Han Ah Lee, Sangheun Lee, Hae Lim Lee, Jeong Eun Song, Dong Hyeon Lee, Sojung Han, Ju Hyun Shim, Bo Hyun Kim, Jong Young Choi, Hyunchul Rhim, Do Young Kim
J Liver Cancer. 2023;23(2):362-376. Published online September 14, 2023
Background/Aim Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established.
Methods Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC.
Results Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05).
Conclusions Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.
Budd-Chiari syndrome (BCS) is defined by the obstruction of the hepatic venous outflow between the small hepatic veins and the junction of the inferior vena cava (IVC) with the right atrium. BCS with IVC obstruction occasionally progresses to hepatocellular carcinoma (HCC). Here, we report the case of a patient with HCC arising from a cirrhotic liver with BCS, in whom the hepatic portion of the IVC was obstructed, and who had a favorable outcome with a multidisciplinary approach and IVC balloon angioplasty.
Jeong Won Jang, Ji Min Kim, Hye Seon Kim, Jin Seoub Kim, Ji Won Han, Soon Kyu Lee, Heechul Nam, Pil Soo Sung, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon
J Liver Cancer. 2022;22(1):30-39. Published online March 21, 2022
Background/Aim Hepatocellular carcinoma (HCC) is associated with poor prognosis, largely due to late detection. Highly accurate biomarkers are urgently needed to detect early-stage HCC. Our study aims to explore the diagnostic performance of serum exosomal microRNA (miR)-720 in HCC.
Methods Exosomal miRNA was measured via quantitative real-time PCR. A correlation analysis of exosomal miR-720 and tumor or clinico-demographic data of patients with HCC was performed. The receiver operating characteristic (ROC) curve was used to assess the diagnostic capacity of serum exosomal miR-720 for HCC, in comparison with α-fetoprotein (AFP) and prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II).
Results MiR-720 was chosen as a potential HCC marker via miR microarray based on significant differential expression between tumor and non-tumor samples. Serum exosomal miR-720 was significantly upregulated in patients with HCC (n=114) versus other liver diseases (control, n=30), with a higher area under the ROC curve (AUC=0.931) than the other markers. Particularly, serum exosomal miR-720 showed superior performance in diagnosing small HCC (< 5 cm; AUC=0.930) compared with AFP (AUC=0.802) or PIVKA-II (AUC=0.718). Exosomal miR-720 levels showed marginal correlation with tumor size. The proportion of elevated miR-720 also increased with intrahepatic tumor stage progression. Unlike AFP or PIVKA-II showing a significant correlation with aminotransferase levels, the exosomal miR-720 level was not affected by aminotransferase levels.
Conclusions Serum exosomal miR-720 is an excellent biomarker for the diagnosis of HCC, with better performance than AFP or PIVKA-II. Its diagnostic utility is maintained even in small HCC and is unaffected by aminotransferase levels.
Background/Aim s: Lenvatinib was recently proven to be non-inferior to sorafenib in treating unresectable hepatocellular carcinoma (HCC) in a phase-3 randomized controlled trial. In this study, we investigated whether the response to lenvatinib was affected by tumor immunogenicity.
Methods Between May 2019 and April 2020, nine patients with intermediate-to-advanced HCC, who were treated with lenvatinib after liver biopsy, were enrolled. Immunohistochemical staining and multi-color flow cytometry were performed on specimens obtained from liver biopsy.
Results Among the nine patients enrolled, four showed objective responses (complete responses+partial responses). Immunohistochemical staining for CD3, CD68, and programmed cell death ligand 1 (PD-L1) demonstrated that patients with objective responses showed marked infiltration of T cells and PD-L1-expressing macrophages in intra-tumoral and peri-tumoral tissues compared to those without objective responses. A significant difference in the numbers of infiltrated T cells, both in the intra-tumoral (P<0.01) and peri-tumoral regions (P<0.05), were identified between responders and non-responders. Regarding the number of infiltrated macrophages, no significant difference was found between the responders and non-responders, although the number of PD-L1-expressing tumor-associated macrophages was significantly higher in responders than that in non-responders (P<0.05).
Conclusions Tumor immunogenicity, as indicated by T cell and PD-L1-positive macrophage infiltration, affects lenvatinib response in unresectable HCC.
Citations
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The efficacy and safety of sequential systemic therapy for the treatment of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) are not well established. This study describes a successful experience where sequential therapy with sorafenib followed by regorafenib was used to treat recurrent HCC in a 54-year old male LT recipient. After HCC recurred in both lungs 10 months after LT, sorafenib was administered with radiation therapy to treat pulmonary metastases. However, after 4 months of sorafenib treatment showed progressive pulmonary metastases, sequential regorafenib treatment was started. After 3 months (cycles) of regorafenib treatment, tumor response was partial, and after 6 months (cycles), disease status remained stable without signs of progression or drug-related serious adverse events. This case suggests that sequential systemic therapy is feasible in patient with recurrent HCC after LT.
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The majority of patients with HCC are diagnosed at advanced disease stages with vascular invasion, where curative approaches are often not feasible. Currently, sorafenib is the only available standard therapy for HCC with portal vein tumor thrombosis (PVTT). However, in many cases, sorafenib therapy fails to achieve satisfactory results in clinical practice. We present a case of advanced HCC with PVTT that was treated with hepatic arterial infusion chemotherapy (HAIC) followed by liver transplantation. Three cycles of HAIC treatment resulted in necrotic changes in most of the tumors, and PVTT was reduced to an extent at which liver transplantation was possible. Further studies are required to determine the treatment strategies for advanced HCC with PVTT that can improve prognosis.
Background/Aim s: Transarterial chemoembolization (TACE) is the standard locoregional
treatment in patients with unresectable hepatocellular carcinoma (HCC). Angiogenesis and
inflammation play important roles in tumor growth in HCC. In this study, we evaluated the
associations between the levels of growth factors and inflammatory markers and clinical
prognosis in patients with unresectable HCC treated with TACE. Methods The clinical outcomes of 58 HCC patients treated with TACE at the Catholic Medical
Centers from January, 2012 to February 2015 were evaluated. Baseline levels of the growth
factors vascular endothelial growth factor, fibroblast growth factor, platelet-derived growth
factor, and hepatocyte growth factor and the inflammatory cytokines interleukin (IL)-17 and
high sensitivity C-reactive protein (hs-CRP) were compared with the treatment outcomes. The
primary endpoint was time to progression (TTP); the secondary endpoint was overall survival
(OS). Results During the 20.8 months of follow-up, TTP was significantly delayed in patients with
low levels of hs-CRP (≤0.15) and IL-17 (≤0.94) and a maximal tumor diameter ≤5 cm (P =0.010,
P =0.015, and 0.048, respectively). Patients with HCC with low hs-CRP and IL-17 levels had
a longer survival than that of those with high hs-CRP levels and IL-17 (35.1 vs. 22.5 months,
P =0.000; 41 vs. 21.8 months, P =0.000, respectively). However, any baseline growth factors
were not significantly correlated with TTP and OS. Conclusions Elevated IL-17 and hs-CRP may be predictive of a poor outcome in patients
with HCC treated with TACE. A better understanding of this relationship will require further
investigation of the immune mechanisms underlying tumor progression.
Despite recent advances in the treatment of hepatocellular carcinoma (HCC), the prognosis
of patients with extrahepatic metastasis from HCC still remains dismal. The current study
presents a case of HCC that was metastatic to the pelvis and describes successful treatment
with multidisciplinary approach to the skeletal metastasis. The patient was a 67-year-old
male who presented with right pelvic pain 28 months following right hepatectomy for HCC.
Computed tomography and magnetic resonance imaging indicated a solitary bone metastasis
without intrahepatic recurrence. Complete response was achieved with multidisciplinary
management including sorafenib, transarterial embolization, surgery to remove the
metastatic mass and radiotherapy after surgery. A post-operative follow-up 15 months later
found that the patient remained in good health with maintained complete response. This case
suggests that a multidisciplinary approach can achieve long-term cancer-free survival and
prolonged life expectancy beyond palliative care for patients with solitary bone metastasis
after curative surgery for HCC.
Bilobar multifocal hepatocellular carcinomas (HCCs) can be treated with transarterial radioembolization in a sequential lobar, or whole liver manner. However, radioembolization could result in a risk of radiation-induced liver toxicity in patients with reduced functional reserve. Here we describe a case with bilobar HCCs successfully treated with a combination therapy using radioembolization and transarterial chemoembolization with drug-eluting beads without significant side effects. A 72-year-old female with liver cirrhosis was diagnosed of hepatocellular carcinoma with bilobar involvement. The main mass in the left lobe was treated with radioembolization while the other lesion in the right lobe was treated with transarterial chemoembolization using drug-eluting beads, and the patient was tolerable. A combination of radioembolization and selective transarterial chemoem- bolization may be considered for an alternative option in patients with bilobar multifocal HCCs with decreased liver function.
Hepatocellular carcinoma (HCC) is one of the most important cause of cancer death in South Korea. Approximately two thirds
of the HCC patients are diagnosed in the unresectable stage. Conventional transarterial chemoembolization (TACE) showed
survival benefit in the unresectable HCC patients, but it had some limitations, such as low response rate and systemic toxicity.
Drug eluting bead has been reported low systemic toxicity and higher tumor necrosis rate. We report a case which showed
response to TACE with DC bead in patient that showed no response to conventional TACE.
Hepatocellular carcinoma (HCC) in childhood is rare but is the second most common malignant liver neoplasm after
hepatoblastoma in children. Surgical resectability is the foundation of curative therapy but only one third of newly diagnosed
HCCs are resectable, and unresectable HCC remains largely unresponsive to systemic chemotherapy. In all reported series of
HCC in children, therapeutic results are poor with overall survival less than 30%. Systemic chemotherapy is only partially
effective but if preoperative downstaging can be achieved, it would result in a higher survival rate. There are scarce data
regarding local ablative treatments such as transarterial chemoembolization (TACE) and therefore survival benefits are still
unclear. TACE may be considered as a therapeutic alternative in cases of unresectable tumors after systemic chemotherapy or in
unresectable, non-metastatic HCCs. The use of orthotopic liver transplantation in childhood HCC remains controversial.
Radioembolization is a mode of treatment that aims to selectively target radiation to all liver tumors using yttrium-90
microspheres while limiting the dose to normal liver parenchyma. It may be considered as another treatment option in childhood
HCC with the purpose of preoperative downstaging but further studies are required to determine the treatment benefits and safety
of radioembolization treatment.
Percutaneous transhepatic obliteration of gastroesophageal varices is one of the effective emergency procedure when
endoscopic therapy is not indicated or has been failed. One of the major complications of this procedure is portal thrombosis. A
53-year-old male with hepatitis B virus infection was diagnosed of infiltrative hepatocellular carcinoma with right portal vein
thrombosis. On the next day after being hospitalization, the patient developed variceal bleeding. With medical management,
endoscopic therapy was initially attempted, however, it ended in failure. Emergency percutaneous transhepatic obliteration of
bleeding gastroesophageal varices was considered as a next option. Bleeding from gastroesophageal varices was stopped after
percutaneous obliateration, however, portal thrombosis was extended to splenic vein or superior mesenteric veins.
Hepatocellular carcinoma (HCC) is the third most common malignancy in Korea where chronic hepatitis B virus is prevalent.
More than 60-70% of HCC cases are diagnosed at an advanced stage that are not eligible for curative therapy such as surgical
resection, liver transplantation, radiofrequency ablation, and percutaneous ethanol injection. According to Barcellona Clinic
Liver Cancer (BCLC) staging and treatment, standard treatment of advanced HCC is sorafenib. And there are some reports that
hepatic arterial infusion chemotherapy (HAIC) could be a beneficial therapeutic option for patients with advanced HCC. We
report a case of advanced HCC with portal vein thrombosis that received liver transplantation after combination treatment of
HAIC and sorafenib.
Hepatocellular carcinoma (HCC) is the fourth most common cancer in Korea and a common cause of cancer death.
Transcatheter arterial chemoembolization (TACE) is used as palliative therapy for patients with inoperable HCC. TACE is an
effective treatments for inoperable HCC, but variable complications due to using embolic agents can occur after TACE.
Complications due to embolic agents include pulmonary lipiodol embolism, splenic infarction, cerebral lipiodol infarction, and
spinal cord injury. This is a rare case of spinal cord injury after a sixth TACE via right T9 intercostal artery.
Hepatic arterial infusion chemotherapy (HAIC) is performed in patients with advanced hepatocellular carcinoma (HCC) in
which locoregional therapeutic methods such as transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI)
or radiofrequency ablation (RFA) could not be the best choice. Sorafenib, the only approved systemic chemotherapeutic agent
for HCC, improves survival rate, but is associated with a low tumor response rate. Thus combining these therapeutic modalities to
treat HCC in advanced stage may help downstaging and leading to better treatment results without taking risk for hepatic failure.
Here we report a case treated to a complete remission by combining HAIC, PEI and sorafenib.