement of health authorities, to improve the participation of at-risk patients in screening programs.
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Affiliation(s)
- Margarita Sala
- Unidad Hepatología, Servicio Digestivo, Hospital Universitari Doctor Josep Trueta, IDIBGI (Institut d’Investigació Biomédica de Girona), Girona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Sonia Pascual
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Unidad Hepática, Servicio Digestivo, Hospital General Universitario Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABAL), Alicante, Spain
| | - Maria Rosa Rota Roca
- Servicio Aparato Digestivo, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Ana María Matilla
- Servicio Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta Campos
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Grupo BCLC, Unidad de Oncología Hepática, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Manuel Delgado
- Servicio de Aparato Digestivo, Hospital Universitario La Coruña, A Coruña, Spain
| | | | - José Luís Montero
- Unidad de Hepatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jesús Manuel González-Santiago
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Laboratorio de Hepatología Experimental y Vectorización de Fármacos (HEVEPHARM), IBSAL (Instituto de Investigación Biomédica de Salamanca), Salamanca, Spain
| | - Antonio Guerrero
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Carles Aracil
- Servicio Aparato Digestivo (Hepatología), Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Carlos Rodríguez-Lope
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marta Romero-Gutiérrez
- Servicio de Aparato Digestivo (Sección Hepatología), Hospital Universitario de Toledo, Toledo, Spain
| | - Miguel Sogbe
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sergio Vázquez-Rodríguez
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo, Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Javier Fuentes Olmo
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Beatriz Mínguez
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Servicio de Hepatología, Hospital Universitario Vall d’Hebron, Vall d’Hebron Institute of Research (VHIR), Universitat Autónoma de Barcelona, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Luís Cortés-García
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Instituto de Investigación Sanitaria de Aragón (ISS Aragón), Spain
| | - Nicolau Vallejo-Senra
- Servicio Aparato Digestivo, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Ariadna Clos
- Servicio Aparato Digestivo, Sección Hepatología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Dácil Díaz-Bethencourt
- Servicio de Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Santa Cruz de Tenerife, Spain
| | | | | | - Javier Bustamante
- Servicio de Gastroenterología y Hepatología, Osakidetza Basque Health Service, Ezkerraldea-Enkarterri-Cruces IHO, Cruces University Hospital, Barakaldo, Spain
| | - Christie Perelló
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | - Camilo Julio Llamoza-Torres
- Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Laboratorio de Obesidad y Metabolismo, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Silvia Montoliu
- Servicio de Aparato Digestivo, Hospital Universitari Joan XXIII, Institut d’Investigació Sanitaria Pere Virgili (IISPV), Tarragona, Spain
| | | | - Ana Guiberteau
- Servicio Aparato Digestivo, Unidad de Hepatología y Trasplante Hepático, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | - Mercedes Vergara
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Unidad de Hepatología, Servicio de Digestivo, Parc Taulí Sabadell Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Susana Coll
- Servei Digestiu, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Berta Cuyás
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Servicio de Patología Digestiva, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | | | | | | | - Mercè Roget
- Unidad de Hepatología, Servicio de Digestivo, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Irina Calvo Ramos
- Servicio de Aparato Digestivo, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Gemma Pacheco del Río
- Servicio de Medicina Digestiva, Hospital Universitario de La Ribera, Alzira, Valencia, Spain
| | - Raimon Rifà
- Servicio de Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | | | | | | | - Irene Peñas
- Servicio de Aparato Digestivo, Unidad de Hepatología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Isabel Serra
- Unidad Hepatología, Servicio Digestivo, Hospital Universitari Doctor Josep Trueta, IDIBGI (Institut d’Investigació Biomédica de Girona), Girona, Spain
| | - Alba Cachero
- Servicio Aparato Digestivo, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - María Reig
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Grupo BCLC, Unidad de Oncología Hepática, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Álvaro Giraldez
- Servicio de Digestivo, Hospital Virgen del Rocío, Sevilla, Spain
| | - Marta Guerrero
- Unidad de Hepatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - José Xavier Segarra
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Laboratorio de Hepatología Experimental y Vectorización de Fármacos (HEVEPHARM), IBSAL (Instituto de Investigación Biomédica de Salamanca), Salamanca, Spain
| | - José Luis Lledó
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Álvaro Díaz-González
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carolina Delgado
- Servicio de Aparato Digestivo (Sección Hepatología), Hospital Universitario de Toledo, Toledo, Spain
| | - Mercedes Iñarrairaegui
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra, Pamplona, Spain
| | - María Milagros Rodríguez-González
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo, Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - María Lázaro
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - María Bermúdez-Ramos
- Servicio de Hepatología, Hospital Universitario Vall d’Hebron, Vall d’Hebron Institute of Research (VHIR), Universitat Autónoma de Barcelona, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alberto Lué
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Instituto de Investigación Sanitaria de Aragón (ISS Aragón), Spain
| | - Esther Molina
- Servicio Aparato Digestivo, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Manuel Rodríguez
- Servicio de Aparato Digestivo, Sección de Hepatología, Hospital Universitario Central de Asturias, IUOPA (Instituto Universitario de Oncología de Principado de Asturias), ISPA (Instituto de Investigación Sanitaria del Principado de Asturias), FINBA (Fundación para la Investigación y la Innovación Biosanitaria del Principado de Asturias), Universidad de Oviedo, Oviedo, Spain
| | - Valentina Chiminazzo
- Plataforma de Bioestadística y Epidemiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - María Varela
- Servicio de Aparato Digestivo, Sección de Hepatología, Hospital Universitario Central de Asturias, IUOPA (Instituto Universitario de Oncología de Principado de Asturias), ISPA (Instituto de Investigación Sanitaria del Principado de Asturias), FINBA (Fundación para la Investigación y la Innovación Biosanitaria del Principado de Asturias), Universidad de Oviedo, Oviedo, Spain
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14
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Ebel S, Busse H, Beeskow A, Meyer HJ, Seehofer D, Berg T, van Bömmel F, Veelken R, Struck MF, Denecke T, Gößmann H. Hepatobiliary phase MRI-guided radiofrequency ablation of small hepatocellular carcinomas invisible on precontrast MRI. Eur J Radiol 2025; 186:112026. [PMID: 40054338 DOI: 10.1016/j.ejrad.2025.112026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 01/28/2025] [Accepted: 02/27/2025] [Indexed: 04/07/2025]
Abstract
PURPOSE In cirrhotic livers reliable visualization and exact localization of small hepatocellular carcinoma (HCC) can be challenging without adequate contrast enhancement. To investigate the feasibility, technical success rate, and safety of hepatobiliary phase MRI-guided percutaneous radiofrequency ablation (RFA) of small HCCs invisible on precontrast MRI. METHODS 53 patients (17f, 63.6 ± 16.7 years), with small HCC that were not visible in non-contrast MRI underwent MRI guided RFA. Feasibility was assessed by analyzing proper identification of the target tumor, tumor delineation during MRI-guided needle positioning and number of needle adjustments required for accurate placement. Technical success was defined as complete ablation with a safety margin of 5 mm. Safety was assessed from reports of procedure-related complications. RESULTS In all 53 cases, target tumors were not visible in non-contrast MRI but in the hepatobiliary phase. In 5 cases, planning imaging showed new tumors, which were either treated in the same session (n = 4) or altered the therapeutic approach (n = 1). Mean tumor diameter was 9.7 ± 1.9 mm and the number of needle adjustments was 5 ± 3. Post-ablation imaging showed a technical success rate of 98 % (51 cases, 55 tumors). No major complications occurred. Follow-up imaging (26.2 ± 22.4 month) showed no local tumor progression or recurrence. CONCLUSIONS Use of the hepatobiliary phase for MRI-guided ablation of otherwise MR-occult tumors is a feasible approach for an effective and safe treatment of small HCC nodules.
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Affiliation(s)
- Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany.
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | - Anne Beeskow
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | - Daniel Seehofer
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Hospital Leipzig, Germany
| | - Thomas Berg
- Department of Gastroenterology, Hepatology, Infectiology and Pneumology, University Hospital Leipzig, Germany
| | - Florian van Bömmel
- Department of Gastroenterology, Hepatology, Infectiology and Pneumology, University Hospital Leipzig, Germany
| | - Rhea Veelken
- Department of Gastroenterology, Hepatology, Infectiology and Pneumology, University Hospital Leipzig, Germany
| | - Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | - Holger Gößmann
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
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15
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Liu YH, Yan YW, Wei SF, Wang WJ, Zeng HJ, Wang R, Tian QF. Construction of a survival prediction model for patients with hepatocellular carcinoma (HCC) based on real clinical data: a single-center retrospective study. J Gastrointest Oncol 2025; 16:615-627. [PMID: 40386590 PMCID: PMC12078820 DOI: 10.21037/jgo-24-806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 02/19/2025] [Indexed: 05/20/2025] Open
Abstract
Background Given the rising incidence of hepatocellular carcinoma (HCC) globally, especially in China, information about independent risk factors for survival and disease prognosis of the illness is scarce. In the field of HCC research, there is an urgent need for a scientific basis to enhance the accuracy of clinical diagnosis, optimize the course of therapy, and accurately predict the prognosis. Against this backdrop, the objective of this work was to develop a scientific, efficient, and methodical nomogram to forecast the survival prognosis of HCC. Methods A real-world study collected clinical data from January 1, 2011, to December 31, 2019, for individuals with HCC. Overall survival (OS) was determined using Kaplan-Meier analysis. Independent risk variables were identified using Cox proportional hazards regression. A nomogram predicting 1-, 3-, and 5-year OS was created. The reliability of the predictions of the model was assessed using receiver operating characteristic (ROC), calibration, and decision curve analysis (DCA). Results Data from 1,128 HCC cases showed 1-, 3-, and 5-year OS rates were 86.3%, 65.3%, and 43.1%, respectively. Univariate Cox regression identified 13 variables influencing HCC survival including age, HCC screening status, hepatitis C virus (HCV) status, nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) status, liver cirrhosis, elevated alpha-fetoprotein (AFP), Child-Pugh grade, tumor size, tumor number, treatment method, tumor thrombus, and extrahepatic metastasis (P<0.05). Multivariate analysis confirmed HCC screening status, tumor size, ALD, Child-Pugh classification, and therapy method as independent prognostic factors (P<0.05). The nomogram achieved an area under the ROC curve (AUC) of 0.868. Calibration curves of the 1-, 3-, and 5-year survival times and the DCA curve confirmed its predictive accuracy. Conclusions Patients without HCC screening, tumor size >5 cm, ALD, Child-Pugh grade C, and conservative treatment had a poor survival prognosis. A nomogram based on these risk variables provides a reliable tool for predicting the survival chances of patients with HCC.
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Affiliation(s)
- Ya-Hui Liu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yun-Wei Yan
- Department of Public Health, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shu-Fan Wei
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wen-Juan Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hong-Ji Zeng
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Rui Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Qing-Feng Tian
- College of Public Health, Zhengzhou University, Zhengzhou, China
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16
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Ben Yedder N, Girot P, Koudougou C, Schnee M, Métairie S, Lim A, Soualah K, Andrault S, Salimon M, Touchefeu Y. Lack of prior screening for advanced liver fibrosis in patients with newly diagnosed hepatocellular carcinoma: Results from a prospective multicentre study. Clin Res Hepatol Gastroenterol 2025; 49:102607. [PMID: 40315983 DOI: 10.1016/j.clinre.2025.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 03/29/2025] [Accepted: 04/28/2025] [Indexed: 05/04/2025]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) most commonly occurs in a cirrhotic liver. In France, a screening rate of 20 % to 35 % has been reported in clinical cohorts. In these studies, patients were generally enrolled in centers of the same category (university or general hospitals). The aim of this study was to prospectively investigate the circumstances of HCC diagnosis and the causes of HCC screening failure in a cohort of patients from a regional network. METHODS This prospective multicenter study enrolled patients with newly diagnosed HCC from October 2022 to July 2024. Investigators were from one university hospital, two private clinics, and three general hospitals. RESULTS Two hundred patients were included. Diagnosis was made by screening in 31.0 % of cases. Most patients had comorbidities that could lead to screening for liver fibrosis: current or past history of alcohol consumption (74.6 %), diabetes (51.4 %), hypertension (75.7 %), dyslipidemia (47.4 %). The FIB-4 score was ≥ 2.67 in 74.5 % of patients in the "in screening" group and 63.9 % in the "not in -screening" group. Among the 138 patient in the "not in screening" group, 115 (83.3 %), 34 (24.6), 23 (16.7 %) and 13 (9.4 %) declared they had visited a general practionner, a cardiologist, a gastroenterologist, and/or an endocrinologist within the 12 months prior to HCC diagnosis, respectively. CONCLUSION Recognition by general practitioners of patients at risk of chronic liver disease and identification of advanced fibrosis are major areas for optimization of HCC screening.
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Affiliation(s)
- Nour Ben Yedder
- Nantes Université, CHU Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, F-44000 Nantes, France
| | - Paul Girot
- Gastroenterology Department, Centre Hospitalier Départemental Vendée, La Roche-Sur-Yon, France
| | - Carelle Koudougou
- Department of Gastroenterology, Clinique Jules Verne, Nantes, France
| | - Matthieu Schnee
- Gastroenterology Department, Centre Hospitalier Départemental Vendée, La Roche-Sur-Yon, France
| | - Sylvie Métairie
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Annie Lim
- Department of Gastroenterology, Clinique Santé Atlantique, Saint Herblain, France
| | - Kouceila Soualah
- Centre Hospitalier Châteaubriant Nozay Pouancé, Châteaubriant, France
| | - Samuel Andrault
- Gastroenterology Department, Centre Hospitalier, Cholet, France
| | - Maëva Salimon
- Department of Gastroenterology, Clinique Santé Atlantique, Saint Herblain, France
| | - Yann Touchefeu
- Nantes Université, CHU Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, F-44000 Nantes, France.
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17
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Choi WJ, Nabavizadeh N. The potential of multi- and single-cancer blood-based early detection tests in liver cancer screening. J Gastrointest Oncol 2025; 16:711-718. [PMID: 40386614 PMCID: PMC12078824 DOI: 10.21037/jgo-24-686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 01/23/2025] [Indexed: 05/20/2025] Open
Abstract
Liver cancer is one of the most common causes of cancer deaths worldwide. Although fatal when diagnosed at an advanced stage, liver cancer has a favorable prognosis when identified at an earlier stage. Guidelines for liver cancer screening do exist, currently recommending the use of ultrasound with or without hematologic markers for early detection of liver cancer. However, studies have revealed shortcomings in the current state of liver cancer screenings such as underutilization stemming from lack of primary care education and logistical barriers for patients, suboptimal sensitivity of current screening methods, and lack of screening for lower risk individuals. A multitude of liquid biopsy tests that use circulating genomic analytes for early detection of cancers are currently under development and have the potential clinical implications in the early detection of liver cancer. In this overview, we highlight limitations of current liver cancer screenings and the ongoing development of multicancer early detection tests as well as cancer specific blood tests for liver cancer. As these multi-analyte blood tests hold promise in filling the gaps of current shortcomings of liver cancer screenings, it is imperative for primary care physicians, oncologists, and hepatologists involved in the screening process to be aware of ongoing studies and the further research necessary to ascertain several parameters such as the cost-benefit ratio, mortality reduction, and sensitivities of the blood tests.
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Affiliation(s)
- Won Jin Choi
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Nima Nabavizadeh
- Department of Radiation Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
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18
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Grimm LJ, Kruse DE, Tailor TD, Johnson KS, Allen BC, Ryser MD. Current Challenges in Imaging-Based Cancer Screening, From the AJR Special Series on Screening. AJR Am J Roentgenol 2025. [PMID: 40266702 DOI: 10.2214/ajr.25.32808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2025]
Abstract
The early detection of cancer confers many significant benefits for patients, primarily by enabling less invasive and more effective treatments and thus lowering disease mortality. Radiology is integral to early cancer detection, playing either a primary or complementary role in screening programs. Imaging-based screening is often performed in conjunction with other screening tests and may involve multiple modalities depending on patient demographics and cancer type. When developing a screening program for cancer early detection, both its potential benefits and harms need to be assessed. These harms, although specific to the modality and cancer, often include overdiagnosis, overtreatment, and false-positive examinations. As radiology technology improves and new tools become available, the ratios of risk to harm of imaging-based screening will shift, and screening recommendations will need to adapt accordingly. Radiologists must be major partners in the development and execution of screening guidelines to ensure the highest quality of care for their patients. This review discusses the major challenges of cancer screening programs and guidelines, exploring sources of evidence as well as harms of overdiagnosis and overtreatment. The article focuses on the most common cancer types that incorporate imaging-based screening including lung cancer, breast cancer, colon cancer, prostate cancer, and hepatocellcular carcinoma.
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19
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Ananthakrishnan AI, Mahin A, Prasad TSK, Abhinand CS. Transcriptome Profiling and Viral-Human Interactome Insights Into HBV-Driven Oncogenic Alterations in Hepatocellular Carcinoma. Microbiol Immunol 2025. [PMID: 40243270 DOI: 10.1111/1348-0421.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 03/21/2025] [Accepted: 03/27/2025] [Indexed: 04/18/2025]
Abstract
Hepatocellular carcinoma (HCC) is the primary form of liver cancer that poses a significant global health concern due to its increasing incidence rates and diverse etiology. Chronic infection induced by hepatitis B virus (HBV) is a prominent etiological factor influencing the development of HCC. Although recent advances in multi-omics approaches have facilitated extensive exploration of HCC molecular characteristics, translating the characteristics of subtypes into clinical applications has been challenging due to parameters like limited sample size and complex classifiers for early detection. In the present study, we performed transcriptomics profiling of HBV-infected HCC patient tissue data to gather comprehensive insights into the intricate molecular mechanisms underlying HBV-associated HCC, specifically, viral protein interactions that influence the expression of oncogenes. The 1059 differentially expressed genes (DEGs) identified across two GEO data sets revealed upregulation of cell cycle and mitosis-related genes, alongside downregulation of genes involved in fatty acid degradation and cytochrome P450 activity. CDK1 and CDC20 which are part of the top cluster and hub gene from interactome analysis were identified as potential markers for HBV-positive HCC through gene expression pattern and overall survival analysis. Additionally, 19 DEGs showing significance in HCC development were identified as interacting partners with HBV proteins. Among them, the interaction of HBsAg with ALB and SHBG and their downregulation correlates to the lower testosterone levels identified in HBV and HCC patients. Together, the study enhances the understanding of the heterogeneity and molecular pathogenesis of HBV-positive HCC.
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Affiliation(s)
- Anilkumar I Ananthakrishnan
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Althaf Mahin
- Centre for Integrative Omics Data Science (CIODS), Yenepoya (Deemed to be University), Mangalore, India
| | | | - Chandran S Abhinand
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
- Department of Virus Genomics, Bioinformatics, and Statistics, Institute of Advanced Virology, Thiruvananthapuram, India
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20
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Jin X, Wong VWS, Yip TCF. Is AI-Based Hepatocellular Carcinoma Prediction Ready for Prime Time? Liver Int 2025; 45:e16165. [PMID: 40083233 DOI: 10.1111/liv.16165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 11/03/2024] [Indexed: 03/16/2025]
Affiliation(s)
- Xinrui Jin
- Medical Data Analytics Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Health Sciences Building, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Medical Data Analytics Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Health Sciences Building, The Chinese University of Hong Kong, Hong Kong, China
| | - Terry Cheuk-Fung Yip
- Medical Data Analytics Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Health Sciences Building, The Chinese University of Hong Kong, Hong Kong, China
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21
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Tian C, Ye C, Guo H, Lu K, Yang J, Wang X, Ge X, Yu C, Lu J, Jiang L, Zhang Q, Song C. Liver elastography-based risk score for predicting hepatocellular carcinoma risk. J Natl Cancer Inst 2025; 117:761-771. [PMID: 39576686 DOI: 10.1093/jnci/djae304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 10/28/2024] [Accepted: 11/18/2024] [Indexed: 04/08/2025] Open
Abstract
BACKGROUND Liver stiffness measurement (LSM) via vibration-controlled transient elastography accurately assesses fibrosis. We aimed to develop a universal risk score for predicting hepatocellular carcinoma (HCC) development in patients with chronic hepatitis. METHODS We systematically selected predictors and developed the risk prediction model (HCC-LSM) in the hepatitis B virus (HBV) training cohort (n = 2251, median follow-up of 3.2 years). The HCC-LSM model was validated in an independent HBV validation cohort (n = 1191, median follow-up of 5.7 years) and a non-viral chronic liver disease (CLD) extrapolation cohort (n = 1189, median follow-up of 3.3 years). An HCC risk score was then constructed based on a nomogram. An online risk evaluation tool Liver Elastography-Based Hepatocellular Carcinoma Risk Score (LEBER) was developed using ChatGPT4.0. RESULTS Eight routinely available predictors were identified, with LSM levels showing a significant dose-response relationship with HCC incidence (P < .001 by log-rank test). The HCC-LSM model exhibited excellent predictive performance in the HBV training cohort (C-index = 0.866) and the HBV validation cohort (C-index = 0.852), with good performance in the extrapolation CLD cohort (C-index = 0.769). The model demonstrated significantly superior discrimination compared to 6 previous models across the 3 cohorts. Cut-off values of 87.2 and 121.1 for the HCC-LSM score categorized participants into low-, medium-, and high-risk groups. An online public risk evaluation tool (LEBER; http://ccra.njmu.edu.cn/LEBER669.html) was developed to facilitate the use of HCC-LSM. CONCLUSION The accessible, reliable risk score based on LSM accurately predicted HCC development in patients with chronic hepatitis, providing an effective risk assessment tool for HCC surveillance strategies.
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Affiliation(s)
- Chan Tian
- Health Management Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, P. R. China
| | - Chunyan Ye
- Department of Liver Diseases, The Third People's Hospital of Changzhou, Changzhou 213000, Jiangsu, China
| | - Haiyan Guo
- Health Management Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, P. R. China
| | - Kun Lu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, P. R. China
| | - Juan Yang
- Health Management Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, P. R. China
| | - Xiao Wang
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xinyuan Ge
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, P. R. China
| | - Chengxiao Yu
- Health Management Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, P. R. China
| | - Jing Lu
- Health Management Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, P. R. China
| | - Longfeng Jiang
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qun Zhang
- Health Management Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ci Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, P. R. China
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22
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Heo S, Kim SY, Lee SJ, Lee SS, Byun JH, Won HJ, Shin YM, Choi SH, Sirlin CB. LI-RADS Ultrasound Surveillance Version 2024: Comparison With Version 2017 for Hepatocellular Carcinoma Detection and Risk Factors for Visualization Score C. AJR Am J Roentgenol 2025; 224:e2432433. [PMID: 39840963 DOI: 10.2214/ajr.24.32433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
Abstract
BACKGROUND. The LI-RADS Ultrasound Surveillance algorithm was updated in 2024, incorporating α-fetoprotein (AFP) and a visualization score of VIS-C into management recommendations after nonpositive results. OBJECTIVE. The purpose of this study was to compare the diagnostic performance of LI-RADS Ultrasound Surveillance version 2017 (v2017) and version 2024 (v2024) for the detection of hepatocellular carcinoma (HCC) in at-risk patients and to identify predictors of VIS-C on follow-up surveillance examinations. METHODS. This retrospective analysis included 407 patients (230 men and 177 women; median age, 56 years) with cirrhosis who underwent rounds of semiannual surveillance ultrasound as part of a prospective trial from November 2011 to August 2014. Two radiologists independently assigned ultrasound categories to round 1 examinations and visualization scores to round 1 and round 2 examinations; a third radiologist adjudicated disagreements. The AFP level was considered positive if elevated or increasing from preenrollment values, per v2024 criteria. The reference standard for HCC was positive biopsy or an LR-5 observation on MRI. Diagnostic performance was compared between v2017 and v2024. Logistic regression analyses were performed to identify predictors of a round 2 VIS-C result, with attention given to risk factors for VIS-C described in v2024. RESULTS. HCC was diagnosed in 28 patients (6.9%). LI-RADS Ultrasound Surveillance v2024, in comparison with v2017, showed greater sensitivity for reader 1 (64.3% vs 42.9%, p = .03) and reader 2 (64.3% vs 39.3%, p = .02) and lower specificity for reader 1 (82.1% vs 92.6%, p < .001) and reader 2 (82.3% vs 92.9%, p < .001). All seven patients with HCC detected by v2024 but not v2017 by means of consensus assessments had increasing AFP; two also had elevated AFP. Among 299 patients who underwent round 2 ultrasound after negative round 1 v2024 surveillance results, the only independent predictor of a round 2 VIS-C result was a round 1 VIS-C result (adjusted OR = 21.04 [95% CI, 10.84-40.83], p < .001). For 88 of these patients with round 1 VIS-C, no v2024 risk factor showed a significant univariable association with repeat VIS-C. CONCLUSION. Compared with v2017, LI-RADS Ultrasound Surveillance v2024 had higher sensitivity but lower specificity for HCC detection, which was primarily related to increasing, rather than elevated, AFP. The only independent predictor of VIS-C on subsequent ultrasound was the initial VIS-C result. CLINICAL IMPACT. The findings support the use of LI-RADS Ultrasound Surveillance v2024 to improve HCC detection in at-risk patients.
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Affiliation(s)
- Subin Heo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil Songpa-gu, 05505 Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil Songpa-gu, 05505 Seoul, Republic of Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil Songpa-gu, 05505 Seoul, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil Songpa-gu, 05505 Seoul, Republic of Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil Songpa-gu, 05505 Seoul, Republic of Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil Songpa-gu, 05505 Seoul, Republic of Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil Songpa-gu, 05505 Seoul, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil Songpa-gu, 05505 Seoul, Republic of Korea
| | - Claude B Sirlin
- Department of Radiology, Liver Imaging Group, UC San Diego, San Diego, CA
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23
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Spiers J, Li W, Aravinthan AD, Bannaga A, Caddick K, Culver EL, Faulkes RE, Gordon V, Hussain Y, Miller H, Merry J, Saad M, Sheth A, Shah T, Shetty S, Srivastava A, Subhani M, Tahir MN, Than NN, Unitt E, Alazawi W. Current Surveillance Strategy Is Less Effective for Detecting Early-Stage Hepatocellular Carcinoma in Patients with Non-Viral and Non-Cirrhotic Liver Disease. Liver Cancer 2025:1-14. [PMID: 40337094 PMCID: PMC12055015 DOI: 10.1159/000542805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 11/21/2024] [Indexed: 05/09/2025] Open
Abstract
Introduction Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths. Current international guidelines recommend 6-monthly ultrasound surveillance in all patients with cirrhosis and those with hepatitis B virus-related risk factors to detect early-stage HCC. However, it is unknown whether the benefits of surveillance are comparable across patient groups and underlying disease-related factors. We aimed to evaluate patient- and disease-related factors associated with HCC stage at diagnosis and survival in an ethnically diverse UK population. Methods This was a multicentre retrospective observational study including patients with newly diagnosed HCC between 2007 and 2020 from six UK centres. Cox proportional-hazards regression and multivariate logistic regression models were used. Results Overall, 1,780 HCC patients comprising 20.9% with ArLD, 29.7% with NAFLD, and 31.0% with viral hepatitis were analysed. Surveillance was associated with improved survival in patients with viral hepatitis but not in patients with ArLD and NAFLD. Surveillance was also associated with early-stage disease (BCLC stage 0 or A) at presentation in viral hepatitis but not in patients with ArLD. Females with ArLD were 2.5-fold more likely to present with early-stage HCC than males. Patients with NAFLD were more likely to develop HCC in the absence of cirrhosis. Type 2 diabetes was not associated with mortality, but metformin use did show survival benefit. Patients of white ethnicity had improved survival and were less likely to present with late-stage HCC compared to other ethnicities. Conclusions HCC surveillance as currently delivered was less effective for detecting early-stage HCC in patients with non-viral and non-cirrhotic liver disease. Gender and ethnicity influences stage at presentation and outcomes. HCC surveillance strategies are needed to refine risk stratification particularly in patients with NAFLD or without cirrhosis.
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Affiliation(s)
- Jessica Spiers
- Barts Liver Centre, Blizard Institute, Queen Mary Unversity of London, London, UK
| | - Wenhao Li
- Barts Liver Centre, Blizard Institute, Queen Mary Unversity of London, London, UK
| | - Aloysious D. Aravinthan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ayman Bannaga
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Emma L. Culver
- Translational Gastroenterology Unit, John Radcliffe Hospital, and Oxford NIHR and BRC Oxford, Oxford, UK
| | | | - Victoria Gordon
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yaqza Hussain
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hamish Miller
- Barts Liver Centre, Blizard Institute, Queen Mary Unversity of London, London, UK
- Translational Gastroenterology Unit, John Radcliffe Hospital, and Oxford NIHR and BRC Oxford, Oxford, UK
| | - Jenny Merry
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Muhammad Saad
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Abhishek Sheth
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tahir Shah
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Mohsan Subhani
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Nwe Ni Than
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Esther Unitt
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - William Alazawi
- Barts Liver Centre, Blizard Institute, Queen Mary Unversity of London, London, UK
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24
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Yang HK, Lee S, Lee MY, Kim MJ. Effectiveness of noncontrast-abbreviated magnetic resonance imaging in a real-world hepatocellular carcinoma surveillance. Eur Radiol 2025:10.1007/s00330-025-11517-0. [PMID: 40111496 DOI: 10.1007/s00330-025-11517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 01/16/2025] [Accepted: 02/17/2025] [Indexed: 03/22/2025]
Abstract
OBJECTIVES Noncontrast-abbreviated magnetic resonance imaging (NC-AMRI) is emerging as a promising alternative to ultrasound (US) for surveillance of hepatocellular carcinoma (HCC) in at-risk patients. We aimed to assess the effectiveness of NC-AMRI in a real-world surveillance population, and to evaluate the appropriateness of NC-AMRI in selected patients with inadequate prior US. MATERIALS AND METHODS This retrospective study included Child-Pugh class A or B adults with chronic hepatitis B or cirrhosis from any cause who underwent NC-AMRI between December 2018 and August 2022. Early- and very early-stage detection, receipt of curative treatment, and false referral were evaluated. Subgroup analysis was performed for patients with inadequate prior US examinations. Descriptive statistics were used. RESULTS Among the 1853 patients (mean age, 58.8 years; 1045 males), 68 HCCs developed in 61 (61/1853, 3.3%, 95% confidence interval: 2.5-4.2) patients. The proportions of early- and very early-stage detection were 95.1% (58/61, 72.2-100.0) and 70.5% (43/61, 51.0-95.0); receipt of curative treatment, 67.2% (41/61, 48.2-91.2); and proportion of false referral, 12.9% (9/70, 5.9-24.4). Among the 375 patients with inadequate prior US, the proportions of early- and very early-stage detection were 94.7% (18/19, 56.2-100.0) and 57.9% (11/19, 28.9-100.0); receipt of curative treatment, 52.6% (10/19, 25.2-96.8); and proportion of false referrals, 17.4% (4/23, 4.7-44.5). CONCLUSION NC-AMRI may be an effective HCC surveillance modality given the results related to early- and very early-stage detection, receipt of curative treatment, and false referral. NC-AMRI can be an alternative HCC surveillance strategy, especially for patients with inadequate prior US examinations. KEY POINTS Question There is insufficient evidence to support the use of noncontrast-abbreviated MRI as an effective surveillance tool in large real-life populations under surveillance. Findings Using noncontrast-abbreviated MRI, most patients who developed HCCs during surveillance were diagnosed at an early stage, with an acceptable false referral rate of 12.9%. Clinical relevance Noncontrast-abbreviated MRI is an effective HCC surveillance modality, especially for patients with inadequate prior ultrasound examinations.
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Affiliation(s)
- Hyun Kyung Yang
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
| | - Min Young Lee
- Office of Research Affairs/University Industry Foundation, Yonsei University, Seoul, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
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Kim A, Song BG, Kang W, Gwak GY, Paik YH, Choi MS, Lee JH, Goh MJ, Sinn DH. Assessing the Validity of the AASLD Surgical Treatment Algorithm in Patients with Early-Stage Hepatocellular Carcinoma. Gut Liver 2025; 19:265-274. [PMID: 39930622 PMCID: PMC11907255 DOI: 10.5009/gnl240214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/22/2024] [Accepted: 08/21/2024] [Indexed: 03/15/2025] Open
Abstract
Background/Aims The aim of this study was to investigate the effect of a surgical treatment algorithm recently proposed by the American Association for the Study of Liver Diseases (AASLD) on survival outcomes in patients with early-stage hepatocellular carcinoma (HCC) and identify effective alternative treatment modalities when liver transplantation (LT) is not available. Methods We studied the clinical data of 1,442 patients who were diagnosed with early-stage HCC (a single lesion measuring 2-5 cm in size or 2 to 3 lesions measuring ≤3 cm in size) between 2013 and 2018 and classified as Child-Turcotte-Pugh (CTP) A or B. Analyses were separately performed for individuals recommended for resection (single lesion, CTP A and no clinically significant portal hypertension) and those recommended for LT (single lesion with impaired liver function such as CTP B or clinically significant portal hypertension or multiple lesions). Results Of 791 patients recommended for surgical resection, 85.8% underwent resection. The 5-year survival rate was higher for patients who underwent surgical resection than for those who received other treatments (89.4% vs 72.3%). Among 651 patients recommended for LT, only 3.4% underwent the procedure. The most common alternative treatment modalities were transarterial therapy (39.3%) followed by resection (28.9%) and ablation (27.8%). The overall survival rate associated with transarterial therapy was lower than that for resection and ablation, whereas that of the latter two treatments were comparable. Conclusions The survival outcomes of treatment strategies that most closely aligned with the algorithm proposed by the AASLD were superior to those of alternative treatment approaches. However, LT in patients with early-stage HCC can be challenging. When LT is not feasible, resection and ablation can be considered first-line alternative options.
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Affiliation(s)
- Aryoung Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Byeong Geun Song
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wonseok Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Geum-Youn Gwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Han Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Seok Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Hyeok Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Ji Goh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Schäfer H, Lajmi N, Valente P, Pedrioli A, Cigoianu D, Hoehne B, Schenk M, Guo C, Singhrao R, Gmuer D, Ahmed R, Silchmüller M, Ekinci O. The Value of Clinical Decision Support in Healthcare: A Focus on Screening and Early Detection. Diagnostics (Basel) 2025; 15:648. [PMID: 40075895 PMCID: PMC11899545 DOI: 10.3390/diagnostics15050648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 02/18/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
In a rapidly changing technology landscape, "Clinical Decision Support" (CDS) has become an important tool to improve patient management. CDS systems offer medical professionals new insights to improve diagnostic accuracy, therapy planning, and personalized treatment. In addition, CDS systems provide cost-effective options to augment conventional screening for secondary prevention. This review aims to (i) describe the purpose and mechanisms of CDS systems, (ii) discuss different entities of algorithms, (iii) highlight quality features, and (iv) discuss challenges and limitations of CDS in clinical practice. Furthermore, we (v) describe contemporary algorithms in oncology, acute care, cardiology, and nephrology. In particular, we consolidate research on algorithms across diseases that imply a significant disease and economic burden, such as lung cancer, colorectal cancer, hepatocellular cancer, coronary artery disease, traumatic brain injury, sepsis, and chronic kidney disease.
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Affiliation(s)
- Hendrik Schäfer
- Clinical Development & Medical Affairs, Roche Diagnostics International Ltd., Forrenstrasse 2, 6343 Rotkreuz, Switzerland (R.S.)
- Medical Faculty, Friedrich Schiller University Jena, 07737 Jena, Germany
| | - Nesrine Lajmi
- Clinical Value & Validation, Roche Information Solutions, 2881 Scott Blvd, Santa Clara, CA 95050, USA
| | - Paolo Valente
- Clinical Development & Medical Affairs, Roche Diagnostics International Ltd., Forrenstrasse 2, 6343 Rotkreuz, Switzerland (R.S.)
| | - Alessandro Pedrioli
- Clinical Value & Validation, Roche Information Solutions, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Daniel Cigoianu
- Clinical Development & Medical Affairs, Roche Diagnostics International Ltd., Forrenstrasse 2, 6343 Rotkreuz, Switzerland (R.S.)
| | - Bernhard Hoehne
- Clinical Development & Medical Affairs, Roche Diagnostics International Ltd., Forrenstrasse 2, 6343 Rotkreuz, Switzerland (R.S.)
| | - Michaela Schenk
- Quality & Regulatory Roche Information Solutions, Roche Diagnostics International Ltd., Forrenstrasse 2, 6343 Rotkreuz, Switzerland
| | - Chaohui Guo
- Clinical Value & Validation, Roche Information Solutions, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Ruby Singhrao
- Clinical Development & Medical Affairs, Roche Diagnostics International Ltd., Forrenstrasse 2, 6343 Rotkreuz, Switzerland (R.S.)
| | - Deniz Gmuer
- Healthcare Insights, Roche Information Solutions, Roche Diagnostics International Ltd., Forrenstrasse 2, 6343 Rotkreuz, Switzerland
| | - Rezwan Ahmed
- Data, Analytics & Research, Roche Information Solutions, 2881 Scott Blvd, Santa Clara, CA 95050, USA
| | - Maximilian Silchmüller
- Medical Faculty, Friedrich Schiller University Jena, 07737 Jena, Germany
- Wiener Gesundheitsverbund, Klinik Landstraße, Juchgasse 25, 1030 Vienna, Austria
| | - Okan Ekinci
- Digital Technology & Health Information, Roche Information Solutions, 2841 Scott Blvd, Santa Clara, CA 95050, USA
- School of Medicine, University College Dublin, D04 C1P1 Dublin, Ireland
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Buchanan RM, Reinson T, Bilson J, Woodland H, Nwoguh C, Cooper K, Harris S, Malone K, Byrne CD. Screening to identify people with type 2 diabetes at risk of liver cancer in primary care: a randomised controlled trial protocol. BMJ Open 2025; 15:e088043. [PMID: 40050060 PMCID: PMC11887308 DOI: 10.1136/bmjopen-2024-088043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 02/07/2025] [Indexed: 03/09/2025] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is expected to become the third most common cause of cancer death worldwide by 2030. The increase in HCC is in large part due to the rising prevalence of risk factors such as type 2 diabetes mellitus (T2DM). Up to 1 in 20 people living with T2DM have liver cirrhosis, and they have a 1% to 2% incidence of HCC per year. Patients with cirrhosis enter surveillance for HCC to identify early-stage, curable tumours. A diagnosis of T2DM does not mandate testing to identify patients with cirrhosis, with testing restricted to those with additional risks. There has never been a trial and nested cost-effectiveness evaluation comparing screening all patients with T2DM for cirrhosis against usual care. METHODS AND ANALYSIS The study will use a multi-centre, unblinded individual randomised controlled trial design. The aim will be to determine the effectiveness and cost-effectiveness of screening all adults with T2DM to identify those at high risk of HCC. The recruitment strategy has been supported by patient and public involvement (PPI). Participants will be identified via an automated search of primary care records and invited to participate via text. 320 participants will be randomised for screening. The screening will include measurement of bio-markers for liver fibrosis (ELF and Fib-4) and vibration-controlled transient elastography. Another 320 participants will be randomised to standard care. Demographic and medical history data will be collected at baseline from all participants. Outcome data will be collected remotely from healthcare records. The primary outcome is the proportion of participants in each arm who are referred to HCC surveillance following testing for liver disease within 12 months of randomisation. The results will be used to calculate the incremental cost-effectiveness ratio of screening via a Markov model. ETHICS AND DISSEMINATION The results of this study will be presented directly to National Health Service England. Additional dissemination via conference proceedings and publication will be supported by our PPI team. Ethical approval was granted by the West of Scotland Research Ethics Service on 2 August 2023, REC reference 23/WS/0102. TRIAL REGISTRATION NUMBER ISRCTN17017677.
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Affiliation(s)
- Ryan M Buchanan
- University of Southampton Faculty of Medicine, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tina Reinson
- Clinical and Experimental Sciences Division, University of Southampton Faculty of Medicine, Southampton, UK
| | - Josh Bilson
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Hazel Woodland
- Salisbury District Hospital NHS Foundation Trust, Salisbury, UK
| | - Chinonso Nwoguh
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Keith Cooper
- Southampton Health Technology Assessment Centre, University of Southampton, Southampton, UK
| | - Scott Harris
- University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Christopher D Byrne
- University of Southampton Faculty of Medicine, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
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28
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Moon AM. Raising the Bar: Is Hepatocellular Carcinoma Surveillance Warranted for Patients With Alcohol-Associated Cirrhosis? Am J Gastroenterol 2025; 120:540-541. [PMID: 39445687 DOI: 10.14309/ajg.0000000000003123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 09/24/2024] [Indexed: 10/25/2024]
Affiliation(s)
- Andrew M Moon
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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29
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Brahmania M, Congly S, Sachar Y, Burak KW, Lethebe B, Szostakiwskyj JH, Lautner D, Medellin A, Bhayana D, Wong J, Nguyen H, Sadler MD, Borman M, Aspinall AI, Coffin CS, Swain M, Shaheen A. Dedicated Automatic Recall Hepatocellular Cancer Surveillance Programme Demonstrates High Retention: A Population-Based Cohort Study. Liver Int 2025; 45:e70020. [PMID: 39927626 PMCID: PMC11809127 DOI: 10.1111/liv.70020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 12/28/2024] [Accepted: 01/27/2025] [Indexed: 02/11/2025]
Abstract
INTRODUCTION Patient, clinician, and system-related barriers may affect adherence to hepatocellular carcinoma (HCC) surveillance programmes. The impact of a dedicated automated recall HCC surveillance programme on retention rates in patients eligible for screening is unknown. We aimed to describe and evaluate a large HCC surveillance programme in a publicly funded healthcare system. METHODS Data were collected from January 1, 2013, to December 31, 2022, from a retrospective cohort of subjects enrolled in a publicly funded automated recall semi-annual surveillance programme as per the American Association for the Study of Liver Disease HCC guidance in the Calgary Health Zone (~1.6 million), Canada. Patients were excluded if there was incomplete data or did not meet indications for surveillance. Cox regression was used to identify predictors of non-retention to surveillance. RESULTS A total of 7269 patients were included. The median was age 55.5 years (IQR: 45.5-63.8), 60% were male, 46% were of Asian descent, 51% had HBV infection, and 36% had cirrhosis (35% alcohol-related). Median follow-up was 4.9 years (IQR: 1.5-7.2). Overall, 52% (n = 3768) of patients were retained in the surveillance programme, while 8.3% (n = 603) left for potential medical reasons, and 40% (n = 2898) were lost in follow-up. The median time in the programme for those lost in follow-up was 0.81 years (IQR: 0.0-2.8) compared to 6.75 years if retained (IQR: 5.6-8.6; p < 0.001). In multivariable Cox regression analysis, HCV aetiology (HR 1.41; CI 1.23-1.62, p < 0.01), African ethnicity (HR 1.20, CI 1.02-1.42, p = 0.03), and cirrhosis (HR 1.16, CI 1.05-1.28, p < 0.01) increased risk of dropout. On interaction analysis, Hepatitis B amongst cirrhotic patients also increased risk of dropout (HR 1.48, CI 1.05-2.07, p = 0.02). CONCLUSION A dedicated automated recall HCC surveillance programme has a high retention rate in a large multi-ethnic cohort of patients while identifying certain marginalised patient populations, such as those with viral liver disease, cirrhosis, or African ethnicity, as particularly vulnerable to loss to follow-up.
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Affiliation(s)
- Mayur Brahmania
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
- O'Brien Institute of Public HealthSchulich School of MedicineLondonOntarioCanada
| | - Stephen Congly
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
- O'Brien Institute of Public HealthSchulich School of MedicineLondonOntarioCanada
| | - Yashasavi Sachar
- Division of Internal Medicine, Department of MedicineSchulich School of MedicineLondonOntarioCanada
| | - Kelly W. Burak
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
- Department of OncologyCumming School of MedicineCalgaryAlbertaCanada
| | - Brendan Lethebe
- Clinical Research UnitCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | | | - David Lautner
- Department of RadiologyCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Alexandra Medellin
- Department of RadiologyCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Deepak Bhayana
- Department of RadiologyCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Jason Wong
- Department of RadiologyCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Henry Nguyen
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
| | - Matthew D. Sadler
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
| | - Meredith Borman
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
| | - Alexander I. Aspinall
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
| | - Carla S. Coffin
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
| | - Mark Swain
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
| | - Abdel‐Aziz Shaheen
- Division of Gastroenterology and Hepatology, Department of MedicineSchulich School of MedicineLondonOntarioCanada
- O'Brien Institute of Public HealthSchulich School of MedicineLondonOntarioCanada
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30
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Gurley T, Hernaez R, Cerda V, Thomas T, Narasimman M, Mittal S, Al-Hasan M, Daher D, Singal AG. Cost-effectiveness of an outreach program for HCC screening in patients with cirrhosis: a microsimulation modeling study. EClinicalMedicine 2025; 81:103113. [PMID: 40040860 PMCID: PMC11876903 DOI: 10.1016/j.eclinm.2025.103113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Revised: 01/29/2025] [Accepted: 01/29/2025] [Indexed: 03/06/2025] Open
Abstract
Background Patients with cirrhosis are at high risk for hepatocellular carcinoma (HCC), but few undergo guideline-recommended semi-annual screening. Randomized clinical trials (RCTs) demonstrate that mailed outreach can increase screening versus visit-based screening. We estimated the costs and cost-effectiveness of an outreach strategy versus usual care. Methods We built a 10-year Markov chain Monte Carlo microsimulation model to conduct a cost-effectiveness analysis comparing a mailed outreach program versus usual care for HCC screening in a cohort of 10,000 patients with cirrhosis. Model inputs were based on literature review (2005-current), and costs were based on inflation-adjusted estimates from Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data. We conducted one-way sensitivity analyses for HCC incidence, outreach costs, efficacy of the outreach strategy to increase screening, and efficacy of curative (versus palliative) HCC treatments. Findings Mailed outreach was estimated to cost $32.45 per patient in the first year and $21.90 per patient in subsequent years. The outreach program increased the number of HCC patients detected at an early stage by 48.4% and increased quality-adjusted life years (QALYs) by 300. Cost savings from these increases offset the costs of mailed outreach. Mailed outreach remained cost-effective across a wide range of HCC incidence rates, outreach costs, efficacy of the outreach strategy to increase screening, and the efficacy of curative HCC treatments. Annual out-of-pocket patient costs in the outreach arm were low at $13 per year. Interpretation Mailed outreach to encourage HCC screening in patients with cirrhosis dominates usual care and should be considered for implementation in routine practice. Funding National Cancer Institute and Cancer Prevention Research Institute of Texas.
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Affiliation(s)
- Tami Gurley
- O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ruben Hernaez
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Vanessa Cerda
- O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tynaje Thomas
- O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manasa Narasimman
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sukul Mittal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mohammed Al-Hasan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darine Daher
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amit G. Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Al-Hasan M, Mehta N, Yang JD, Singal AG. Role of biomarkers in the diagnosis and management of HCC. Liver Transpl 2025; 31:384-394. [PMID: 38738964 DOI: 10.1097/lvt.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
For many cancers, biomarkers have served as an important tool across the cancer care continuum from risk stratification and early detection to diagnosis and treatment. Alpha-fetoprotein (AFP) remains one of the few validated biomarkers for patients with HCC. Although AFP has shown potential for each of these steps, its performance, when used alone, has often been suboptimal. There continue to be discordant recommendations about AFP's value when combined with ultrasound for surveillance, as well as its role in diagnostic algorithms. Conversely, high AFP levels are associated with aggressive tumor biology and survival, so it remains a key factor for the selection of candidates for liver transplant. There have been immense efforts to identify and validate additional biomarkers for each of these steps in the HCC care continuum. Indeed, biomarker panels have shown promising data for HCC risk stratification and surveillance among patients with cirrhosis, as well as prognostication and detection of minimal residual disease in patients undergoing HCC treatment. Several large prospective studies are currently ongoing to evaluate the role of these emerging biomarkers in clinical practice.
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Affiliation(s)
- Mohammed Al-Hasan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Neil Mehta
- Department of Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ju Dong Yang
- Department of Internal Medicine, Cedars Sinai, Los Angeles, California, USA
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Mohnasky M, Gad S, Moon A, Barritt AS, Charalel RA, Eckblad C, Caddell A, Xing M, Kokabi N. Hepatocellular Carcinoma Screening: From Current Standard of Care to Future Directions. J Am Coll Radiol 2025; 22:260-268. [PMID: 40044304 DOI: 10.1016/j.jacr.2024.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 10/09/2024] [Accepted: 10/23/2024] [Indexed: 05/13/2025]
Abstract
Hepatocellular carcinoma (HCC) represents a significant portion of global cancer incidence and mortality. Screening with ultrasound with or without alpha-fetoprotein is recommended for those at high-risk. Although screening can lead to earlier treatment and better outcomes, existing screening paradigms have several flaws. Ultrasound does not capture all early lesions and has lower efficacy in specific populations such as patients with obesity or those with metabolic dysfunction-associated steatotic liver disease (MASLD). Additionally, individuals with noncirrhotic MASLD and chronic hepatitis C also develop HCC, although not at high enough rates to justify screening based on current standards. These individuals, however, represent a substantial proportion of new HCC cases given rising MASLD rates and the endemic nature of hepatitis C in certain regions. Risk-stratifying these populations may reveal subsets that are higher risk and warrant screening. Several imaging advances, including contrast-enhanced ultrasound and abbreviated MRI protocols, may improve detection compared with the current approach. Evaluation of risk stratification and validation of these new imaging methods via clinical trials would likely lead to adjusting screening guidelines. This narrative review provides a diagnostic and interventional radiology-focused summary of the HCC screening guidelines and their recent evolution and highlights emerging imaging methods as potential screening tools of the future.
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Affiliation(s)
- Michael Mohnasky
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina.
| | - Sandra Gad
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina; Saint George's University, School of Medicine, West Indies, Grenada
| | - Andrew Moon
- Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina
| | - A Sidney Barritt
- Professor of Medicine, Director of Hepatology, Transplant Hepatology Program Director, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina
| | - Resmi A Charalel
- Assistant Professor of Population Health Science, Assistant Professor of Radiology, Division of Interventional Radiology, Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Caroline Eckblad
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina
| | - Andrew Caddell
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina
| | - Minzhi Xing
- Assistant Professor of Public Health Leadership and Practice, Gillings School of Global Public Health; Adjunct Assistant Professor of Radiology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nima Kokabi
- Associate Professor of Radiology, Vice Chair of Clinical Research, Director of Interventional Oncology, and Director of Cancer Imaging, Department of Radiology, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina
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Wu B, Wang Z, Wang G, Zhong Q, Wu Q, Li J, Ma B, Tan X, Chen J, Wang Y, Zhang X. Quantification of Fascin-1-Positive Extracellular Vesicles by Nanoflow Cytometry for Early Detection of Hepatocellular Carcinoma in Liquid Biopsy. Int J Med Sci 2025; 22:1574-1584. [PMID: 40093808 PMCID: PMC11905273 DOI: 10.7150/ijms.102438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 01/23/2025] [Indexed: 03/19/2025] Open
Abstract
Background: Hepatocellular carcinoma (HCC) lacks effective early diagnostic biomarkers. Identifying extracellular vesicles (EVs)-associated biomarkers for early HCC detection in HCC progression is precise and critical. Methods: Databases, tissue microarrays (TMA) were used to identify Fascin-1 as a candidate target for HCC, EVs isolated from tumoral and adjacent tissues. The tumor cells were transfected with lentivirus to obtain the engineered EVs. Results: Fascin-1-enriched EVs promoted HCC cell migration and induced cytoskeleton reorganization in vitro. Importantly, quantifying Fascin-1-positive EVs (Fascin-1+EVs) in patient plasma by nanoflow cytometry (nFCM) demonstrated high diagnostic performance (AUC=0.8925, 95%CI: 0.7959-0.9891) for discriminating advanced stage from early stage of HCC patients and healthy individuals. Conclusion: Our findings highlight the potential of Fascin-1+EVs as a novel non-invasive biomarker for early HCC detection, and quantitative Fascin-1+EV analysis by nanoflow cytometry provides a promising approach for HCC diagnosis.
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Affiliation(s)
- Bodeng Wu
- Department of Laboratory Medicine, Guangdong Provincial Key Laboratory of Precision Medical Diagnostics, Guangdong Engineering and Technology Research Center for Rapid Diagnostic Biosensors, Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zhenxun Wang
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Guanbo Wang
- The Second Clinical Medical School of Guangdong Medical University, Dongguan, 523000, China
| | - Quan Zhong
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qiaoting Wu
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jiawei Li
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Bo Ma
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xinyi Tan
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jiaming Chen
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yu Wang
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xin Zhang
- Department of Laboratory Medicine, Guangdong Provincial Key Laboratory of Precision Medical Diagnostics, Guangdong Engineering and Technology Research Center for Rapid Diagnostic Biosensors, Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
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Arvind A, Redmon K, Singal AG. Persisting challenges in the early detection of hepatocellular carcinoma. Expert Rev Anticancer Ther 2025:1-12. [PMID: 39943795 DOI: 10.1080/14737140.2025.2467184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 02/11/2025] [Indexed: 02/25/2025]
Abstract
INTRODUCTION Prognosis in patients with HCC is largely determined by stage at diagnosis, highlighting the importance of effective early detection strategies. HCC surveillance is associated with increased early detection and reduced HCC-related mortality and is currently recommended in patients with cirrhosis or chronic HBV infection. AREAS COVERED We performed a targeted literature review to identify limitations of current HCC surveillance practices and strategies for improvement. EXPERT OPINION Semi-annual ultrasound continues as the cornerstone modality for HCC surveillance but has limited sensitivity for detecting early-stage HCC, particularly in patients with obesity and non-viral etiologies. Although sensitivity for early-stage HCC can be improved by using ultrasound with alpha fetoprotein, this strategy misses over one-third of HCC at an early stage. Emerging imaging and biomarker-based surveillance strategies currently remain in varying stages of validation and are not yet ready for routine use in practice. The cost-effectiveness of surveillance in patients with non-cirrhotic liver disease related to hepatitis C or metabolic dysfunction-associated steatotic liver disease continues to be debated, although subgroups with advanced fibrosis may warrant surveillance. Finally, the effectiveness of surveillance is diminished by underuse in clinical practice, particularly in racial minority and low-income groups, highlighting a need for interventions to increase utilization.
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Affiliation(s)
- Ashwini Arvind
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kennedy Redmon
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Wei C, Chen J, Huang T, Zhou L, Xu Y, Lin Q, Qin Y, Tang Z, Yang W, Fang M. The microRNA landscape and regulatory network in Clonorchis sinensis-infected hepatocellular carcinoma: implications for tumor progression. Parasit Vectors 2025; 18:68. [PMID: 39985046 PMCID: PMC11846337 DOI: 10.1186/s13071-025-06689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 01/27/2025] [Indexed: 02/23/2025] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality globally, and its progression is associated with various factors, including parasitic infections such as Clonorchis sinensis (C. sinensis). Although C. sinensis infection has been implicated in HCC, the molecular mechanisms, particularly the role of microRNAs (miRNAs), remain poorly understood. This study aims to fill this gap by investigating the miRNA expression profiles in C. sinensis+ and C. sinensis- HCC tissues. METHOD We performed miRNA sequencing on HCC tissues from C. sinensis+ and C. sinensis- patients, followed by bioinformatics analyses to identify differentially expressed miRNAs (DEMs) and their target genes. Gene Ontology (GO) enrichment analysis was conducted to explore relevant biological processes, while a competitive endogenous RNA (ceRNA) network was constructed to investigate the interactions among miRNAs, long noncoding RNAs (lncRNAs), and messenger RNAs (mRNAs). Additionally, we performed survival analysis using Gene Expression Profiling Interactive Analysis 2 (GEPIA2) based on the The Cancer Genome Atlas-Liver Hepatocellular Carcinoma (TCGA-LIHC) cohort and assessed the clinical relevance of DEMs. Key miRNAs identified from this analysis were further validated through quantitative real‑time polymerase chain reaction (qRT-PCR) assays to confirm their expression in MHCC97H. RESULTS Our research identified significant miRNA dysregulation in C. sinensis+ HCC tumors compared with C. sinensis- HCC tumors. Notably, miR-143-3p, miR-10a-5p, and miR-100-5p were upregulated in C. sinensis+ HCC, contributing to immune responses and tumor progression, while let-7 family members and miR-221-3p were downregulated, affecting metabolic pathways. GO enrichment analysis highlighted the involvement of developmental processes, immune system regulation, and metabolic reprogramming in C. sinensis+ HCC. The construction of a ceRNA network revealed key interactions between miRNAs, lncRNAs, and mRNAs in C. sinensis+ HCC, suggesting regulatory mechanisms that could be potential therapeutic targets. Additionally, validation through qRT-PCR confirmed these findings, highlighting miRNA dysregulation as a critical factor in C. sinensis+ HCC progression. CONCLUSIONS This study provides novel insights into the role of miRNAs in C. sinensis-infected HCC progression. The findings highlight the critical role of miRNA dysregulation in the progression of C. sinensis-associated HCC, emphasizing the potential for therapeutic interventions targeting these molecular alterations in affected patients.
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Affiliation(s)
- Caibiao Wei
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Junxian Chen
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Taijun Huang
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Lingling Zhou
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Yulong Xu
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Qiumei Lin
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Yuling Qin
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Zeli Tang
- Department of Cell Biology and Genetics, School of Basic Medical Sciences, Guangxi Medical University, Nanning, 530021, China.
| | - Weilong Yang
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Min Fang
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, 530021, China.
- Engineering Research Center for Tissue and Organ Injury and Repair Medicine, Guangxi Medical University Cancer Hospital, Nanning, 530021, China.
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Radosavaljevic I, Miwa T, Kawade M, Unome S, Imai K, Takai K, Yamaji F, Fukuta T, Nomura S, Shimizu M. A case of non-occlusive mesenteric ischemia following hepatocellular carcinoma rupture. Clin J Gastroenterol 2025; 18:119-124. [PMID: 39422859 DOI: 10.1007/s12328-024-02051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 10/05/2024] [Indexed: 10/19/2024]
Abstract
Hepatocellular carcinoma (HCC) rupture is a severe complication, yet there is limited literature on cases complicated by subsequent non-occlusive mesenteric ischemia (NOMI). A 77-year-old man presented to our hospital with abdominal pain and shock. Arterial phase computed tomography (CT) hepatic arteriography revealed a 77-mm HCC in the left lobe with active extravasation, and the feeding artery was embolized. Although the abdominal pain initially subsided after the procedure, it recurred the next day. A contrast-enhanced CT scan revealed pneumatosis intestinalis and decreased enhancement of the small intestinal wall. The patient underwent resection of the affected segment of the small intestine and was ultimately diagnosed with NOMI based on pathological findings. This is the first reported case of NOMI following HCC rupture. Given the high mortality associated with these conditions, clinicians should be aware of this rare complication and ensure comprehensive evaluation and timely intervention to improve patient outcomes.
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Affiliation(s)
- Ivana Radosavaljevic
- Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd. MDC40, Tampa, FL, 33612-4799, USA
| | - Takao Miwa
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
- Health Administration Center, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan.
| | - Masafumi Kawade
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shinji Unome
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
- Division for Regional Cancer Control, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Fuminori Yamaji
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tetsuya Fukuta
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shusuke Nomura
- Department of Pathology and Translational Study, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Singal AG, Daher D, Narasimman M, Yekkaluri S, Liu Y, Cerda V, Banala C, Khan A, Lee M, Seif El Dahan K, Murphy CC, Kramer JR, Hernaez R. Benefits and harms of hepatocellular carcinoma screening outreach in patients with cirrhosis: a multicenter randomized clinical trial. J Natl Cancer Inst 2025; 117:262-269. [PMID: 39288308 PMCID: PMC11807434 DOI: 10.1093/jnci/djae228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/06/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND The value of hepatocellular carcinoma screening is defined by the balance of benefits from early tumor detection vs harms because of false-positive results. We evaluated the value of a mailed outreach strategy for hepatocellular carcinoma screening in patients with cirrhosis. METHODS We conducted a multicenter pragmatic randomized clinical trial comparing mailed outreach for hepatocellular carcinoma screening (n = 1436) and usual care with visit-based screening (n = 1436) among patients with cirrhosis at 3 health systems from March 2018 to September 2021. Outcomes of interest were early stage hepatocellular carcinoma detection (ie, screening benefit) and diagnostic evaluation for false-positive or indeterminate results (ie, screening harm). Screening harm was categorized as mild, moderate, and severe based on number and type of diagnostic exams. All patients were included in intention-to-screen analyses. RESULTS Of 125 patients diagnosed with hepatocellular carcinoma (67 outreach and 58 usual care), 71.2% were found at an early stage per the Milan criteria. Early tumor detection did not statistically significantly differ between the outreach and usual care arms (64.2% vs 79.3%; P = .06). The proportion of patients with physical harms also did not differ between the outreach and usual care arms (10.8% vs 10.7%; P = .95) with 5.9% in both arms having mild harms; 4.0% and 3.8%, respectively, with moderate harms; and 0.9% and 1.0%, respectively, with severe harms. CONCLUSION Most patients enrolled in hepatocellular carcinoma screening were detected at an early stage, and a minority experienced physical harms. A mailed outreach strategy did not increase early hepatocellular carcinoma detection or physical harms compared with usual care. CLINICAL TRIALS NUMBER NCT02582918 and NCT03756051.
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Affiliation(s)
- Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX, USA
| | - Darine Daher
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX, USA
| | - Manasa Narasimman
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX, USA
| | - Sruthi Yekkaluri
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX, USA
| | - Yan Liu
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Vanessa Cerda
- O’Donnell School of Public Health, University of Texas Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX, USA
| | - Chaitra Banala
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Aisha Khan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - MinJae Lee
- O’Donnell School of Public Health, University of Texas Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX, USA
| | - Karim Seif El Dahan
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX, USA
| | - Caitlin C Murphy
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX, USA
| | - Jennifer R Kramer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Ruben Hernaez
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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Sangro B, Argemi J, Ronot M, Paradis V, Meyer T, Mazzaferro V, Jepsen P, Golfieri R, Galle P, Dawson L, Reig M. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol 2025; 82:315-374. [PMID: 39690085 DOI: 10.1016/j.jhep.2024.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 08/29/2024] [Indexed: 12/19/2024]
Abstract
Liver cancer is the third leading cause of cancer-related deaths worldwide, with hepatocellular carcinoma (HCC) accounting for approximately 90% of primary liver cancers. Advances in diagnostic and therapeutic tools, along with improved understanding of their application, are transforming patient treatment. Integrating these innovations into clinical practice presents challenges and necessitates guidance. These clinical practice guidelines offer updated advice for managing patients with HCC and provide a comprehensive review of pertinent data. Key updates from the 2018 EASL guidelines include personalised surveillance based on individual risk assessment and the use of new tools, standardisation of liver imaging procedures and diagnostic criteria, use of minimally invasive surgery in complex cases together with updates on the integrated role of liver transplantation, transitions between surgical, locoregional, and systemic therapies, the role of radiation therapies, and the use of combination immunotherapies at various stages of disease. Above all, there is an absolute need for a multiparametric assessment of individual risks and benefits, considering the patient's perspective, by a multidisciplinary team encompassing various specialties.
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Roberts LR. Surveillance for Hepatocellular Carcinoma. Clin Liver Dis 2025; 29:17-31. [PMID: 39608955 DOI: 10.1016/j.cld.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2024]
Abstract
This article reviews surveillance for the detection of early stage hepatocellular carcinoma, covering the rationale for surveillance, optimal selection of persons needing surveillance, methods and frequency of screening, strategies for addressing barriers to surveillance, and trends for future improvement in surveillance leading to more effective cancer control and improved patient outcomes. The importance of integrating liver cancer surveillance as a core component of national public health programs is emphasized. The impact of emerging technologies for identifying persons at risk, stratifying individual risk to improve the cost-effectiveness of surveillance programs, and improving the performance, accessibility, and convenience of surveillance are discussed.
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Affiliation(s)
- Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, 200 First Street Southwest, Rochester, MN 55905, USA.
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Hwang SY, Danpanichkul P, Agopian V, Mehta N, Parikh ND, Abou-Alfa GK, Singal AG, Yang JD. Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment. Clin Mol Hepatol 2025; 31:S228-S254. [PMID: 39722614 PMCID: PMC11925437 DOI: 10.3350/cmh.2024.0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 11/08/2024] [Accepted: 12/20/2024] [Indexed: 12/28/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.g., cirrhosis, chronic HBV). Alternative surveillance tools such as blood-based biomarker panels and abbreviated magnetic resonance imaging (MRI) are being investigated. Multiphasic computed tomography or MRI is the standard for HCC diagnosis, but histological confirmation should be considered, especially when inconclusive findings are seen on cross-sectional imaging. Staging and treatment decisions are complex and should be made in multidisciplinary settings, incorporating multiple factors including tumor burden, degree of liver dysfunction, patient performance status, available expertise, and patient preferences. Early-stage HCC is best treated with curative options such as resection, ablation, or transplantation. For intermediate-stage disease, locoregional therapies are primarily recommended although systemic therapies may be preferred for patients with large intrahepatic tumor burden. In advanced-stage disease, immune checkpoint inhibitor-based therapy is the preferred treatment regimen. In this review article, we discuss the recent global epidemiology, risk factors, and HCC care continuum encompassing surveillance, diagnosis, staging, and treatments.
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Affiliation(s)
- Soo Young Hwang
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, Maryland, USA
| | - Pojsakorn Danpanichkul
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Vatche Agopian
- Dumont-UCLA Transplant and Liver Cancer Centers, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Neil Mehta
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California, USA
| | - Neehar D. Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ghassan K. Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Medicine, Weill Medical College at Cornell University, New York, USA
- Trinity College Dublin, Dublin, Ireland
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Zhang Y, Zhang Y, Zhou S, Rehman MU, Lin F, Zhang J, Zhou H. HTR1D regulates the PI3K/Akt signaling pathway to impact hepatocellular carcinoma development and resistance to sorafenib. BMC Cancer 2025; 25:185. [PMID: 39891115 PMCID: PMC11786334 DOI: 10.1186/s12885-025-13575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 01/21/2025] [Indexed: 02/03/2025] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) has a poor prognosis, partly due to resistance to treatments like sorafenib. The 5-hydroxytryptamine receptor 1D (HTR1D) is involved in cancer progression through the PI3K/Akt pathway, but its role in HCC is not well understood. This study investigates HTR1D's expression, function, and potential as a prognostic marker in HCC. METHODS First, the correlation between HTR1D and hepatocellular carcinoma was analyzed using the TCGA database, and the expression level of HTR1D in clinical samples was detected by qPCR. Then the siRNA was transfected into Huh-7 and Hep3B cells, and the cell proliferation ability, colony formation ability, migration and invasion ability were detected with or without sorafenib. And the expression of the PI3K/Akt pathway was detected by Western Blot. Finally, the potential of HTR1D as a predictive marker for patient prognosis was evaluated by immunohistochemistry. RESULTS Analysis of TCGA data showed that methylation of the HTR1D gene was associated with cancer status. Clinical samples confirmed significant differences in HTR1D expression between HCC and adjacent tissues, with higher expression correlating with poorer patient prognosis. Interference with HTR1D gene expression demonstrated its role in promoting HCC proliferation, migration, and drug resistance through the PI3K/Akt pathway. These findings were validated in a mouse model. Immunohistochemical analysis of clinicopathological samples suggested that HTR1D could be a valuable prognostic marker for HCC. CONCLUSION HTR1D is highly expressed in hepatocellular carcinoma tissues, and it can influence hepatocellular carcinoma development and resistance to sorafenib by regulating the PI3K/Akt signaling pathway. In addition, HTR1D has potential as a prognostic indicator.
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Affiliation(s)
- Yingai Zhang
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, Hainan, 570208, China
- School of Life and Health Sciences, Hainan University, Haikou, Hainan, 570228, China
| | - Yuting Zhang
- School of Life and Health Sciences, Hainan University, Haikou, Hainan, 570228, China
- Shanxi Medical University, Taiyuan, Shanxi, 030607, China
| | - Shuai Zhou
- Hepatobiliary surgery, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou Hainan, 570208, China
| | - Mujeeb Ur Rehman
- Algal Bioactives and Bio products Group, State Key Laboratory of Marine Resource Utilization in South China Sea, Hainan University, Haikou, 570228, China
| | - Fankai Lin
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, Hainan, 570208, China
| | - Jianquan Zhang
- Hepatobiliary surgery, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou Hainan, 570208, China.
| | - Hailong Zhou
- School of Life and Health Sciences, Hainan University, Haikou, Hainan, 570228, China
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Decharatanachart P, Poovorawan K, Tangkijvanich P, Charatcharoenwitthaya P, Peeraphatdit T, Taychakhoonavudh S, Treeprasertsuk S, Chaiteerakij R. Cost-Utility Analysis of Non-Invasive Tests to Initiate Hepatocellular Carcinoma Surveillance in Metabolic Dysfunction-Associated Steatotic Liver Disease. Am J Gastroenterol 2025:00000434-990000000-01565. [PMID: 39878449 DOI: 10.14309/ajg.0000000000003332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 01/13/2025] [Indexed: 01/31/2025]
Abstract
BACKGROUND AIMS Non-invasive tests (NITs), e.g. Fibrosis-4 Index (FIB-4) and vibration-controlled elastography (VCTE), have been used to identify metabolic dysfunction-associated steatotic liver disease (MASLD) patients at high risks for hepatocellular carcinoma (HCC). This study investigates the cost-effectiveness of NITs to identify MASLD patients with advanced liver fibrosis and initiate HCC surveillance. METHODS A cost-utility analysis using a Markov model compared no use of NITs with three NIT strategies: 1) FIB-4 and VCTE (FIB-4/VCTE), 2) FIB-4 alone, and 3) VCTE alone to identify advanced liver fibrosis and initiate HCC surveillance with biannual ultrasonography with alpha-fetoprotein in 4 MASLD populations: 1) general MASLD patients, 2) MASLD patients with body mass index (BMI) >30 kg/m2, 3) MASLD patients with diabetes, and 4) MASLD patients with three metabolic traits (diabetes, hypertension and BMI >30). RESULTS FIB-4/VCTE was the most cost-effective approach across all groups, showing the lowest ICER, followed by FIB-4 alone and VCTE alone. In the general MASLD population, both FIB-4/VCTE and FIB-4 alone were cost-effective in the US, while only FIB-4/VCTE was cost-effective in Thailand. For MASLD patients with BMI >30, all strategies were cost-effective in the US, while only FIB-4/VCTE was cost-effective in Thailand. In MASLD patients with diabetes or 3 metabolic traits, all strategies were cost-effective in the US, while FIB-4/VCTE and FIB-4 alone were cost-effective in Thailand. CONCLUSIONS Using FIB-4/VCTE to initiate HCC surveillance is cost-effective for MASLD patients. If VCTE is unavailable, FIB-4 alone is a cost-effective alternative for MASLD patients with diabetes or 3 metabolic traits.
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Affiliation(s)
| | - Kittiyod Poovorawan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pisit Tangkijvanich
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Biochemistry, Chulalongkorn University, Bangkok, Thailand
| | | | - Thoetchai Peeraphatdit
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Suthira Taychakhoonavudh
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roongruedee Chaiteerakij
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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43
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Toy M, Hutton D, Conners EE, Pham H, Salomon JA, So S. Cost-effectiveness of monitoring and liver cancer surveillance among patients with inactive chronic hepatitis B. PLoS One 2025; 20:e0313898. [PMID: 39841655 PMCID: PMC11753660 DOI: 10.1371/journal.pone.0313898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 01/06/2025] [Indexed: 01/24/2025] Open
Abstract
Patients with chronic hepatitis B infection (CHB) have an increased risk for death from liver cirrhosis and hepatocellular carcinoma (HCC). In the United States, only an estimated 37% of adults with chronic hepatitis B diagnosis without cirrhosis receive monitoring with at least an annual alanine transaminase (ALT) and hepatitis B deoxyribonucleic acid (DNA), and an estimated 59% receive antiviral treatment when they develop active hepatitis or cirrhosis. A Markov model was used to calculate the costs, health impact and cost-effectiveness of increased monitoring of adults with HBeAg negative inactive or HBeAg positive immune tolerant CHB who have no cirrhosis or significant fibrosis and are not recommended by the current American Association for the Study of Liver Diseases (AASLD) clinical practice guidelines to receive antiviral treatment, and to assess whether the addition of HCC surveillance would be cost-effective. For every 100,000 adults with CHB who were initially not recommended for treatment, if the monitoring rate increased from the current 37% to 90% and treatment rate increased from 59% to 80%, 4,600 cases of cirrhosis, 2,450 cases of HCC and 4,700 HBV-related deaths would be averted with a gain of 45,000 QALYs and a savings of $180 million in lifetime health care costs. At a willingness to pay threshold of $100,000/QALY, the addition of HCC surveillance with the standard recommended biannual liver ultrasound and alfa fetoprotein levels is likely cost-effective if the HCC risk ≥ 0.55%/year. Regular monitoring of persons with inactive or immune tolerant CHB who are initially not recommended to receive antiviral treatment in the United States is cost-saving. The addition of HCC surveillance with biannual US and AFP would be cost-effective for individuals with HCC incidence ≥ 0.55%/year.
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Affiliation(s)
- Mehlika Toy
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - David Hutton
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Erin E. Conners
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hang Pham
- Department of Surgery, Asian Liver Center, Stanford University School of Medicine, Stanford, California, United States of America
| | - Joshua A. Salomon
- Department of Health Policy, Stanford University School of Medicine, Stanford, California, United States of America
- Center for Health Policy, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, United States of America
| | - Samuel So
- Department of Surgery, Asian Liver Center, Stanford University School of Medicine, Stanford, California, United States of America
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Zhan T, Betge J, Schulte N, Dreikhausen L, Hirth M, Li M, Weidner P, Leipertz A, Teufel A, Ebert MP. Digestive cancers: mechanisms, therapeutics and management. Signal Transduct Target Ther 2025; 10:24. [PMID: 39809756 PMCID: PMC11733248 DOI: 10.1038/s41392-024-02097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 10/20/2024] [Accepted: 11/29/2024] [Indexed: 01/16/2025] Open
Abstract
Cancers of the digestive system are major contributors to global cancer-associated morbidity and mortality, accounting for 35% of annual cases of cancer deaths. The etiologies, molecular features, and therapeutic management of these cancer entities are highly heterogeneous and complex. Over the last decade, genomic and functional studies have provided unprecedented insights into the biology of digestive cancers, identifying genetic drivers of tumor progression and key interaction points of tumor cells with the immune system. This knowledge is continuously translated into novel treatment concepts and targets, which are dynamically reshaping the therapeutic landscape of these tumors. In this review, we provide a concise overview of the etiology and molecular pathology of the six most common cancers of the digestive system, including esophageal, gastric, biliary tract, pancreatic, hepatocellular, and colorectal cancers. We comprehensively describe the current stage-dependent pharmacological management of these malignancies, including chemo-, targeted, and immunotherapy. For each cancer entity, we provide an overview of recent therapeutic advancements and research progress. Finally, we describe how novel insights into tumor heterogeneity and immune evasion deepen our understanding of therapy resistance and provide an outlook on innovative therapeutic strategies that will shape the future management of digestive cancers, including CAR-T cell therapy, novel antibody-drug conjugates and targeted therapies.
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Affiliation(s)
- Tianzuo Zhan
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Johannes Betge
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nadine Schulte
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena Dreikhausen
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Michael Hirth
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Moying Li
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philip Weidner
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Antonia Leipertz
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Teufel
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias P Ebert
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- DKFZ Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany.
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany.
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Suzuki H, Fujiwara N, Singal AG, Baumert TF, Chung RT, Kawaguchi T, Hoshida Y. Prevention of liver cancer in the era of next-generation antivirals and obesity epidemic. Hepatology 2025:01515467-990000000-01139. [PMID: 39808821 PMCID: PMC7617594 DOI: 10.1097/hep.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 10/07/2024] [Indexed: 01/16/2025]
Abstract
Preventive interventions are expected to substantially improve the prognosis of patients with primary liver cancer, predominantly HCC and cholangiocarcinoma. HCC prevention is challenging in the face of the evolving etiological landscape, particularly the sharp increase in obesity-associated metabolic disorders, including metabolic dysfunction-associated steatotic liver disease. Next-generation anti-HCV and HBV drugs have substantially reduced, but not eliminated, the risk of HCC and have given way to new challenges in identifying at-risk patients. The recent development of new therapeutic agents and modalities has opened unprecedented opportunities to refine primary, secondary, and tertiary HCC prevention strategies. For primary prevention (before exposure to risk factors), public health policies, such as universal HBV vaccination, have had a substantial prognostic impact. Secondary prevention (after or during active exposure to risk factors) includes regular HCC screening and chemoprevention. Emerging biomarkers and imaging modalities for HCC risk stratification and detection may enable individual risk-based personalized and cost-effective HCC screening. Clinical studies have suggested the potential utility of lipid-lowering, antidiabetic/obesity, and anti-inflammatory agents for secondary prevention, and some of them are being evaluated in prospective clinical trials. Computational and experimental studies have identified potential chemopreventive strategies directed at diverse molecular, cellular, and systemic targets for etiology-specific and/or agnostic interventions. Tertiary prevention (in conjunction with curative-intent therapies for HCC) is an area of active research with the development of new immune-based neoadjuvant/adjuvant therapies. Cholangiocarcinoma prevention may advance with recent efforts to elucidate risk factors. These advances will collectively lead to substantial improvements in liver cancer mortality rates.
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Affiliation(s)
- Hiroyuki Suzuki
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Naoto Fujiwara
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas F. Baumert
- Inserm, U1110, Institute for Translational Medicine and Liver Diseases, University of Strasbourg, F-67000, France
- IHU Strasbourg, F-67000 Strasbourg, France
- Gastroenterology and Hepatology Service, Strasbourg University Hospitals, F-67000Strasbourg, France
| | - Raymond T. Chung
- Liver Center, GI Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yujin Hoshida
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Koshy A. Evolving Global Etiology of Hepatocellular Carcinoma (HCC): Insights and Trends for 2024. J Clin Exp Hepatol 2025; 15:102406. [PMID: 39346785 PMCID: PMC11426038 DOI: 10.1016/j.jceh.2024.102406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 08/17/2024] [Indexed: 10/01/2024] Open
Abstract
The epidemiology of HCC is changing all over the world and the incidence of HCC is expected to continue increasing over the next 30 years. The changes are in the predisposing factors. Hepatitis B and hepatitis C as predisposing etiologies are decreasing while NAFLD/MAFLD is increasing. The increase in MAFLD is so great that despite the decrease in hepatitis B and C, the overall incidence of HCC is increasing. HCC in persons below the age of 20 years has distinct characteristics different from that of HCC in adults. The changing etiology of hepatocellular carcinoma has implications for the early detection, prevention, the stage of HCC at time of detection and in the treatment of HCC. The extent of these changes and their significance are discussed.
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Affiliation(s)
- Abraham Koshy
- Departments of Gastroenterology, VPS Lakeshore Hospital, Kochi, 682040, India
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Haj Ali S, Alqato SI, Almansi AM, Haj Ali NS, Amaireh MA. Hepatocellular Carcinoma: The Search for an Optimal Screening Test. Middle East J Dig Dis 2025; 17:31-39. [PMID: 40322566 PMCID: PMC12048830 DOI: 10.34172/mejdd.2025.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 11/20/2024] [Indexed: 05/08/2025] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the third leading cause of cancer-related death, with a 5-year survival rate of 10%-12%. It usually develops in the setting of chronic liver disease (CLD), with chronic viral hepatitis, alcohol, and non-alcoholic fatty liver disease (NAFLD) being the most common risk factors. Some patients are at higher risk of developing hepatocellular cancer, so it is important to screen them regularly to diagnose the disease at an early stage and improve their chances for curative treatment. Six-monthly ultrasound with or without alpha-fetoprotein (AFP) is the currently recommended surveillance method. AFP has been used as a biomarker for liver cancer; however, it has low sensitivity and specificity, which necessitates the search for other, more accurate biomarkers. Promising biomarkers include lens culinaris agglutinin-reactive AFP, des-gamma-carboxy prothrombin, methylated DNA markers, plasma microRNA expression, circulating tumor DNA, and circulating tumor cells. In addition, combinations of biomarkers, like the GALAD score and the Doylestown algorithm, may help in the early detection of HCC. In this review, we summarize the screening tests for early detection of HCC that have been studied over the last decade.
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Affiliation(s)
- Sara Haj Ali
- Internal Medicine Department, Faculty of Medicine, Al-Balqa Applied University, Salt 19117, Jordan
| | - Shahd I Alqato
- Internal Medicine Department, Arab Medical Center, Amman 11181, Jordan
| | - Amjad M Almansi
- Internal Medicine Department, Faculty of Medicine, Al-Balqa Applied University, Salt 19117, Jordan
| | - Noor S Haj Ali
- Internal Medicine Department, Faculty of Medicine, Al-Balqa Applied University, Salt 19117, Jordan
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Shiha G, Hassan A, Mousa N, El-Domiaty N, Mikhail N, Gameaa R, Kobtan A, El Bassat H, Sharaf-Eldin M, Waked I, Eslam M, Soliman R. Individualized HCC surveillance using risk stratification scores in advanced fibrosis and cirrhotic HCV patients who achieved SVR: Prospective study. Aliment Pharmacol Ther 2025; 61:99-108. [PMID: 39313490 DOI: 10.1111/apt.18291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/09/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Several HCC risk stratification scores were developed; however, none has been prospectively validated. The primary aim is to validate the clinical utility of six HCC risk scores in large prospective study of F3-4 patients achieving SVR following DAAs according to EASL guidelines. The secondary aim is to explore whether individualized risk stratification improves detection of HCC at early stages amenable to curative treatment. METHODS This prospective study included two cohorts: Egyptian Liver Research Institute and Hospital (ELRIAH) cohort of 463 chronic HCV patients with advanced liver disease (F3 and F4) achieved SVR with a follow-up every 6 months according to EASL guidelines using 6 simple HCC risk scores and Tanta cohort of 492 comparable patients where individualized surveillance intervals were tailored based on HCC risk assessments using GES score as follows: low-risk patients were followed yearly, intermediate-risk every 6 months and high-risk every 2-3 months. RESULTS All scores, except Watanabe post, successfully stratified patients into low-, intermediate- and high-risk groups, with log-rank p-value of 0.001 and Harrell's C ranging from 0.669 to 0.728. Clinical utility of these scores revealed that the highest percentage of patients classified as low risk was 42.5% using the GES, while the lowest was 8.9% using the aMAP. ELRIAH cohort, 25 patients developed HCC with 52% diagnosed at BCLC 0 and A. Tanta cohort, 35 patients developed HCC, with 80% diagnosed at BCLC 0 and A. CONCLUSION Individualized risk stratification using HCC risk scores was associated with improved early-stage detection and receipt of curative treatment.
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Affiliation(s)
- Gamal Shiha
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
| | - Ayman Hassan
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
- Higher Institute of Applied Medical Sciences, Mansoura, Egypt
| | - Nasser Mousa
- Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nada El-Domiaty
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Nabiel Mikhail
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
- Biostatistics and Cancer Epidemiology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Reham Gameaa
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Abdelrahman Kobtan
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hanan El Bassat
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Sharaf-Eldin
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Imam Waked
- National Liver Institute, Menofia University, Menofia, Egypt
| | - Mohamed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Riham Soliman
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
- Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt
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Prince DS, Hoque S, Kim C, Maher S, Miller J, Chomley P, Pritchard-Jones J, Spruce S, McGarry N, Baker D, Elix P, Liu K, Strasser SI, Goodger B, Zekry A, McCaughan GW. Cirrhosis in primary practice: many patients remain potentially undiagnosed and are not receiving liver cancer surveillance. J Gastroenterol Hepatol 2025; 40:250-257. [PMID: 39444308 DOI: 10.1111/jgh.16782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 10/09/2024] [Accepted: 10/13/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND AND AIM Most patients with cirrhosis have compensated disease and are cared for in primary care; however, the exact epidemiology within Australia remains largely unknown. The aim of this study was to assess cirrhosis care in an Australian primary care setting by evaluating rates of cirrhosis diagnosis, appropriate hepatocellular carcinoma (HCC) surveillance and specialist communication. METHODS Electronic medical records in consenting general practices were reviewed using the "Liver Toolkit" to identify patients with an existing cirrhosis diagnosis. Individual cases were reviewed to identify outcomes of interest. RESULTS One hundred seventy-one patients with confirmed cirrhosis across nine general practices were identified (74% male, mean age: 61.2 years). There was significant variation in the rate of cirrhosis diagnosis between practices (range 31.7-637.9 per 100 000 patients, P < 0.0001). Patients with cirrhosis had predominately compensated disease (75% Child-Pugh A) and common etiologies of cirrhosis were alcohol (49%), hepatitis C (47%), and metabolic dysfunction-associated steatotic liver disease (29%). Forty-two patients (25%) had received appropriate HCC surveillance. Predictors of inadequate HCC surveillance were time from last specialist correspondence (odds ratio [OR] = 1.06 per month increase, 95% confidence interval [CI]: 1.02-1.10, P = 0.002) and hepatitis B (OR = 0.24, 95% CI: 0.06-0.98, P = 0.047). Specialist correspondence with primary care was older than 2 years or absent in 37% of cases. CONCLUSIONS There was a 20-fold difference in the rate of cirrhosis diagnosis between general practices within Sydney, suggesting a large proportion of patients remain undiagnosed. Three quarters of patients with diagnosed cirrhosis are not receiving appropriate HCC surveillance.
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Affiliation(s)
- David S Prince
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Liver Injury and Cancer Program, Centenary Institute, Sydney, New South Wales, Australia
- Department of Gastroenterology and Liver, Liverpool Hospital, Liverpool, New South Wales, Australia
- Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shakira Hoque
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia
| | - Christy Kim
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia
| | - Salim Maher
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia
| | - Jane Miller
- Central and Eastern Sydney Primary Health Network, Mascot, New South Wales, Australia
| | - Phoebe Chomley
- Central and Eastern Sydney Primary Health Network, Mascot, New South Wales, Australia
| | - Janice Pritchard-Jones
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sally Spruce
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nathan McGarry
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia
| | - David Baker
- East Sydney Doctors, Darlinghurst, New South Wales, Australia
| | - Penelope Elix
- Fountain Street General Practice, Alexandria, New South Wales, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Liver Injury and Cancer Program, Centenary Institute, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Brendan Goodger
- Central and Eastern Sydney Primary Health Network, Mascot, New South Wales, Australia
| | - Amany Zekry
- Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia
| | - Geoffrey W McCaughan
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Liver Injury and Cancer Program, Centenary Institute, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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50
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Cong X, Song S, Li Y, Song K, MacLeod C, Cheng Y, Lv J, Yu C, Sun D, Pei P, Yang L, Chen Y, Millwood I, Wu S, Yang X, Stevens R, Chen J, Chen Z, Li L, Kartsonaki C, Pang Y. Comparison of models to predict incident chronic liver disease: a systematic review and external validation in Chinese adults. BMC Med 2024; 22:601. [PMID: 39736748 DOI: 10.1186/s12916-024-03754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 11/05/2024] [Indexed: 01/01/2025] Open
Abstract
BACKGROUND Risk prediction models can identify individuals at high risk of chronic liver disease (CLD), but there is limited evidence on the performance of various models in diverse populations. We aimed to systematically review CLD prediction models, meta-analyze their performance, and externally validate them in 0.5 million Chinese adults in the China Kadoorie Biobank (CKB). METHODS Models were identified through a systematic review and categorized by the target population and outcomes (hepatocellular carcinoma [HCC] and CLD). The performance of models to predict 10-year risk of CLD was assessed by discrimination (C-index) and calibration (observed vs predicted probabilies). RESULTS The systematic review identified 57 articles and 114 models (28.4% undergone external validation), including 13 eligible for validation in CKB. Models with high discrimination (C-index ≥ 0.70) in CKB were as follows: (1) general population: Li-2018 and Wen 1-2012 for HCC, CLivD score (non-lab and lab) and dAAR for CLD; (2) hepatitis B virus (HBV) infected individuals: Cao-2021 for HCC and CAP-B for CLD. In CKB, all models tended to overestimate the risk (O:E ratio 0.55-0.94). In meta-analysis, we further identified models with high discrimination: (1) general population (C-index ≥ 0.70): Sinn-2020, Wen 2-2012, and Wen 3-2012 for HCC, and FIB-4 and Forns for CLD; (2) HBV infected individuals (C-index ≥ 0.80): RWS-HCC and REACH-B IIa for HCC and GAG-HCC for HCC and CLD. CONCLUSIONS Several models showed good discrimination and calibration in external validation, indicating their potential feasibility for risk stratification in population-based screening programs for CLD in Chinese adults.
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Affiliation(s)
- Xue Cong
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Shuyao Song
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Yingtao Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Kaiyang Song
- Medical Sciences Division, University of Oxford, Oxford, OX3 9DU, UK
| | - Cameron MacLeod
- Medical Sciences Division, University of Oxford, Oxford, OX3 9DU, UK
| | - Yujie Cheng
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China
| | - Dianjianyi Sun
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China
| | - Pei Pei
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, 100191, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, OX3 7LF, UK
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, OX3 7LF, UK
| | - Iona Millwood
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, OX3 7LF, UK
| | - Shukuan Wu
- Meilan Center for Disease Control and Prevention, Haikou, 570100, China
| | - Xiaoming Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Rebecca Stevens
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, 100022, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Liming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, OX3 7LF, UK.
| | - Yuanjie Pang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China.
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, 100191, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China.
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