Inflammation-related prognostic markers in resected hepatocellular carcinoma

Preoperative blood tests provide diagnostic and prognostic information about patients with hepatocellular carcinoma

INTRODUCTION

Our aim was to assess parameters derived from preoperative blood tests as diagnostic or prognostic markers in patients with operable hepatocellular carcinoma (HCC).

METHODS

We included 210 patients who underwent liver resection as the first treatment for suspected hepatocellular adenoma (HCA) or HCC (January 2010-December 2022). Parameters originated from preoperative complete blood count and biochemical blood tests were examined for associations with clinicopathological parameters and survival.

RESULTS

There were 31 cases of HCA and 179 cases of HCC. Fibrosis-4 index (FIB-4)≥0.77 provided the best diagnostic accuracy for differentiating between HCA and HCC [area under the curve: 0.914, P  < 0.001, sensitivity: 93.8%, specificity: 82.8%, positive predictive value (PPV): 96.9%, negative predictive value (NPV): 69.9%]. Patients with T2-T4 tumours had higher levels of aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT) ( P  < 0.001), liver function tests index ( P  = 0.005), platelets-liver function tests index (PLFTI) ( P  = 0.011), and α-fetoprotein (AFP) ( P  < 0.001), but the diagnostic accuracy was mediocre. Patients with moderately or poorly differentiated tumours had higher levels of FIB-4 ( P  = 0.023), and AFP ( P  = 0.001), providing high PPV (89.4 and 95.1%, respectively). Albumin to alkaline phosphatase ratio (ALB/ALP)>0.508 [hazard ratio (HR): 0.501, P  = 0.009], FIB-4>1.41 (HR: 2.272, P  = 0.007), PLFTI>0.087 (HR: 1.849, P  = 0.016), and AFP>3.1 (HR: 3.066, P  = 0.006) provided statistically significant results in relation to disease-free survival, and ALB/ALP>0.389 (HR: 0.505, P  = 0.036) provided statistically significant results in relation to overall survival.

CONCLUSION

Preoperative blood tests provide useful information in treatment-naive surgical candidates with suspected HCC regarding distinguishing from HCA, tumour differentiation, and risk of disease recurrence and death.

Impact of bile leak on the prognosis of patients with hepatocellular carcinoma who have undergone liver resection

PURPOSE

The impact of postoperative bile leak on the prognosis of patients with hepatocellular carcinoma who underwent liver resection is controversial. This study aimed to investigate the prognostic impact of bile leak for patients with hepatocellular carcinoma who underwent liver resection.

METHODS

Patients with hepatocellular carcinoma who underwent liver resection between 2009 and 2019 at Kobe University Hospital and Hyogo Cancer Center were included. After propensity score matching between the bile leak and no bile leak groups, differences in 5-year recurrence-free and overall survival rates were evaluated using the Kaplan-Meier method.

RESULTS

A total of 781 patients, including 43 with postoperative bile leak, were analyzed. In the matched cohort, 40 patients were included in each group. The 5-year recurrence-free survival rates after liver resection were 35% and 32% for the bile leak and no bile leak groups, respectively (P = 0.857). The 5-year overall survival rates were 44% and 54% for the bile leak and no bile leak groups, respectively (P = 0.216).

CONCLUSION

Overall, bile leak may not have a profound negative impact on the prognosis of patients with hepatocellular carcinoma who have undergone liver resection.

Constructing a prognostic model for hepatocellular carcinoma based on bioinformatics analysis of inflammation-related genes

Background

This study aims to screen inflammation-related genes closely associated with the prognosis of hepatocellular carcinoma (HCC) to accurately forecast the prognosis of HCC patients.

Methods

Gene expression matrices and clinical information for liver cancer samples were obtained from the Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC). An intersection of differentially expressed genes of HCC and normal and GeneCards yielded inflammation-related genes associated with HCC. Cox regression and the minor absolute shrinkage and selection operator (LASSO) regression analysis to filter genes associated with HCC prognosis. The prognostic value of the model was confirmed by drawing Kaplan-Meier and ROC curves. Select differentially expressed genes between the high-risk and low-risk groups and perform GO and KEGG pathways analyses. CIBERSORT analysis was conducted to assess associations of risk models with immune cells and verified using real-time qPCR.

Results

A total of six hub genes (C3, CTNNB1, CYBC1, DNASE1L3, IRAK1, and SERPINE1) were selected using multivariate Cox regression to construct a prognostic model. The validation evaluation of the prognostic model showed that it has an excellent ability to predict prognosis. A line plot was drawn to indicate the HCC patients' survival, and the calibration curve revealed satisfactory predictability. Among the six hub genes, C3 and DNASE1L3 are relatively low expressed in HCCLM3 and 97H liver cancer cell lines, while CTNNB1, CYBC1, IRAK1, and SERPINE1 are relatively overexpressed in liver cancer cell lines.

Conclusion

One new inflammatory factor-associated prognostic model was constructed in this study. The risk score can be an independent predictor for judging the prognosis of HCC patients' survival.

The prognostic nutritional index as a predictor of efficacy and early recurrence for adjuvant transarterial chemoembolization in hepatocellular carcinoma

BACKGROUND AND AIMS

Postoperative adjuvant transcatheter arterial chemoembolization (TACE) can prevent recurrence of hepatocellular carcinoma (HCC) in certain patients. This study aimed to identify the potential beneficiaries of adjuvant TACE.

METHODS

477 patients who underwent curative resection for HCC were enrolled in this retrospectively cohort study. The trajectory of the prognostic nutritional index (PNI) during the perioperative period was fitted using a latent-class growth mixed model. The association between adjuvant TACE and recurrence-free survival in each PNI group was assessed using the Kaplan-Meier curve. Furthermore, Cox regression analysis was conducted to identify the risk factors for early recurrence after adjuvant TACE and develop a nomogram model.

RESULTS

Patients in the PNI group III had a high risk of recurrence and could benefit from adjuvant TACE (P = 0.009). The prognostic prediction model for adjuvant TACE (PAT) incorporated eight variables (PNI, tumor size, tumor number, microvascular invasion, sex, aspartate aminotransferase, gamma-glutamyl transferase, and degree of differentiation). Patients with PAT score >330 and 235-330 had significantly higher recurrence rates than those with PAT score <235 (P < 0.001).

CONCLUSION

PNI may help guide the selection of adjuvant TACE beneficiaries. PAT demonstrated a high accuracy in predicting the prognosis of patients who underwent postoperative TACE.

Efficacy and safety of targeted therapy plus immunotherapy combined with hepatic artery infusion chemotherapy (FOLFOX) for unresectable hepatocarcinoma

BACKGROUND

The advent of cutting-edge systemic therapies has driven advances in the treatment of hepatocellular carcinoma (HCC), and therapeutic strategies with multiple modes of delivery have been shown to be more efficacious than monotherapy. However, the mechanisms underlying this innovative treatment modality have not been elucidated.

AIM

To evaluate the clinical efficacy of targeted therapy plus immunotherapy combined with hepatic arterial infusion chemotherapy (HAIC) of FOLFOX in patients with unresectable HCC.

METHODS

We enrolled 53 patients with unresectable HCC who received a combination of targeted therapy, immunotherapy, and HAIC of FOLFOX between December 2020 and June 2021 and assessed the efficacy and safety of the treatment regimen.

RESULTS

The objective response rate was 60.4% (32/53), complete response was 24.5% (13/53), partial response was 35.9% (19/53), and stable disease was 39.6% (21/53). The median duration of response and median progression-free survival were 9.1 and 13.9 months, respectively. The surgical conversion rate was 34.0% (18/53), and 1-year overall survival was 83.0% without critical complicating diseases or adverse events (AEs).

CONCLUSION

The regimen of HAIC of FOLFOX, targeted therapy, and immunotherapy was curative for patients with unresectable HCC, with no serious AEs and a high rate of surgical conversion.

Prognostic impact of preoperative nutritional and immune inflammatory parameters on liver cancer

The immune response to tissue damage or infection involves inflammation, a multifaceted biological process distinguished by immune cell activation, mediator secretion, and immune cell recruitment to the site of injury. Several blood-based immune-inflammatory biomarkers with prognostic significance in malignancies have been identified. In this issue of the World Journal of Gastrointestinal Surgery, they examined the prognosis of liver cancer radical resection in relation to preoperative systemic immune-inflammation and nutritional risk indices. Comparing older and younger individuals often reveals compromised nutritional and immunological statuses in the former. Therefore, performing preoperative evaluations of the nutritional status and immunity in geriatric patients is critical. In addition to being a primary treatment modality, radical resection is associated with a significant mortality rate following surgery. Insufficient dietary consumption and an elevated metabolic rate within tumor cells contribute to the increased probability of malnutrition associated with the ailment, consequently leading to a substantial deterioration in prognosis. Recent studies, reinforce the importance of nutritional and immune-inflammatory biomarkers. Prior to surgical intervention, geriatric nutritional risk and systemic immune-inflammatory indices should be prioritized, particularly in older patients with malignant diseases.