Pathological predictive factors for late recurrence of hepatocellular carcinoma in chronic liver disease

Lasso-Based Nomogram for Predicting Early Recurrence Following Radical Resection in Hepatocellular Carcinoma

Background

Hepatocellular carcinoma (HCC) is a common malignancy with a high recurrence rate following curative resection. This study aimed to identify factors contributing to early recurrence (within 2 years) and develop a Lasso-based nomogram for individualized risk assessment.

Methods

We conducted a retrospective analysis of 206 hCC patients who underwent curative resection at Taizhou Hospital, Zhejiang Province, from January 2019 to August 2022. Patients were randomly divided into training (n=144) and validation (n=62) cohorts. Lasso regression was used to identify potential recurrence risk factors among 17 candidate predictors. A Cox proportional hazards model was constructed based on variables selected by Lasso. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results

Five independent predictors of early HCC recurrence were identified: age, serum alanine aminotransferase (ALT) levels, cirrhosis, tumor diameter, and microvascular invasion (MVI). The nomogram demonstrated area under the curve (AUC) values for recurrence-free survival (RFS) of 0.828 (95% confidence interval [CI]: 0.753-0.904) at 1 year, 0.799 (95% CI: 0.718-0.880) at 2 years, and 0.742 (95% CI: 0.642-0.842) at 5 years in the training cohort. The corresponding AUCs in the validation cohort were 0.823 (95% CI: 0.686-0.960), 0.804 (95% CI: 0.686-0.922), and 0.857 (95% CI: 0.722-0.992) at 1, 2 and 5 years, respectively. Calibration curves and DCA confirmed the nomogram's high accuracy and clinical utility.

Conclusion

The Lasso-Cox regression nomogram effectively predicts HCC recurrence within two years post-hepatectomy, providing a valuable tool for personalized postoperative management to improve patient outcomes.

MiR-145-5p inhibits proliferation of hepatocellular carcinoma, acting through PAI-1

OBJECTIVES

Hepatocellular carcinoma (HCC) mostly developsfrom cirrhosis, so we compared the miRNA profiles of patients with cirrhosis who developed HCC with those who did not, and screened for miR-145-5p, which may be involved in the progression of liver cancer. The study's purpose was to explore the mechanism of miR-145-5p in cirrhosis that becomes HCC.

METHODS

Cell counting kit 8 (CCK-8) and clone formation assays were employed to calculate cell proliferative ability. Quantitative real-time PCR (qRT-PCR) was conducted to measure the mRNA levels of miR-145-5p, plasminogen activator inhibitor 1 (PAI-1), and Circular RNA PVT1 (circPTV1).

RESULTS

MiR-145-5p was downregulated in HCC, and miR-145-5p inhibited Huh-7 cell viability and clone formation. The Area Under the Curve (AUC) of miR-145-5p for distinguishing between the HCC and Tumor-free groups was 0.900, indicating a high diagnostic accuracy. PAI-1 was identified as a downstream target of miR-145-5p. Silencing PAI-1 decreased the viability and clone formation of Huh-7 cells. circPVT1 directly binding to miR-145-5p in HuH-7 cells. circPVT1 regulates cell viability and clone formation through miR-145-5p. In summary, we identified miRNA miR-145-5p, which was lowly expressed in HCC, and inhibited the viability and clone formation of HCC cells.

CONCLUSION

Our research elucidates the regulatory role of the circPVT1/miR-145-5p/PAI-1 axis in HCC, suggesting its potential as a novel diagnostic biomarker or therapeutic target for HCC.

Diagnostic value of whole-tumor apparent diffusion coefficient map radiomics analysis in predicting early recurrence of solitary hepatocellular carcinoma ≤ 5 cm

PURPOSE

To evaluate the role of whole-tumor radiomics analysis of apparent diffusion coefficient (ADC) maps in predicting early recurrence (ER) of solitary hepatocellular carcinoma (HCC) ≤ 5 cm and compare the diagnostic efficiency of whole-tumor and single-slice ADC measurements.

METHODS

One hundred and seventy patients with primary HCC were randomly divided into the training set (n = 119) and the test set (n = 51). The diagnostic efficiency was compared between the whole-tumor and single-slice ADC measurements. The clinical-radiological model was established by selected significant clinical characteristics and qualitative imaging features. The radiomics model was constructed using the least absolute shrinkage and selection operator (LASSO) logistic regression algorithm. The significant clinical-radiological risk factors and radiomics features were integrated to develop the combined model. Receiver operating characteristic (ROC) curves were used for evaluating the predictive performance.

RESULTS

Cirrhosis, age, and albumin were significantly associated with ER in the clinical-radiological model selected by the random forest classifier. The diagnostic efficiency of the whole-tumor ADC measurements was slight higher than that of the single-slice (AUC = 0.602 and 0.586, respectively). The clinical-radiological model (AUC = 0.84 and 0.82 in the training and test sets, respectively) showed better diagnostic performance than the radiomics model (AUC = 0.70 and 0.69 in the training and test sets, respectively) in predicting ER. The combined model showed optimal predictive performance with the highest AUC values of 0.88 and 0.85 in the training and test sets, respectively.

CONCLUSIONS

The whole-tumor ADC measurements performed better than the single-slice ADC measurements. The clinical-radiological model performed better than the radiomics model for predicting ER in patients with solitary HCC ≤ 5 cm.

Tertiary Prevention of HCC in Chronic Hepatitis B or C Infected Patients

Simple Summary

Hepatocellular carcinoma (HCC) recurrence is the major obstacle concerning patients’ survival. Tertiary prevention by antiviral therapies could reduce HCC recurrence rate in both chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infected patients. In chronic hepatitis B (CHB) patients, nucleos(t)ide analogues (Nuc) provide a more effective HCC tertiary prevention effect than an interferon (IFN)-based regimen. In chronic hepatitis C (CHC) patients, the tertiary prevention effect by direct acting antiviral agents (DAAs) was reported non-inferior to that by IFN-based therapy. Chronic hepatitis C patients left untreated had the worst survival benefit as well as shorted recurrence-free interval than those treated by either type of antiviral regimen. Although the risk of HCC recurrence could only be decreased but not diminished by antiviral therapies due to host and microenvironmental factors beyond virus infection, antiviral therapy helps to preserve and improve liver function which makes multi-modality anticancer treatment feasible to improve survival.

Abstract

Hepatocellular carcinoma (HCC) ranks as a leading cause of common cancer and cancer-related death. The major etiology of HCC is due to chronic hepatitis virus including HBV and HCV infections. Scheduled HCC surveillance in high risk populations improves the early detection rate and the feasibility of curative treatment. However, high HCC recurrence rate still accounts for the poor prognosis of HCC patients. In this article, we critically review the pathogenesis of viral hepatitis-related hepatocellular carcinoma and the evidence of tertiary prevention efficacy by current available antiviral treatment, and discuss the knowledge gap in viral hepatitis-related HCC tertiary prevention.