Disease Burden, Risk Factors, and Recent Trends of Liver Cancer: A Global Country-Level Analysis

A public health call for action to address liver cancer and hepatitis in northern Ghana

Tuck et al. discuss the unethical lack of access to diagnosis and treatment of hepatitis and consequential avoidable liver cancer cases. Existing evidence and current research in Ghana identifies a number of ways to address hepatitis and liver cancer in Ghana.

Association Between Dietary Inflammatory Potential and Liver Cancer Risk: A Systematic Review and Dose-Response Meta-Analysis

OBJECTIVE

To investigate the dose-response association between dietary inflammatory potential and the risk of liver cancer.

METHODS

A systematic search was conducted across Medline (National Library of Medicine using PubMed as the search engine) and Web of Science and Embase databases published until January 9, 2024. Dietary inflammatory potential was expressed using a combination of dietary inflammatory index (DII) and empirical dietary inflammatory pattern (EDIP). The summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated to evaluate the association between dietary inflammatory potential and liver cancer risk. Restricted cubic splines were used to explore the potential dose-response relationship between the DII and liver cancer risk.

RESULTS

Seven articles were included, which involved 352,660 participants. The summary RR of liver cancer risk was 1.99 (95%CI:1.47-2.70) for the highest dietary inflammatory potential compared with the lowest dietary inflammatory potential. For higher dietary inflammatory potential compared with lower higher dietary inflammatory potential, the summary RR was 1.73 (95%CI:1.30-2.30). Each 1-unit increment of the DII score was associated with an increased risk of 23% for liver cancer (RR: 1.23, 95%CI:1.09-1.39). Dose-response analysis showed that, following a slight increase risk within baseline DII score, the risk of liver cancer increased in a nearly linear manner as the DII score progressed from the less proinflammatory threshold to the more proinflammatory threshold (p = 0.042 for nonlinearity).

CONCLUSION

High dietary inflammatory potential increases the risk of liver cancer. Ultra-processed foods have flooded the food marketplace and are nearly universally proinflammatory. Therefore, avoiding ultra-processed foods may help reduce the risk of liver cancer. A pressing need to reform the current food policy and subsidies clearly exists.

Global burden of viral skin diseases from 1990 to 2021: a systematic analysis for the global burden of disease study 2021

BACKGROUND

The scarcity of knowledge regarding the epidemiology and temporal patterns of viral skin diseases worldwide poses significant challenges to their control and management.

METHODS

We analyzed the global incidence, prevalence, and age-standardized rates (ASR) of disability-adjusted life years (DALYs) for viral skin diseases in 2021. To examine temporal trends from 1990 to 2021, we employed the EPAC model, assessing changes by country, gender, age, Socio-demographic Index (SDI), and GBD regions. Additionally, we utilized the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model to forecast the burden of viral skin diseases for the next 25 years.

RESULTS

In 2021, the global burden of viral skin diseases was estimated at 84.7 million incident cases, with a prevalence of over 130 million cases and 4.2 million DALYs. Males experienced a slightly higher ASR burden than females. The highest burden was observed among individuals aged 10 to 19, with significant geographical variations in cases and ASR, particularly in high SDI regions. Unexpected rises in incidence were noted in East Asia and Sub-Saharan Africa in the detected period. Despite modest declines in ASPR and ASDR, the global ASIR displayed a significant upward trend.

CONCLUSION

Our study provides detailed data on the global impact of viral skin diseases from 1990 to 2021, highlighting the need for continuous surveillance and tailored interventions to manage and reduce the effects of these diseases. Targeted public health measures are essential to address and mitigate the global health burden of viral skin diseases.

Diagnostic performance of microRNAs for predicting response to transarterial chemoembolization in hepatocellular carcinoma: a meta-analysis

Purpose

To provide a detailed pooled analysis of the diagnostic accuracy of microRNAs (miRNAs) in predicting the response to transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC).

Methods

A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science to identify studies assessing the diagnostic performance of miRNAs in predicting TACE response in HCC. Two independent reviewers performed quality assessment and data extraction using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (SROC) curve were calculated using a bivariate random-effects model. Subgroup analyses and meta-regression were performed to explore potential sources of heterogeneity, including sample size, response criteria, specimen source, response evaluation methods, TACE efficacy interval window, and geographical location.

Results

Seven studies, comprising 320 HCC responders and 187 non-responders, were included in this meta-analysis. The miRNAs studied included miR-373, miR-210, miR-4492, miR-1271, miR-214, miR-133b, and miR-335. The pooled sensitivity of miRNAs in predicting recurrence after TACE was 0.79 [95% CI: 0.72-0.84], and the pooled specificity was 0.82 [95% CI: 0.74-0.88]. The DOR was 17 [95% CI: 9-33], and the pooled area under the SROC curve (AUC) was 0.85 [95% CI: 0.81-0.88], indicating excellent diagnostic accuracy. Subgroup analyses revealed significant differences in diagnostic performance based on response criteria and geographical location. Meta-regression did not identify any significant sources of interstudy heterogeneity.

Conclusion

MiRNAs show promise as diagnostic tools for predicting TACE response in HCC patients. However, their clinical application requires further validation in larger cohorts. Future research should focus on standardizing RNA extraction methods, selecting consistent endogenous controls, and adopting uniform response evaluation criteria to improve reliability and reduce variability.

Temporal trends of incidence, mortality, and survival of liver cancer during 2011-2020 in Fujian Province, Southeast China

BACKGROUND

Liver cancer is a common malignant tumor of the digestive system. We aimed to estimate the trend in the burden of liver cancer in Fujian Province, China, during 2011-2020.

METHODS

The population-based cancer data was collected from the cancer registry in Fujian Province during 2011-2020. Segi's world standard population was used to calculate the age-standardized incidence rates and age-standardized mortality rates. The temporal trend of liver cancer was displayed by annual percentage change and average annual percentage change (AAPC). Relative survival of liver cancer was calculated as the ratio of observed survival to expected survival. The age-standardized relative survival was calculated according to the International Cancer Survival Standards 1.

RESULTS

There were 14,725 patients diagnosed with liver cancer and 12,698 patients died between 2011 and 2020. For males, there was a downward trend in incidence and mortality (AAPC: -3.86%, -3.44%). Similarly, the downward trend was also shown in females (AAPC: -3.96%, -2.79%). The highest age-specific incidence and mortality were in the 75-79 age group (146.59/100,000 and 137.99/100,000, respectively), and there was no downward trend in this group during the period. The overall age-standardized 5-year relative survival was 10.77% in 2011-2015 and 14.54% in 2016-2020. During the study period, the percentage improvement of survival was higher in males than in females (34.75% and 25.33%). The percentage improvement of survival in urban was higher than that in rural (38.64% and 28.75%). Except for the age group over 75, the survival of patients in other age groups all has improved.

CONCLUSIONS

Liver cancer remains a serious public health problem in Fujian Province, China, which needs to be solved, especially in some high-risk groups such as the elderly, high-risk males, and rural populations. Early detection and treatment is the key to the prevention and treatment of liver cancer.

In-silico studies on evaluating the liver-protective effectiveness of a polyherbal formulation in preventing hepatocellular carcinoma progression

Liv-52, an herbal formulation consisting of seven distinct plants and Mandur Bhasma, is recognized for its hepatoprotective, anti-inflammatory, and antioxidant properties. To investigate the pharmacological potential of each phytochemical from these plants, we conducted ADMET analysis, molecular docking, and molecular dynamic simulations to identify potent molecules capable of inhibiting the interaction between Alpha-fetoprotein (AFP) and Cysteine aspartyl protease 3 (Caspase-3/CASP3). In our study, we have used molecular docking of all the compounds against AFP and filtered them on the basis of ADME properties. Among the compounds analyzed, (-) Syringaresinol from Solanum nigrum, exhibited good binding interactions with AFP, the highest binding free energy, and maintained stability throughout the simulation along with favorable drug likeness properties based on ADME and Toxicity analysis. These findings have strongly indicated that (-) Syringaresinol is a potential inhibitor of AFP, providing a promising therapeutic avenue for hepatocellular carcinoma (HCC) treatment by inhibiting the interaction between AFP and CASP3, thereby reinstating normal CASP3 activity. Further in vitro studies are imperative to validate the therapeutic efficacy of (-) Syringaresinol as an AFP inhibitor, potentially impeding the progression of HCC.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40203-024-00285-2.

Multiplex Collagen Fingerprinting for the Staging of Hepatic Fibrosis Using High-Precision Fluorescence-Guided SERS Imaging

Hepatic fibrosis is a common chronic liver disease, and its severe progression can culminate in cirrhosis and hepatocellular carcinoma (HCC). Precise diagnosis and staging of hepatic fibrosis are essential to prevent liver cirrhosis and HCC. Simultaneous detection of multiplex collagen biomarkers within liver tissue is crucial for staging hepatic fibrosis. We herein for the first time constructed multiplex collagen fingerprinting for the staging of hepatic fibrosis using high-precision fluorescence-guided surface-enhanced Raman scattering (SERS) imaging. SERS/fluorescent probes, collectively referred to as SF, comprising silver nanoparticles (Ag NPs), Raman reporters, and FAM-labeled collagen targeting peptides. These probes exhibit exceptional aqueous dispersion and stability, attributed to the increased number of Asp residues in CTP. Meanwhile, SF probes, namely SF-I, SF-IV, and SF-D have demonstrated specific targeting of type I, type IV, and denatured collagen, respectively, within hepatic fibrotic tissues. The results from fluorescence-guided SERS imaging underscore the method's capacity for typing, localization, and quantification of collagen, thus providing novel insights into collagen's role in the development of hepatic fibrosis. The collagen fingerprinting strategy offers a potent toolkit for the multifaceted profiling of collagen superfamilies, holding significant implications for the precise staging of hepatic fibrosis.

Temporal trends in prevalence of liver cancer and etiology-specific liver cancer from 1990 to 2019

BACKGROUND

Liver cancer (LC) remains a major cause of cancer death worldwide. Grasping prevalence trends is key to informing strategies for control and prevention. We analyzed the global, regional and national trends in LC prevalence and its major causes from 1990 to 2019.

METHODS

We obtained LC age-standardized prevalence rate (ASPR) estimates from the Global Burden of Disease study 2019 and assessed trends using Joinpoint regression. LC cases were categorized into those due to hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol use, nonalcoholic steatohepatitis (NASH) and other causes.

RESULTS

While the ASPR of LC has shown a global decrease, there are specific regions where an increase in ASPR has been observed, with the highest rates in America. HBV remained the leading cause of LC (41.45 %) but significant increases occurred for HCV, alcohol use and NASH. Prevalence correlated with socioeconomic development. High-income countries had higher LC rates from HCV and alcohol but lower HBV-related LC. In high-income nations, LC prevalence climbs; the converse holds in middle- and low-income countries.

CONCLUSIONS

Despite a global ASPR decrease, LC due to HCV, NASH, and alcohol is rising. Prevention strategies must prioritize HBV vaccination, HCV treatment, and alcohol regulation.

IMPACT

The study informs targeted LC control policies and emphasizes the importance of continued monitoring and regional cooperation to combat LC.

Plant-derived flavonoids are a potential source of drugs for the treatment of liver fibrosis

Liver fibrosis is a dynamic pathological process that can be triggered by any chronic liver injury. If left unaddressed, it will inevitably progress to the severe outcomes of liver cirrhosis or even hepatocellular carcinoma. In the past few years, the prevalence and fatality of hepatic fibrosis have been steadily rising on a global scale. As a result of its intricate pathogenesis, the quest for pharmacological interventions targeting liver fibrosis has remained a formidable challenge. Currently, no pharmaceuticals are exhibiting substantial clinical efficacy in the management of hepatic fibrosis. Hence, it is of utmost importance to expedite the development of novel therapeutics for the treatment of this condition. Various research studies have revealed the ability of different natural flavonoid compounds to alleviate or reverse hepatic fibrosis through a range of mechanisms, which are related to the regulation of liver inflammation, oxidative stress, synthesis and secretion of fibrosis-related factors, hepatic stellate cells activation, and proliferation, and extracellular matrix synthesis and degradation by these compounds. This review summarizes the progress of research on different sources of natural flavonoids with inhibitory effects on liver fibrosis over the last decades. The anti-fibrotic effects of natural flavonoids have been increasingly studied, making them a potential source of drugs for the treatment of liver fibrosis due to their good efficacy and biosafety.

Systematic training of LI-RADS CT v2018 improves interobserver agreements and performances in LR categorization for focal liver lesions

AIM

To retrospectively explored whether systematic training in the use of Liver Imaging Reporting and Data System (LI-RADS) v2018 on computed tomography (CT) can improve the interobserver agreements and performances in LR categorization for focal liver lesions (FLLs) among different radiologists.

MATERIALS AND METHODS

A total of 18 visiting radiologists and the liver multiphase CT images of 70 hepatic observations in 63 patients at high risk of HCC were included in this study. The LI-RADS v2018 training procedure included three thematic lectures, with an interval of 1 month. After each seminar, the radiologists had 1 month to adopt the algorithm into their daily work. The interobserver agreements and performances in LR categorization for FLLs among the radiologists before and after training were compared.

RESULTS

After training, the interobserver agreements in classifying the LR categories for all radiologists were significantly increased for most LR categories (P < 0.001), except for LR-1 (P = 0.053). After systematic training, the areas under the curve (AUCs) for LR categorization performance for all participants were significantly increased for most LR categories (P < 0.001), except for LR-1 (P = 0.062).

CONCLUSION

Systematic training in the use of the LI-RADS can improve the interobserver agreements and performances in LR categorization for FLLs among radiologists with different levels of experience.

Global burden, risk factors, and trends of non-Hodgkin lymphoma: A worldwide analysis of cancer registries

BACKGROUND

Non-Hodgkin lymphoma (NHL) accounts for 90% of all malignant lymphomas. This study aimed to evaluate the global incidence, mortality, associated risk factors, and temporal trends of NHL by sex, age, and country.

METHODS

Data from 185 countries globally were used for analysis. NHL incidence and mortality were collected via the GLOBOCAN (2020), CI5 series I-X, WHO mortality database, the Nordic Cancer Registries, and the SEER Program. The WHO Global Health Observatory provided country-level, age-standardized prevalence of lifestyle and metabolic risk factors. Trends were examined and reported based on average annual percentage change (AAPC) calculated using Joinpoint regression analysis. Incidence and AAPC are based on data for the last 10 years across countries.

RESULTS

Globally, age-standardized incidence and mortality rates for NHL were recorded at 5.8 and 2.6 per 100,000 individuals, respectively. At country-level, NHL incidence was significantly associated with various factors, including HDI (Human Development Index), GDP per capita, prevalence of tobacco and alcohol consumption, sedentary lifestyle, obesity, hypertension, diabetes and hypercholesterolaemia. Rising trend in NHL incidence was observed, with the highest increase recorded in Estonia (AAPCmale  = 4.15, AAPCfemale  = 5.14), Belarus (AAPCfemale  = 5.13), and Lithuania (AAPCfemale  = 4.68). While overall NHL mortality has been decreasing, certain populations experienced increased mortality over the decade. In Thailand, AAPC for mortality was 31.28% for males and 30.26% for females. Estonia saw an AAPC of 6.46% for males, while Slovakia experienced an AAPC of 4.24% for females. Colombia's AAPC was 1.29% for males and 1.51% for females.

CONCLUSIONS

This study indicates a rising trend of NHL incidence over the past decade- particularly in developed countries, older males, and younger populations. Further research should investigate deeper insights into specific etiology and prognosis of NHL across subtypes, and potential contributors towards these epidemiologic trends.

Differences in the incidence and mortality of digestive cancer between Global Cancer Observatory 2020 and Global Burden of Disease 2019

The burden of digestive cancers is increasing worldwide. The Global Cancer Observatory (GLOBOCAN) 2020 and the Global Burden of Disease (GBD) 2019 are two primary cancer databases, which have a significant impact on policy formulation and resource allocation. We aim to compare the incidence and mortality of digestive cancers between them. Digestive cancer (esophageal, stomach, colorectal, liver, gallbladder and pancreatic cancer) incidence was obtained from the Cancer Today and GBD 2019 result tool. The top five countries with the most or minor difference between GLOBOCAN 2020 and GBD 2019 in age-standardized incidence rates (ASIRs) of digestive cancers were identified. A systematic search on the incidence of specific digestive cancer in selected countries from PubMed and Embase was conducted, and 20 of 281 publications were included. The most significant differences in digestive cancers incidence were commonly found in Asian countries (70%), particularly Indonesia, Vietnam and Myanmar, located in Southeast Asia. The ASIRs for most digestive cancers, except liver cancer, in GLOBOCAN 2020 were higher than those in GBD 2019. Gallbladder cancer had the highest average ratio, followed by liver cancer. The most commonly used standard population was Segi's standard population, followed by the World Health Organization standard population. The data sources nor the processing methods of GLOBOCAN 2020 and GBD 2019 were not similar. Low- and middle-income countries without population-based cancer registries were more likely to have selection bias in data collection and amplify regional variations of etiological factors. Better judgments on the quality of cancer data can be made.

Predictors for early recurrence beyond up-to-7 or distant metastasis after hepatocellular carcinoma resection: proposal for borderline resectable HCC

BACKGROUND

The recurrence rate after curative resection for hepatocellular carcinoma (HCC) reaches over 70% after 5 years and early recurrence (within 1 year) is now recognized as having a poor prognosis and has limited treatment options.

METHODS

We retrospectively reviewed 184 consecutive patients who underwent curative hepatic resection for HCC. Severe early recurrence was defined as multiple (beyond up-to-7) liver recurrence or distant metastasis after hepatic resection within 1 year. We divided the participants into two groups according to severe early recurrence and analyzed clinicopathological and long-term outcomes.

RESULTS

Among the patients with multiple or distant metastasis (n = 59), 49 patients (83%) had recurrence within 1 year. Overall survival (OS) and recurrence-free survival (RFS) were significantly worse in the severe early recurrence group than in the others group. Logistic regression analysis revealed that severe early recurrence was significantly associated with macroscopic vascular invasion (MVI), tumor burden score (TBS) > 4.70, and ALBI grade 2. In patients with scores of 2 and 3 (the sum of the three factors), OS and RFS rates were significantly poorer than those of patients with scores of 0 or 1. Positive predictive value and negative predictive value for severe early recurrence was 68.4% and 84.2%, respectively. Furthermore, a validation study demonstrated that cases with these factors were at high risk of severe early recurrence and had poor prognosis.

CONCLUSIONS

In this retrospective analysis, MVI, TBS, and ALBI could predict severe early recurrence after hepatic resection for HCC, and patients with these risk factors had a poor prognosis.

Development of Liver Cancer Organoids: Reproducing Tumor Microenvironment and Advancing Research for Liver Cancer Treatment

Liver cancer a leading cause of cancer-related deaths worldwide, yet understanding of its development mechanism remains limited, and treatment barriers present substantial challenges. Owing to the heterogeneity of tumors, traditional 2D culture models are inadequate for capturing the complexity and diversity of tumor biology and understanding of the disease. Organoids have garnered considerable attention because of their ability to self-renew and develop functional structures in vitro that closely resemble those of human organs. This review explores the history of liver organoids, their cellular origins, techniques of constructing tumor microenvironments that recapitulate liver cancer organoids, and the biological and clinical applications of liver and liver cancer organoids and explores the current challenges related to liver cancer organoid applications and potentially valuable solutions, with the aim of facilitating the construction of in vitro clinical models of liver cancer therapeutic research.

Deciphering Role of lncRNA 91H in Liver Cancer: Impact on Tumorigenesis

OBJECTIVE

This study aimed to investigate functional role of long ncRNA (lncRNA) 91H in liver cancer tumorigenesis, focusing on its effect on cell proliferation, apoptosis, cell cycle progression, migration, invasion, epithelial-mesenchymal transition (EMT) and In vivo tumor growth.

MATERIALS AND METHODS

In this experimental study, liver cancer tissues and cell lines were analyzed for lncRNA 91H expression using quantitative reverse transcription polymerase chain reaction (qRT-PCR). By employing si-RNA to silence 91H, we aimed to gain a more in-depth understanding of its specific contributions and effects within these cells. Cell proliferation was assessed through the CCK-8 assay, while apoptosis and cell cycle progression were quantified using Annexin V-FITC staining and flow cytometry, respectively. Migration and invasion capabilities of liver cancer cells were assessed through transwell assay. EMT was assessed by analyzing protein expression levels of EMT-associated markers through western blotting. In vivo effect of 91H was assessed through xenograft experiments.

RESULTS

Significantly higher levels of lncRNA 91H were observed in the liver cancer tissues and cell lines, than the normal cells. Silencing 91H in liver cancer cells led to a notable reduction of cell proliferation by inducing apoptosis and arresting the cell cycle. Liver cancer cells with decreased 91H expression exhibited diminished migration and invasion abilities, suggesting a role for 91H in promoting these processes. Furthermore, 91H knockdown weakened EMT in liver cancer cells, indicating its involvement in modulating this critical cellular transition. Furthermore, growth of subcutaneous xenograft tumors and weight was effectively suppressed by sh-lncRNA 91H.

CONCLUSION

Our study strongly supports lncRNA 91H's role in liver cancer progression by enhancing proliferation, migration, invasion, and EMT. Targeting 91H reduced in vivo tumor growth, highlighting its potential as a therapeutic liver cancer target. These findings suggest 91H's pivotal role in liver cancer aggressiveness, opening doors for future therapeutic approaches.

Trends in liver cancer mortality in China from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019

OBJECTIVE

We aimed to examine trends in overall mortality rates for liver cancer and those within subgroups according to sex, age, aetiological factors and modifiable risk factors in China from 1990 to 2019.

DESIGN

The design of this study involved analysing liver cancer mortality rates in China from 1990 to 2019 using joinpoint regression analysis to identify significant changes in mortality rates. Annual percentage changes (APCs) and 95% CIs were used to quantify the magnitude of changes in mortality rates. The study also conducted subgroup analyses based on sex, age, aetiological factors and risk factors to better understand trends in liver cancer mortality rates.

RESULTS

The age-standardised mortality from liver cancer in China first increased from 28.12 to 31.54 deaths per 100 000 population in 1990-1996 (APC=2.1%, 95% CI: 1.5% to 2.6%), then dropped at varying rates (1996-2000, APC=-3.7%, 95% CI: -5.2% to -2.1%; 2000-2004, APC=-17.4%, 95% CI: -18.7% to -16.1%; 2004-2007, APC=-5.4%, 95% CI: -8.3% to -2.3%; and 2007-2012, APC=-1.4%, 95% CI: -2.3% to -0.4%), and began to increase again after 2012 (APC=1.3%, 95% CI: 0.9% to 1.7%). Hepatitis B and C virus infections accounted for 63% and 18% of liver cancer-related deaths, respectively, in China from 1990 to 2019. Smoking, drug use, alcohol use and elevated body mass index were the four leading risk factors for liver cancer mortality in China during the study period. Notable variations in both liver cancer mortality rates and changes in mortality rates were observed across sexes and age groups.

CONCLUSIONS

The age-standardised liver cancer mortality rate in China significantly decreased from 1996 to 2019. The major differences in liver cancer mortality rates and inconsistent changes in mortality rates between 1990 and 2019 merit the attention of researchers and policymakers.

Survival Improvements in Advanced Hepatocellular Carcinoma with Sequential Therapy by Era

Treatment modalities for advanced hepatocellular carcinoma (HCC) have changed dramatically, with systemic therapy as the primary option. However, the effect of sequential treatment on prognosis remains unclear. This retrospective study included patients who began systemic therapy between 2009 and 2022. The patients were separated into three groups according to systemic therapy commencement. The number of therapy lines, treatment efficacy, and overall survival (OS) were compared. Multivariate analyses of the prognostic factors were analyzed using the Cox proportional hazards model. Overall, 336 patients were included (period 1: 2009-2013, n = 86; period 2: 2014-2018, n = 132; period 3: 2019-2022, n = 118). A significant etiological trend was observed with decreasing viral hepatitis-related HCC and increasing non-viral hepatitis-related HCC. Across periods 1-3, the proportion of patients who were administered >2 lines progressively increased (1.2%, 12.9%, and 17.0%, respectively; p < 0.001) and the median OS was significantly prolonged (14.3, 16.8, and 31.0 months; p < 0.001). The use of <3 lines, the non-complete and partial response of the first line, modified albumin-bilirubin at grade 2b or 3, an intrahepatic tumor number ≥ 5, extrahepatic metastasis, and alpha-fetoprotein at ≥400 ng/mL were the strongest factors associated with shorter OS. Sequential therapies have contributed to significant improvements in HCC prognosis, suggesting that sequential treatment post-progression is worthwhile for better survival.

Trends and future projections of liver cancer incidence in Hong Kong: a population-based study

BACKGROUND

Liver cancer remains a significant burden in Hong Kong. We sought to examine trends in liver cancer incidence using 30 years of cancer registry data in Hong Kong. Additionally, we aimed to assess the impact of age, period and birth cohort on liver cancer incidence, provided projections for liver cancer incidence until 2030, and examined the drivers of liver cancer incidence.

METHODS

Data on liver cancer incidence were collected from the Hong Kong Cancer Registry (HKCaR). We assessed age, period, and birth cohort effects using age-period-cohort (APC) models. We employed Bayesian APC analysis with integrated nested Laplace approximations to project the future burden of liver cancer in Hong Kong. Furthermore, we attributed the changes in new liver cancer cases to population growth, population ageing, and epidemiological changes.

RESULTS

The study included a total of 51,333 individuals, of whom 39,287 (76.53%) were male. From 1991 to 2020, the age-standardized liver cancer incidence rate in Hong Kong continued declining, while the number of new cases increased significantly, especially among males. The net drift, representing the overall annual percentage change of the age-adjusted rate, was - 3.06% (95% confidence interval [CI]: -3.31% to -2.80%) for males and - 3.85% (95% CI: -4.61% to -3.09%) for females. Local drift, which estimates the annual percentage change over time specific to age group, decreased in all age groups for both sexes, with a more pronounced decrease in younger age groups. The period and cohort risk of developing liver cancer also showed decreasing trends for both sexes. The study projected a decline in liver cancer cases for males but an increase for females in Hong Kong, with an estimated 1,083 cases in males and 710 cases in females by 2030. Demographic decomposition analysis revealed that while population growth and ageing were the main drivers of increased liver cancer cases, epidemiologic shifts mostly offset these factors.

CONCLUSION

The period and cohort risk of developing liver cancer in Hong Kong declined due to epidemiological changes. Although the age-standardized incidence rates of liver cancer have also declined, demographic and epidemiological factors have led to lower case expectations in males but a likely increase in females. Further research and epidemiological assessment of the disease are needed.

Changing treatment landscape associated with improved survival in advanced hepatocellular carcinoma: a nationwide, population-based study

BACKGROUND AND AIMS

The treatment of hepatocellular carcinoma (HCC) is undergoing a historic transformation with the approval of several new systemic therapies in the last few years. This study aimed to examine the impact of this changing landscape on survival and costs in a Western nationwide, real-world cohort.

METHODS

A nationwide representative claims database (InGef) was screened for HCC cases between 2015 and 2020. Survival in an era with only sorafenib (period A, January 2015 to July 2018) and after approval of lenvatinib and other systemic treatments (period B, August 2018 to December 2020) was analysed. Health care costs were assessed.

RESULTS

We identified 2876 individuals with HCC in the study period. The proportion of patients receiving systemic therapy increased significantly over time, from 11.8% in 2015 to 15.1% in 2020 (p < 0.0001). The median overall survival in period B was 6.5 months (95% confidence interval [CI]: 4.9-8.9) and in period A was 5.3 months (95% CI: 4.5-6.3; p = 0.046). In period B, the median overall survival with lenvatinib was 9.7 months (95% CI: 6.3-18.4) versus 4.8 months with sorafenib (95% CI: 4.0-7.1, p = 0.008). Costs for prescription drugs per patient increased from €6150 in 2015 to €9049 in 2020 (p < 0.0001), and costs for outpatient care per patient increased from €1646 to €2149 (p = 0.0240).

CONCLUSION

The approval of new systemic therapies resulted in a survival benefit in patients with HCC. The magnitude of the effect is modest and associated with a moderate increase in health costs.

Oxidative Stress in Liver Pathophysiology and Disease

The liver is an organ that is particularly exposed to reactive oxygen species (ROS), which not only arise during metabolic functions but also during the biotransformation of xenobiotics. The disruption of redox balance causes oxidative stress, which affects liver function, modulates inflammatory pathways and contributes to disease. Thus, oxidative stress is implicated in acute liver injury and in the pathogenesis of prevalent infectious or metabolic chronic liver diseases such as viral hepatitis B or C, alcoholic fatty liver disease, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Moreover, oxidative stress plays a crucial role in liver disease progression to liver fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Herein, we provide an overview on the effects of oxidative stress on liver pathophysiology and the mechanisms by which oxidative stress promotes liver disease.

Mortality from chronic liver disease: Recent trends and impact of the COVID-19 pandemic

Prepandemic time trends in mortality from chronic liver disease (CLD) differed according to specific cause of death (decreasing for liver cirrhosis, stable or increasing for liver cancer), etiology (increasing for nonalcoholic fatty liver disease, generally decreasing for other etiologies), and world region (decreasing in areas with the highest burden of hepatitis B virus, increasing in Eastern Europe and other countries). The coronavirus disease 2019 (COVID-19) pandemic affected mortality of patients with CLD both directly, with a higher risk for severe illness and death depending on age, stage and etiology of the disease, and indirectly, through social isolation and loss of support, harmful drinking, and difficulties in access to care. Nevertheless, only sparse data are available on variations in CLD as a cause of death during the pandemic. In the USA, in 2020-2021 a growth in mortality was registered for all liver diseases, more marked for alcoholic liver disease, especially among young people aged 25-44 years and in selected ethnic groups. COVID-19 related deaths accounted only for a minor part of the excess. Further data from mortality registers of other countries are warranted, preferably adopting the so-called multiple cause-of-death approach, and extended to deaths attributed to viral hepatitis and liver cancer.

Global trajectories of liver cancer burden from 1990 to 2019 and projection to 2035

BACKGROUND

Large disparities exist in liver cancer burden trends across countries but are poorly understood. We aimed to investigate the global trajectories of liver cancer burden, explore the driving forces, and predict future trends.

METHODS

Data on the liver cancer burden in 204 countries and territories from 1990 to 2019 were extracted from the Global Burden of Disease Study. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) trajectories were defined using growth mixture models. Five major risk factors contributing to changes in the ASIR or ASMR and socioeconomic determinants were explored using the identified trajectories. A Bayesian age-period-cohort model was used to predict future trends through 2035.

RESULTS

Three trajectories of liver cancer burden were identified: increasing, stable, and decreasing groups. Almost half of the American countries were classified in the decreasing group (48.6% for ASIR and ASMR), and the increasing group was the most common in the European region (ASIR, 49.1%; ASMR, 37.7%). In the decreasing group, the decrease of liver cancer due to hepatitis B contributed 63.4% and 60.4% of the total decreases in ASIR and ASMR, respectively. The increase of liver cancer due to alcohol use, hepatitis C, and hepatitis B contributed the most to the increase in the increasing group (30.8%, 31.1%, and 24.2% for ASIR; 33.7%, 30.2%, and 22.2% for ASMR, respectively). The increasing group was associated with a higher sociodemographic index, gross domestic product per capita, health expenditure per capita, and universal health coverage (all P <0.05). Significant variations in disease burden are predicted to continue through 2035, with a disproportionate burden in the decreasing group.

CONCLUSION

Global disparities were observed in liver cancer burden trajectories. Hepatitis B, alcohol use, and hepatitis C were identified as driving forces in different regions.

Does global warming increase the risk of liver cancer in Australia? Perspectives based on spatial variability

Australia has experienced an astonishing increase in liver cancer over the past few decades and the epidemiological reasons behind this are puzzling. The existing recognized risk factors for liver cancer, viral hepatitis, and alcohol consumption, are inconsistent with the trend in liver cancer. Behind the effects of migration and metabolic disease lies a potential contribution of climate change to an increase in liver cancer. This study explored the climate-associated distribution of high-risk areas for liver cancer by comparing liver cancer to lung cancer and finds that the incidence of liver cancer is more pronounced in hot and humid areas. This study showed the risk of liver cancer was higher in the equatorial region and tropical regions. These results will extend the study on the health consequences of climate change and provide more ideas and directions for future researchers.

Cancer mortality in 2020 and its trend analysis in Inner Mongolia during four time periods from 1973 to 2020

Cancer is one of the leading causes of mortality in China and is responsible for placing a major burden on its economic system. Inner Mongolia is located close to the northern border of China and spans more than 2,400 km from east to west. It has a total area of 1,183,000 km², which accounts for about one-third of the total area of the country. Its ethnic demographics are complex and unique. We were interested in understanding whether these situations lead to a higher mortality rate for certain types of cancer, which was the motivation behind our research. This study aims to estimate cancer mortality in Inner Mongolia, its burden, and its trend over a 60-year time span. We compiled data pertaining to cancer in Inner Mongolia, obtained from the three national causes of death sample surveys. In addition, we obtained data pertaining to cancer mortality rates from the cause of death surveillance system in Inner Mongolia in the year 2020. The proportion of deaths from various cancers, crude mortality rates, and standardized mortality rates were calculated. The Joinpoint Regression Program was used to calculate mortality trends and the periodic percentage change (PPC) in these rates. We found that the mortality rate of cancer was 142.15/10⁵; the age-standardized mortality rate using the Chinese standard population in 2000 (ASMRC) and Segi's world population (ASMRW) were 86.49/10⁵ and 85.73/10⁵ in 2020, respectively. From 1973 to 2020, during the four time periods, the leading five cancer types contributing to the mortality rate among Inner Mongolia residents in 2020 were stomach cancer, esophageal cancer, liver cancer, cervix/uterine cancer, and lung cancer. The four periods of time PYLL ‰ were 9.05‰, 10.79‰, 12.1‰, and 10.38‰ from 1973 to 2020. The overall trend of the crude mortality rate of cancer in Inner Mongolia from 1973 to 2020 increased (PPC =1.77%, P<0.05). Also, the crude mortality rate and ASMRC were higher in men than in women (P<0.05). The mortality rates of cancer in Inner Mongolia increased with age ie first time period and in 2020 for ages 10 to 84. The same trend was observed for ages 0 and 74 in the second and the third time periods. Overall, in 2020, the CMR and the ASMRW in Inner Mongolia were lower than the national level and significantly lower than those in other domestic Chinese provinces. Lung cancer was the most reported cancer. Cancers from the first to seventh place ranking were consistent with the national ranking in 2020. The overall crude mortality rate of cancer in Inner Mongolia during the four periods revealed an increasing trend, and liver cancer-related mortality also showed an upward trend during the four periods. The findings may provide baseline data for cancer research.

Updated epidemiology of gastrointestinal cancers in East Asia

Globally, gastrointestinal cancers represent more than one-fourth of all cancer incidence and one-third of cancer-related mortality. Although there has been much progress in screening colorectal cancer, the prognosis of other gastrointestinal cancers tends to be poor. The highest burden of gastrointestinal cancers, including stomach, liver, oesophageal and gallbladder cancers, was observed in regions in East Asia. The increasing burden of gastrointestinal cancers in East Asian regions is related to population growth, ageing and the westernization of lifestyle habits in this region. Furthermore, the rising incidence of young-onset colorectal cancer is an emerging trend in East Asia. This Review provides a comprehensive and updated summary of the epidemiology of gastrointestinal cancers in East Asia, with emphasis on comparing their epidemiology in East Asia with that in Western regions, and highlights the major risk factors and implications for prevention. Overall, to optimally reduce the disease burden incurred by gastrointestinal cancers in East Asian regions, a concerted effort will be needed to modify unhealthy lifestyles, promote vaccination against the hepatitis virus, control Helicobacter pylori, liver fluke and hepatitis virus infections, increase the uptake rate of colorectal cancer screening, enhance detection of early cancers and their precursors, and improve cancer survivorship through an organized rehabilitation programme.

Incidence and mortality of thyroid cancer in 50 countries: a joinpoint regression analysis of global trends

PURPOSE

To evaluate the incidence and mortality trend of thyroid cancer, and compare its global incidence trends among different countries by age group and sex.

METHODS

Data on age-standardized incidence and mortality rate of thyroid cancer among 50 countries were collected from the Cancer Incidence in Five Continents Volume XI; the Surveillance, Epidemiology, and End Results Program (SEER), the National Cancer Institute; the Nordic Cancer Registries (NORDCAN), and the WHO mortality database. The Average Annual Percent Change (AAPC) of the incidence and mortality trends was calculated by joinpoint regression analysis.

RESULTS

The age-standardized incidence of thyroid cancer was 3.1 and 10.1 cases per 100,000 persons in men and women, respectively. The incidence of thyroid cancer increased in most countries among individuals irrespective of age groups, and increased in populations aged <40 years in several countries, including Korea (male: AAPC 25.3, 95% C.I. 22.3-28.4, p < 0.001; female: AAPC 18.5, 95% C.I. 16.2-20.9, p < 0.001), Poland (male: AAPC 19.1, 95% C.I. 1.4-39.7, p = 0.036; female: AAPC 13.7, 95% C.I. 7.6-20.2), and China (male: AAPC 18.6, 95% C.I. 12.1-25.5, p < 0.001; female: AAPC 13.3, 95%C.I. 11.5-15.1, p < 0.001).

CONCLUSION

An increasing incidence of thyroid cancer was observed in younger subjects in a majority of countries, highlighting the need for more preventive strategies in this population and possible avoidance of over-diagnosis.

Construction and validation of prognostic signature for hepatocellular carcinoma basing on hepatitis B virus related specific genes

BACKGROUND

Hepatocellular carcinoma (HCC) is a frequent primary liver cancer, and it is one of the leading cause of cancer-related deaths. Hepatitis B virus (HBV) infection is a crucial risk factor for HCC. Thus, this study aimed to explore the prognostic role of HBV-positive HCC related specific genes in HCC.

METHODS

The HCC related data were downloaded from three databases, including The Cancer Genome Atlas (TCGA), International Cancer Genome Consortium (ICGC), and Gene Expression Omnibus (GEO). Univariate Cox regression analysis and LASSO Cox regression analysis were conducted to build the Risk score. Multivariate Cox regression analysis and survival analysis determined the independent prognostic indicators.

RESULTS

After cross analysis of differentially expressed genes (DEGs), we have identified 106 overlapped DEGs, which were probably HBV-positive HCC related specific genes. These 106 DEGs were significantly enriched in 213 GO terms and 8 KEGG pathways. Among that, 11 optimal genes were selected to build a Risk score, and Risk score was an independent prognostic factor for HCC. High risk HCC patients had worse OS. Moreover, five kinds of immune cells were differentially infiltrated between high and low risk HCC patients.

CONCLUSION

The prognostic signature, based on HMMR, MCM6, TPX2, KIF20A, CCL20, RGS2, NUSAP1, FABP5, FZD6, PBK, and STK39, is conducive to distinguish different prognosis of HCC patients.

LncRNA colorectal neoplasia differentially expressed promotes glycolysis of liver cancer cells by regulating hypoxia-inducible factor 1α

LncRNAs are associated with tumorigenesis of liver cancer. LncRNA Colorectal Neoplasia Differentially Expressed (CRNDE) was identified as an oncogenic lncRNA and involved in tumor growth and metastasis. The role of CRNDE in liver cancer was investigated. CRNDE was elevated in liver cancer cells. Knockdown of CRNDE decreased cell viability and inhibited proliferation of liver cancer. Moreover, knockdown of CRNDE reduced levels of extracellular acidification rate, glucose consumption, and lactate production to repress glycolysis of liver cancer. Silence of CRNDE enhanced the expression of miR-142 and reduced enhancer of zeste homolog 2 (EZH2) and hypoxia-inducible factor 1α (HIF-1α). Over-expression of HIF-1α attenuated CRNDE silence-induced decrease of glucose consumption and lactate production. Injection with sh-CRNDE virus reduced in vivo tumor growth of liver cancer through up-regulation of miR-142 and down-regulation of EZH2 and HIF-1α. In conclusion, knockdown of CRNDE suppressed cell proliferation, glycolysis, and tumor growth of liver cancer through EZH2/miR-142/HIF-1α.

Tumor-Targeting Polymer–Drug Conjugate for Liver Cancer Treatment In Vitro

Bufalin (buf) has poor solubility in aqueous solution, poor tumor targeting, and many non-specific toxic and side effects. The advantages of high-molecular-weight polymer conjugates are that they can improve the water solubility of buf, prolong plasma half-life, and reduce non-specific toxicity. A novel water-soluble polymer–drug conjugate with buf and fluorescein pendants was prepared by the combination of reversible addition-fragmentation transfer (RAFT) polymerization and click chemistry. Its anticancer performance and cellular uptake behavior against liver cancer were investigated in vitro. The polymer–buf conjugates exhibit controlled release and tumor-targeting capabilities, showing promise for clinical applications.

DNA Topoisomerase II-α Regulated by miR-22-5p Promotes Hepatocellular Carcinoma Invasion and Migration through the Hippo Pathway

DNA topoisomerases (TOPs) are dysregulated in various types of cancer. However, how TOP II-alpha (TOP2A) contributes to hepatocellular carcinoma (HCC) progression remains elusive. Cohort analysis revealed that the increased expression of TOP2A was associated with poor clinical outcomes and TOP2A was significantly upregulated in HCC tissues and cell lines. In vitro, TOP2A expression level is related to cell invasion and migration, which may be due to the alteration of epithelial-mesenchymal transition by the TOP2A. Moreover, we used verteporfin (a Hippo inhibitor) to test how the Hippo pathway promotes the effect of TOP2A on the HCC phenotype and found that TOP2A induces tumor progression through the Hippo pathway. Finally, miR-22-5p inhibited tumor progression by sponging TOP2A.

Is early-onset cancer an emerging global epidemic? Current evidence and future implications

Over the past several decades, the incidence of early-onset cancers, often defined as cancers diagnosed in adults <50 years of age, in the breast, colorectum, endometrium, oesophagus, extrahepatic bile duct, gallbladder, head and neck, kidney, liver, bone marrow, pancreas, prostate, stomach and thyroid has increased in multiple countries. Increased use of screening programmes has contributed to this phenomenon to a certain extent, although a genuine increase in the incidence of early-onset forms of several cancer types also seems to have emerged. Evidence suggests an aetiological role of risk factor exposures in early life and young adulthood. Since the mid-20th century, substantial multigenerational changes in the exposome have occurred (including changes in diet, lifestyle, obesity, environment and the microbiome, all of which might interact with genomic and/or genetic susceptibilities). However, the effects of individual exposures remain largely unknown. To study early-life exposures and their implications for multiple cancer types will require prospective cohort studies with dedicated biobanking and data collection technologies. Raising awareness among both the public and health-care professionals will also be critical. In this Review, we describe changes in the incidence of early-onset cancers globally and suggest measures that are likely to reduce the burden of cancers and other chronic non-communicable diseases.

A highly sensitive strategy for glypican-3 detection based on aptamer/gold carbon dots/magnetic graphene oxide nanosheets as fluorescent biosensor

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths in China. Glypican-3 (GPC3) is a specific antigen related to HCC, which is widely used in clinical detection as a reliable marker of HCC. In this paper, a highly sensitive homogeneous apatasensor was designed for GPC3 detection based on fluorescence resonance energy transfer (FRET) where the GPC3 aptamer labelled gold carbon dots (AuCDs-GPC3_Apt) are used as a donor and magnetic graphene oxide (Fe₃O₄/GO) nanosheets are used as an acceptor. A one-step hydrothermal method was used to synthesize AuCDs to provide sufficient fluorescence. The FRET phenomenon exists between AuCDs-GPC3_Apt and Fe₃O₄/GO, which weakens the fluorescence intensity of the whole system. When the target GPC3 is added to the FRET system, the fluorescent AuCDs-GPC3_Apt binds to the GPC3 and forms a folded structure, which leads to AuCDs-GPC3_Apt separation from Fe₃O₄/GO nanosheets. The Fe₃O₄/GO is then magnetically separated so that the fluorescence of free labelled AuCDs-GPC3_Apt is restored. Under the optimum conditions, the fluorescence recovery rate is linearly correlated with the concentration of GPC3 (5-100 ng·mL^-1) and the detection limit is 3.01 ng·mL^-1 (S/N = 3). This strategy shows recoveries from 98.76 to 101.29% in real human serum samples and provides an immediate and effective detection method for the quantification of GPC3 with great potential applications for early diagnosis of HCC. A sensitive homogeneous FRET-based apatasensor was designed for GPC3 detection where the AuCDs-GPC3_Apt is a donor and Fe₃O₄/GO nanosheets are an acceptor. The GPC3 fluorescent aptasensor combines wider output range with low cost, high specificity, and good anti-interference.

Mixed Ni(II) and Co(II) complexes of nalidixic acid drug: Synthesis, characterization, DNA/BSA binding profile and in vitro cytotoxic evaluation against MDA-MB-231 and HepG2 cancer cell lines

In this work, herein we report the synthesis, structural characterization and in vitro cytotoxic evaluation of two mixed Co(II)/Ni(II)-nalidixic acid-bipyridyl complexes (1 and 2). The structural analysis of metal complexes 1 and 2 was carried out by analytical and multispectroscopic techniques (FT-IR, UV-vis, EPR, sXRD). The crystallographic details of complexes 1 and 2 revealed a monoclinic crystal system with P21/c space group. DFT studies of complexes were performed to get electronic structure and localization of HOMO and LUMO electron densities. Hirshfeld surface analysis of metal complexes 1 and 2 was employed to understand the various intermolecular interactions (C-H···O, N-H···H and O-H···O) that define the stability of crystal lattice structures. The comparative interaction studies of complex 1 and complex 2 with DNA/BSA were performed by diverse multispectroscopic and analytical techniques to evaluate their chemotherapeutic potential. The magnitude of the DNA binding propensity and binding mode was verified by calculating K_b, K and K_sv values. Higher binding affinity was observed in case of complex 2via intercalative mode. Furthermore, the cytotoxic assessment of complexes 1 and 2 was examined against MDA-MB-231 (triple negative human breast cancer cell line) and HepG2 (liver carcinoma cell line) employing MTT assay which revealed remarkably effecient and specific cytotoxic activity of complex 2.

Global pattern of trends in incidence, mortality, and mortality-to-incidence ratio rates related to liver cancer, 1990-2019: a longitudinal analysis based on the global burden of disease study

BACKGROUND

Liver cancer (LC) is considered as one of the most dominant malignant tumors which ranked 4th and in terms of global mortality and incidence, respectively. This work aimed to investigate the global temporal trends in LC mortality-to-incidence ratio (MIR) and its components, with a particular focus on examining long-term effect of human development index (HDI) on these metrics in a 30-year follow-up.

METHODS

The age-standardized LC incidence and mortality data were derived from the global burden of disease (GBD) study 2019. We first leveraged joinpoint piecewise linear regression analysis to ascertain time trends in LC incidence, mortality, and MIR complement [1-MIR] and the average annual percentage change (AAPC) of the rates over the period 1990-2019. Then, the association between the metrics and HDI was explored through longitudinal multilevel models (LMMs).

RESULTS

The incidence rates paralleled the mortality rates worldwide and they had similar significant monotonic decrementing trends with AAPC values of - 1.10% (95% confidence interval (CI): - 1.40, - 0.90%) and - 1.40% (- 1.50, - 1.30%), respectively from 1990 to 2019. The [1-MIR] rates were around 0 and showed an increasing pattern from 1.70 to 8.10 per 100,000 people (AAPC, 4.90%) at the same period of time. Results from the LMMs displayed that the majority of the variation lies at the country level accounted for about 88% of the total variance. Moreover, our analysis supported that the HDI was negatively associated with either incidence or mortality over time (p < 0.05).

CONCLUSIONS

Our findings highlighted that the global long-term temporal trends of LC incidence and mortality decreased slightly during 1990-2019 which may reflect improved therapeutic strategies and public health interventions. Besides, the low rates of [1-MIR] revealed the five-year relative survival rate was poor implying LC is diagnosed late in its development. Thereby, the policymakers' focus must be on early screening and detection of liver cancer.

Significance of zinc deficiency in patients with hepatocellular carcinoma undergoing hepatic resection

AIM

Few reported studies examine the relationship between zinc (Zn) deficiency and short- and long-term outcomes in patients with hepatocellular carcinoma undergoing hepatic resection.

METHODS

We retrospectively reviewed data from 179 consecutive patients who had undergone curative hepatic resection for hepatocellular carcinoma in our institute between January 2016 and May 2019. Zn deficiency was defined in accordance with the Japanese Society of Clinical Nutrition guidelines. We allocated the participants into two groups according to Zn deficiency status, and analyzed the clinicopathological and short- and long-term outcomes.

RESULTS

In this series, 32 patients (17.8%) had Zn deficiency. Zn deficiency was significantly associated with older age, lower serum albumin, higher aspartate aminotransferase, lower hemoglobin, higher creatinine, lower prognostic nutritional index, higher liver fibrosis markers, albumin-bilirubin 2, portal hypertension, larger amount of estimated blood loss, larger amount of maximum ascites, longer hospital stay, postoperative complications, and liver-related complications. Concentrations of liver fibrosis markers were negatively correlated with serum Zn concentrations. Zn deficiency, albumin-bilirubin 2, and non-laparoscopic approach were identified as independent predictors of postoperative complications. Multivariate analyses revealed that the overall survival rate decreased in parallel with decreasing Zn concentrations.

CONCLUSIONS

In this study, Zn deficiency was significantly associated with poorer liver function, more severe liver fibrosis, higher incidence of postoperative complications, and worse overall survival according to multivariate analysis. Serum Zn status could serve as a new surrogate marker for predicting short- and long-term outcomes in patients undergoing hepatic resection for hepatocellular carcinoma.

The Role of Protein SUMOylation in Human Hepatocellular Carcinoma: A Potential Target of New Drug Discovery and Development

Small ubiquitin-like modifier (SUMO) is a highly conserved post-translational modification protein, mainly found in eukaryotes. They are widely expressed in different tissues, including the liver. As an essential post-translational modification, SUMOylation is involved in many necessary regulations in cells. It plays a vital role in DNA repair, transcription regulation, protein stability and cell cycle progression. Increasing shreds of evidence show that SUMOylation is closely related to Hepatocellular carcinoma (HCC). The high expression of SUMOs in the inflammatory hepatic tissue may lead to the carcinogenesis of HCC. At the same time, SUMOs will upregulate the proliferation and survival of HCC, migration, invasion and metastasis of HCC, tumour microenvironment as well as drug resistance. This study reviewed the role of SUMOylation in liver cancer. In addition, it also discussed natural compounds that modulate SUMO and target SUMO drugs in clinical trials. Considering the critical role of SUMO protein in the occurrence of HCC, the drug regulation of SUMOylation may become a potential target for treatment, prognostic monitoring and adjuvant chemotherapy of HCC.

Real-World Lenvatinib Versus Sorafenib in Patients With Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

Background

Lenvatinib is approved for patients with advanced hepatocellular carcinoma (HCC) due to its non-inferiority to sorafenib of overall survival (OR) in clinical trials. This study was to compare the effectiveness and safety of lenvatinib and sorafenib in the real world.

Methods

We retrospectively evaluated 338 patients with unresectable HCC who had undergone lenvatinib or sorafenib treatment between January 2018 and August 2020. Propensity-score matching analysis was performed with a 1:2 ratio to reduce the real-life baseline difference between the two groups.

Results

A total of 210 patients (Male/Female: 150/60, mean age: 65.8 years) were recruited including 70 patients in the Lenvatinib group and 140 patients in the Sorafenib group. Compared with sorafenib, lenvatinib had significantly longer progression-free survival (PFS) (5.2 vs 3.3 months, p=0.019) but similar OR (13.3 vs 11.8 months, p=0.714). Additionally, lenvatinib had better disease control rates (62.3 vs 48.6%, p=0.029) and equivalent incidences of treatment-related adverse events over sorafenib. In multivariate analysis, lenvatinib was associated with better PFS over sorafenib (hazard ratio: 0.49, 95% confidence interval: 0.3–0.79, p=0.004) after adjustments of albumin-bilirubin grade and alpha-fetoprotein level; however, different agents using lenvatinib or sorafenib did not contribute to OS, whether in univariate or multivariate analysis. Patients who failed lenvatinib had a lower proportion of having sequential systemic therapies compared with the Sorafenib group (36.2 vs 47.8%, p=0.02). The most frequently used sequential therapy following lenvatinib and sorafenib was chemotherapy (n=9, 42.8%) and regorafenib (n=33, 50.8%), respectively.

Conclusions

In clinical real-life practice, lenvatinib illustrated promising survival benefits and acceptable safety for patients with unresectable HCC, while reducing the risk of progression disease compared with sorafenib. Additionally, lack of approved post-lenvatinib systemic therapies is a serious issue in the real world.

Revealing the Roles of Keratin 8/18-Associated Signaling Proteins Involved in the Development of Hepatocellular Carcinoma

Although hepatocellular carcinoma (HCC) is developed with various etiologies, protection of hepatocytes seems basically essential to prevent the incidence of HCC. Keratin 8 and keratin 18 (K8/K18) are cytoskeletal intermediate filament proteins that are expressed in hepatocytes. They maintain the cell shape and protect cells under stress conditions. Their protective roles in liver damage have been described in studies of mouse models, and K8/K18 mutation frequency in liver patients. Interestingly, K8/K18 bind to signaling proteins such as transcription factors and protein kinases involved in HCC development. Since K8/K18 are abundant cytoskeletal proteins, K8/K18 binding with the signaling factors can alter the availability of the factors. Herein, we discuss the potential roles of K8/K18 in HCC development.