Abstract No. 30: Superselective transhepatic arterial chemoembolization for hepatocellular carcinoma in high risk patients as a bridge towards liver transplantation

Abstract Background: Although liver transplantation (LT) is one of the most effective treatments for the patients with hepatocellular carcinoma (HCC), the high-risk patients suffer from a high ratio of tumor recurrence after LT. So this study was designed to evaluate the role of adjuvant lenvatinib in preventing recurrence of high-risk LT recipients with HBV-related HCC.Methods: We retrospectively analyzed 23 high-risk patients consisting of lenvatinib group (n = 14) and control group (n = 9) with HBV-related HCC who underwent LT in our center. Disease-free survival (DFS) and HCC recurrence of the two groups were compared. The adverse events (AEs) and drug tolerance of lenvatinib were evaluated.Results: The median DFS in lenvatinib group was 291 (95%CI 204–516) days, significantly longer than 182 (95%CI 56–537) days in control group (P = 0.04). Three patients in lenvatinib group (21.4%) and 5 patients in control group (55.6%) had short-term HCC recurrence (P = 0.11). All patients in lenvatinib group could tolerate oral lenvatinib for at least 3 cycles except 6 cases (42.9%) of dose reduction and 1 case of interruption (14.3%). Thirteen patients (92.9%) taking lenvatinib experienced AEs. The most common AEs were hypertension (64.3%) and proteinuria (42.9%), and the most serious AEs were CTCAE Grade 3 for 4 cases (28.5%). Additionally, no influence of lenvatinib on the dosage and blood concentration of FK506 was observed.Conclusion: Adjuvant lenvatinib had a potential benefit on prolonging the DFS and reducing the recurrence of high-risk HBV-related HCC patients following liver transplantation with an acceptable drug safety and patient tolerance.

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A Novel Epigenetic Machine Learning Model to Define Risk of Progression for Hepatocellular Carcinoma Patients

International Journal of Molecular Sciences ◽

10.3390/ijms22031075 ◽

2021 ◽

Vol 22 (3) ◽

pp. 1075

Author(s):

Luca Bedon ◽

Michele Dal Bo ◽

Monica Mossenta ◽

Davide Busato ◽

Giuseppe Toffoli ◽

...

Keyword(s):

Machine Learning ◽

Hepatocellular Carcinoma ◽

High Risk ◽

Progression Free Survival ◽

Low Risk ◽

Functional Enrichment ◽

Free Survival ◽

High Risk Patients ◽

Risk Of Progression ◽

Risk Patients

Although extensive advancements have been made in treatment against hepatocellular carcinoma (HCC), the prognosis of HCC patients remains unsatisfied. It is now clearly established that extensive epigenetic changes act as a driver in human tumors. This study exploits HCC epigenetic deregulation to define a novel prognostic model for monitoring the progression of HCC. We analyzed the genome-wide DNA methylation profile of 374 primary tumor specimens using the Illumina 450 K array data from The Cancer Genome Atlas. We initially used a novel combination of Machine Learning algorithms (Recursive Features Selection, Boruta) to capture early tumor progression features. The subsets of probes obtained were used to train and validate Random Forest models to predict a Progression Free Survival greater or less than 6 months. The model based on 34 epigenetic probes showed the best performance, scoring 0.80 accuracy and 0.51 Matthews Correlation Coefficient on testset. Then, we generated and validated a progression signature based on 4 methylation probes capable of stratifying HCC patients at high and low risk of progression. Survival analysis showed that high risk patients are characterized by a poorer progression free survival compared to low risk patients. Moreover, decision curve analysis confirmed the strength of this predictive tool over conventional clinical parameters. Functional enrichment analysis highlighted that high risk patients differentiated themselves by the upregulation of proliferative pathways. Ultimately, we propose the oncogenic MCM2 gene as a methylation-driven gene of which the representative epigenetic markers could serve both as predictive and prognostic markers. Briefly, our work provides several potential HCC progression epigenetic biomarkers as well as a new signature that may enhance patients surveillance and advances in personalized treatment.

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Prevention of hepatocellular carcinoma and surveillance of high risk patients

Hepatology Forum ◽

10.14744/hf.2021.2021.0033 ◽

2021 ◽

Author(s):

Ali Canbay

Keyword(s):

Hepatocellular Carcinoma ◽

High Risk ◽

High Risk Patients ◽

Risk Patients

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Cyclosporin Toxicity and Liver Transplantation in High Risk Patients

Drugs and the Liver: High Risk Patients and Transplantation - Medical Science Symposia Series ◽

10.1007/978-94-011-1994-8_5 ◽

1993 ◽

pp. 31-32

Author(s):

D. Galmarini ◽

L. R. Fassati ◽

G. Rossi ◽

B. Gridelli ◽

L. Caccamo ◽

...

Keyword(s):

Liver Transplantation ◽

High Risk ◽

High Risk Patients ◽

Risk Patients

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Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System in Diagnosing Hepatocellular Carcinoma: Diagnostic Performance and Interobserver Agreement

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1168-6321 ◽

2020 ◽

Author(s):

Hang Zhou ◽

Chao Zhang ◽

Linyao Du ◽

Jiapeng Jiang ◽

Qing Zhao ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

High Risk ◽

Diagnostic Performance ◽

Data System ◽

Liver Imaging ◽

Contrast Enhanced Ultrasound ◽

High Risk Patients ◽

Contrast Enhanced ◽

Sensitivity Range ◽

Risk Patients

Abstract Objectives To determine the diagnostic performance and inter-reader agreement of the contrast-enhanced ultrasound liver imaging reporting and data system (CEUS-LI-RADS) for diagnosing hepatocellular carcinoma (HCC) in high-risk patients. Methods In this prospective study, CEUS-LI-RADS categories (LR-5 for predicting HCC) were assigned by six blinded readers and compared to the definitive HCC diagnosis in patients with liver cirrhosis per the 2017 China Liver Cancer Guidelines (CLCG). CEUS features were recorded in 96 patients with 96 histology-proven lesions. The diagnostic performance of LR-5 was described by the sensitivity, specificity and accuracy. Multi-reader agreement was assessed by using intraclass correlation coefficients (ICC). Results In cirrhotic patients, the specificity of LR-5 (range: 92.7–100.0 %) was statistically higher than that of CLCG for each reader (range: 28.6–64.3 %). However, the sensitivity (range: 38.6–63.6 %) and accuracy (range: 53.4–70.7 %) were statistically lower in CEUS-LIRADS than in CLCG (sensitivity range: 88.6–100.0 %; accuracy range: 77.6–86.2 %). Only fair to moderate inter-reader agreement was achieved for the CEUS-LI-RADS category (ICC = 0.595) and washout appearance (ICC range: 0.338 to 0.555). Neither nodule-in-nodule nor mosaic architecture was observed more often in HCC (all P > 0.05), with poor inter-reader consistency for both (both ICC < 0.20). Conclusion CEUS-LI-RADS category 5 has a high specificity but a low accuracy for identifying HCC in high-risk patients. Inter-reader agreement is not satisfactory concerning CEUS-LIRADS category and washout appearance. Moreover, the clinical value of ancillary features favoring HCC is quite limited.

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