Hepatitis B and hepatocellular carcinoma recurrence after living donor liver transplantation: The role of the Milan criteria

Construction and Validation of a Novel Butyrylation-Related Gene Signature Related to Prognosis, Clinical Implications, and Immune Microenvironment Characterization of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a common and highly lethal malignant tumor that poses a serious threat to human health. The post-transcriptional modification of proteins known as butyrylation has emerged as a critical factor in tumorigenesis, playing a pivotal role in the initiation and progression of cancer. This study aimed to develop a prognostic risk model for HCC using butyrylation-related genes (BRGs). Differentially expressed BRGs were identified from the LIHC-TCGA data sets, and a prognostic risk model was constructed using LASSO and multivariate regression analysis. The model's robustness was further confirmed in the GSE14520 cohort. The clinicopathological characteristics, immune features, enrichment pathways, and antitumor drug sensitivity of the BRG signature were also assessed. Additionally, a nomogram was created to improve the predictive accuracy of the model. A set of 16 BRGs, including MMP1, ACOT7, AGPAT5, FLAD1, PDSS1, HSPD1, FKBP1A, AKR1B10, HDAC1, HDAC2, MAPT, ACADS, ACAT1, ACSL6, PDE2A, and PON1, were identified. Kaplan-Meier survival analysis showed that patients in the high-risk group had worse overall survival (OS) and progression-free survival (PFS) compared with those in the low-risk group. Univariate and multivariate Cox regressions, along with LASSO analysis, consistently indicated that the BRG signature is an independent prognostic factor for HCC. Clinical line plots accurately predicted 1, 3, and 5 year survival with AUC values of 0.805, 0.729, and 0.710, respectively. Additionally, the distribution of immune cells varied between different risk groups, and the low-risk group showed more potential for immunotherapy and chemotherapy. This study provides a novel biological basis for prognostic prediction in HCC and offers insights into personalized treatment strategies, including candidate drug selection, for clinicians to guide therapeutic decisions.

Pathologic response translates to improved patient survival after locoregional treatment for hepatocellular carcinoma: the importance of minimally invasive microwave ablation

BACKGROUND

Hepatectomy or transplantation can serve as curative treatment for early-stage hepatocellular carcinoma (HCC). Unfortunately, as progression remains a reality, locoregional therapies (LRT) for curative or bridging intent have become common. Efficacy on viability, outcomes, and accuracy of imaging should be defined to guide treatment.

METHODS

Patients with HCC who underwent minimally invasive (MIS) microwave ablation (MWA), transarterial chemoembolization (TACE), or both (MIS-MWA-TACE) prior to hepatectomy or transplantation were identified. Tumor response and preoperative computed tomography (CT) accuracy were assessed and compared to pathology. Clinical and oncologic outcomes were compared between MIS-MWA, TACE, and MIS-MWA-TACE.

RESULTS

Ninety-one patients, with tumors from all stages of the Barcelona Clinic Liver Cancer (BCLC) staging, were identified who underwent LRT prior to resection or transplant. Fourteen patients underwent MIS-MWA, 46 underwent TACE, and 31 underwent both neoadjuvantly. TACE population was older; otherwise, there were no differences in demographics. Fifty-seven percent of MIS-MWA patients had no viable tumor on pathology whereas only 13% of TACE patients and 29% of MIS-MWA-TACE patients had complete destruction (p = 0.004). The amount of remaining viable tumor in the explant was also significantly different between groups (MIS-MWA: 17.2%, TACE: 48.7%, MIS-MWA-TACE: 18.6%; p ≤ 0.0001). Compared with TACE, the MIS-MWA and MIS-MWA-TACE groups had significantly improved overall survival (MIS-MWA: 99.94 months, TACE: 75.35 months, MIS-MWA-TACE: 140 months; p = 0.017). This survival remained significant with stratification by tumor size. CT accuracy was found to be 50% sensitive and 86% specific for MIS-MWA. For TACE, CT had an 82% sensitivity and 33% specificity and for MIS-MWA-TACE, there was a 42% sensitivity and 78% specificity.

CONCLUSION

The impact of locoregional treatments on tumor viability is distinct and superior with MIS-MWA alone and MIS-MWA-TACE offering significant advantage over TACE alone. The extent of this effect may be implicated in the improved overall survival.