Transcatheter arterial chemoembolization alone versus combined with microwave ablation for recurrent small hepatocellular carcinoma after resection: a retrospective comparative study

Identification of candidates with hepatocellular carcinoma to receive TACE combined with MWA by assessing tumor burden and radiologic features

Background

There is still no noninvasive, automated, and accurate model for guiding physicians in the decision-making of transarterial chemoembolization combined with microwave ablation (TACE-MWA) in intermediate-stage hepatocellular carcinoma (HCC).

Objectives

To develop a prognostic score based on the tumor burden and radiomic features for the prediction of the long-term survival of patients with intermediate-stage HCC after TACE-MWA.

Methods

From June 2008 to October 2022, a total of 2189 consecutive patients from seven tertiary-care hospitals with intermediate-stage HCC who received initial TACE combined with MWA were enrolled. Among them, 2189 were divided into training cohort (N = 1753), and internal test cohort (N = 436) in a single center, and 316 patients were assigned to external test cohort in another 6 centers. A prognostic scoring system was constructed using tumor burden and radiologic features (TBR) and compared with conventional predicting systems.

Results

In training cohort, multivariate Cox regression analysis suggested that tumor burden (hazard ratio (HR), 0.693; 95% confidence interval (CI): 0.505, 0.814; 1 point per 1.0 increase, p = 0.024), radiologic features (HR, 0.349; 95% CI: 0.236, 0.517; p < 0.001), and alpha-fetoprotein (HR, 1.629; 95% CI: 1.280, 2.073; p < 0.001) were independent prognostic factors for OS. A prognostic model that comprises TBR was built, which showed significantly higher AUC values than other clinical stagings in all three cohorts. Moreover, the TBR score provided greater net benefit across the range of reasonable threshold probabilities than other models. Based on cutoff values of 32 and 74 centiles of the TBR score, the cohort was divided into low-, middle-, and high-risk strata, which provide consistent performance in survival discrimination across different patient subgroups.

Conclusion

The TBR score serves as an efficient instrument for risk stratification, guiding the course of adjuvant targeted and immunotherapies for HCC patients undergoing TACE-MWA combined treatment.

Design

A retrospective, multi-institutional study.

Impact of Linggui Zhugan decoction on microwave ablation outcomes and recurrence in liver cancer

BACKGROUND

Liver cancer is one of the most common malignant tumors of the digestive system, and early detection and effective treatment are crucial for improving the prognosis. Microwave ablation (MWA) has shown promising results as a local therapeutic method for liver cancer; however, further improvement of its efficacy remains a key focus of current research.

AIM

To evaluate the clinical efficacy of Linggui Zhugan decoction combined with MWA for the treatment of primary liver cancer.

METHODS

Data were collected from 164 patients with primary liver cancer who underwent MWA at our hospital between March 2019 and April 2021. Among them, 79 patients (control group) received routine treatments and 85 patients (research group) received Linggui Zhugan decoction in addition to routine treatment. The clinical efficacy, incidence of adverse reactions, and levels of serum alpha-fetoprotein (AFP), des-γ-carboxy prothrombin (DCP), AFP-L3, total bilirubin (TBil), alanine aminotransferase (ALT), CD4 cell count, CD8 cell count, and CD4/CD8 ratio were compared between the two groups, before and after treatment. The three-year recurrence rates between the two groups were compared, and independent prognostic factors for recurrence were identified.

RESULTS

The study results revealed that the objective response rate (ORR) in the research group was significantly higher than that in the control group (P = 0.005). After treatment, the CD4 cell count and CD4/CD8 ratio significantly increased, whereas the CD8 cell count and TBil, ALT, AFP, DCP, and AFP-L3 Levels were significantly lower in the research group than in the control group (P < 0.001). The Cox regression analysis revealed that the treatment regimen (P = 0.003), presence of cirrhosis (P = 0.019), tumor diameter (P = 0.037), Child-Pugh score (P = 0.003), pretreatment AFP level (P = 0.006), and AFP-L3 Level (P = 0.002) were independent prognostic factors for disease-free survival.

CONCLUSION

The combination of Linggui Zhugan decoction with MWA significantly improved the clinical efficacy and long-term prognosis of patients with primary liver cancer.

Advancements in locoregional therapy for advanced hepatocellular carcinoma: Emerging perspectives on combined treatment strategies

Hepatocellular carcinoma (HCC) persists as a leading cause of cancer-related mortality, often diagnosed at advanced stages with limited treatment options. Locoregional therapies (LRTs) are crucial in HCC management, playing significant roles in neoadjuvant and palliative treatments, among others. However, the unique disease background of HCC necessitates multidisciplinary and integrated treatment strategies. The therapeutic landscape for advanced HCC has been significantly broadened by the advent of combined therapies, presenting multiple approaches aimed at improving long-term survival, which remains a critical challenge. This review offers a comprehensive overview of major LRTs for HCC, highlighting recent technological advancements and exploring the challenges and limitations in their application, and presents the latest developments in combination therapies, including combinations between different LRTs and their integration with systemic treatments. Additionally, we outline future directions for the development of integrated treatment modalities for advanced HCC.

Research progress on machine algorithm prediction of liver cancer prognosis after intervention therapy

The treatment for liver cancer has transitioned from traditional surgical resection to interventional therapies, which have become increasingly popular among patients due to their minimally invasive nature and significant local efficacy. However, with advancements in treatment technologies, accurately assessing patient response and predicting long-term survival has become a crucial research topic. Over the past decade, machine algorithms have made remarkable progress in the medical field, particularly in hepatology and prognosis studies of hepatocellular carcinoma (HCC). Machine algorithms, including deep learning and machine learning, can identify prognostic patterns and trends by analyzing vast amounts of clinical data. Despite significant advancements, several issues remain unresolved in the prognosis prediction of liver cancer using machine algorithms. Key challenges and main controversies include effectively integrating multi-source clinical data to improve prediction accuracy, addressing data privacy and ethical concerns, and enhancing the transparency and interpretability of machine algorithm decision-making processes. This paper aims to systematically review and analyze the current applications and potential of machine algorithms in predicting the prognosis of patients undergoing interventional therapy for liver cancer, providing theoretical and empirical support for future research and clinical practice.

Superselective ablative chemo-ethanol embolization for recurrent single hepatocellular carcinoma: a 6-month outcome analysis

BACKGROUNDS/AIMS

To evaluate the safety and effectiveness of superselective ablative chemo-ethanol embolization (SACE) for the treatment of patients with recurrent single hepatocellular carcinoma (rHCC).

METHODS

This retrospective study included 22 patients (19 men; median age, 63 years [range, 38-86]) with Child-Pugh class of A/ B/C (16/3/3) that underwent SACE between January and June 2023 for recurrent single HCCs measuring ≤5 cm in diameter using a mixture of 99% ethanol and ethiodized oil/doxorubicin emulsion. The primary endpoint was the 6-month tumor response, and the secondary endpoints were the 1-month tumor response and treatment-related safety. This study was approved by our institutional review board, and the requirement for informed consent was waived.

RESULTS

SACE was successfully performed in 22 patients (95.2%). The complete response rates at 1-month and 6-month after treatment were 100.0% and 83.3%, respectively. At 6-month, local tumor progression occurred in one patient and intrahepatic distant metastasis was found in six patients (30.0%). No 6-month mortalities were reported. No adverse events greater than grade 2 or laboratory deteriorations were observed. Biliary complications or liver abscesses were not observed.

CONCLUSIONS

SACE for a single rHCC was highly effective in achieving a favorable 6-month tumor response and showed acceptable adverse events. However, further prospective studies are required to verify these findings.

Threatment Strategies for Recurrent Hepatocellular Carcinoma Patients: Ablation and its Combination Patterns

With the development of guidance technology and ablation equipment, ablative procedures have emerged as important loco-regional alternatives to surgical resection for recurrent hepatocellular carcinoma (rHCC) patients. Currently, ablation modalities used in clinical practice mainly include radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA), cryoablation (CRA), high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE). Accumulated comparative data of ablation versus surgical resection reveal noninferior responses and outcomes but superior adverse effects. Moreover, studies demonstrate that ablation may serve as an excellent procedure for rHCC given its exact minimal invasiveness and immune modulation. We focus on the current status of ablation in clinical practice for rHCC and discuss new research in the field, including ablation combined with these other modalities, such as targeted therapy and immunotherapy.

Radiological findings in non-surgical recurrent hepatocellular carcinoma: From locoregional treatments to immunotherapy

Since hepatocellular carcinoma (HCC) represents an important cause of mortality and morbidity all over the world. Currently, it is fundamental not only to achieve a curative treatment but also to manage in the best way any possible recurrence. Even if the latest update of the Barcelona Clinic Liver Cancer guidelines for HCC treatment has introduced new locoregional techniques and confirmed others as well-established clinical practices, there is still no consensus about the treatment of recurrent HCC (RHCC). Locoregional treatments and medical therapy represent two of the most widely accepted approaches for disease control, especially in the advanced stage of liver disease. Different medical treatments are now approved, and others are under investigation. On this basis, radiology plays a central role in the diagnosis of RHCC and the assessment of response to locoregional treatments and medical therapy for RHCC. This review summarized the actual clinical practice by underlining the importance of the radiological approach both in the diagnosis and treatment of RHCC.

Salvage locoregional therapies for recurrent hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death worldwide. Despite the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies, recurrence rates remain high. In contrast to first-line treatment for HCC, which relies on several factors, including clinical staging, tumor burden, and liver function, there is no consensus or general treatment recommendations for recurrent HCC (R-HCC). Locoregional therapies include a spectrum of minimally invasive liver-directed treatments which can be used as either curative or neoadjuvant therapy for HCC. Herein, we provide a comprehensive review of recent evidence using salvage loco-regional therapies for R-HCC after failed curative-intent.