• Adjuvant therapy
• Cirrhosis Guideline
• GRADE
• Hepatocellular carcinoma
• Immunotherapy
• Liver cancer
• Liver transplant
• Multidisciplinary board
• PICO
• Recurrence
• Resection
• Surgery
• Survival
• Transplant benefit

• Humans
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/complications
• Gastroenterology
• Radiology, Interventional
• Gastroenterologists
• Liver Neoplasms/surgery
• Liver Neoplasms/complications
• Hepatitis/complications
• Medical Oncology
• Organ Transplantation
• Italy

• Hepatocellular carcinoma
• Locoregional therapy
• Systemic therapy

• Humans
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/pathology
• Liver Neoplasms/therapy
• Liver Neoplasms/pathology
• Chemoembolization, Therapeutic

• CT
• Deep learning
• Hepatocellular carcinoma
• Radiomics
• Transarterial chemoembolization

• Humans
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/pathology
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/therapy
• Liver Neoplasms/pathology
• Retrospective Studies
• Chemoembolization, Therapeutic/methods
• Prognosis
• Tomography, X-Ray Computed/methods

• barcelona clinic liver cancer staging
• hepatocellular carcinoma
• intermediate-stage b
• liver resection
• transarterial chemoembolization

• Humans
• Carcinoma, Hepatocellular/surgery
• Liver Neoplasms/surgery
• Vascular Surgical Procedures
• Chemoembolization, Therapeutic

• TACE inappropriate
• TACE refractory
• atezolizumab plus bevacizumab
• conversion therapy
• durvalumab plus tremelimumab
• hepatocellular carcinoma
• immune checkpoint inhibitor
• intermediate-stage hepatocellular carcinoma
• molecular-targeted therapy
• transarterial chemoembolization
• tyrosine kinase inhibitor
• up-to-7 criteria

• bevacizumab
• hepatocellular carcinoma
• microspheres
• transarterial chemoembolization

The purpose of this study was to investigate outcomes of transarterial chemoembolization (TACE) in treating hepatocellular carcinoma (HCC) comparing the different approaches used in Germany and Japan.

This binational IRB-approved retrospective dual-center study included a total of 94 HCC patients subdivided in a German and a Japanese cohort. For each patient, liver and tumor volumetry was performed using computed tomography (CT) and magnetic resonance imaging (MRI). Furthermore, a comprehensive risk profile, including body constitution and liver and kidney function was established. Primary endpoints were progression-free and overall survival (PFS/OS).

PFS in the German cohort was 168 vs 224d in the Japanese cohort (p=0.640). When subdivided by BCLC stage, no significant differences were reported (p=0.160–0.429). OS was significantly longer in the Japanese cohort with 856 vs. 303d (p<0.001). OS for BCLC A was significantly longer in the Japanese cohort (1960 vs. 428d; p<0.001), while survival rates did not differ significantly in BCLC B (785 vs 330d; p=0.067) and C-stages (208 vs 302d; p=0.186). Older age (p=0.034), poorer liver/kidney function (p=0.025-0-035), and a higher liver/tumor ratio (p<0.001) were found to correlate with shorter survival. ECOG scores were significantly higher in the German cohort (p=0.002).

While OS is longer in TACE-treated patients in the Japanese cohort compared to the German cohort, the two approaches seem to be equally effective as PFS does not differ significantly. The different survival rates may be caused by the different clinical performance status of the selected collectives. In very early and early stage HCC, TACE in Japan seems to be an effective treatment option while in Germany for patients in those stages TACE remains a second-line option for patients not available for surgery or ablation.

Transarterial chemoembolization (TACE) has been considered the standard treatment for intermediate-stage hepatocellular carcinoma (HCC). However, intermediate‐stage HCC is highly heterogeneous with a broad population with varying tumour burdens, liver function. This suggests that TACE monotherapy treatment might not be suitable for all patients with intermediate‐stage HCC. The administration of tyrosine kinase inhibitors (TKIs) has become an important treatment option for improving the prognosis of patients with advanced HCC. Over the years, several trials have been conducted to explore the effects of TACE combined with TKIs for intermediate-stage HCC. However, the clinical efficacy is still controversial, and its potential clinical utility needs to be confirmed. This review will focus on the recent progress of TACE combined TKIs for intermediate-stage HCC.

• combination therapy
• hepatocellular carcinoma
• intermediate stage
• transarterial chemoembolization
• tyrosine kinase inhibitors

Thermal rheology (TR) fluid, which comprises polyethylene (PE) particles, their dispersant, and solvent, is a material that increases in viscosity to various degrees depending on the type and ratio of these constituents when its temperature rises. The viscosity of type 1 (TRF-1) increases more than that of type 2 (TRF-2) near rabbit body temperature. This preliminary animal study aimed to determine the basic characteristics and embolic effect of TR fluid by comparing TRF-1 and TRF-2.

Twenty-four Japanese white rabbits underwent unilateral renal artery embolization using TRF-1 or TRF-2 and follow-up angiography at 7 or 28 days (4 subgroups, n = 6 each). Subsequently, the rabbits were euthanized, and the embolized kidneys were removed for pathological examination. The primary and final embolization rates were defined as the ratio of renal artery area not visible immediately after embolization and follow-up angiography, respectively, to visualized renal artery area before embolization. The final embolization rate and maximum vessel diameter filled with PE particles were compared between materials. Moreover, the embolic effect was determined to be persistent when a two-sided 95% confidence interval (CI) for the difference in means between the embolization rates was < 5%.

The final embolization rate was significantly higher for the TRF-1 than for the TRF-2 at both 7 (mean 80.7% [SD 18.7] vs. 28.4% [19.9], p = 0.001) and 28 days (94.0% [3.5] vs. 37.8% [15.5], p < 0.001). The maximum occluded vessel diameter was significantly larger for TRF-1 than for TRF-2 (870 µm [417] vs. 270 µm [163], p < 0.001). The embolic effect of TRF-1 was persistent until 28 days (difference between rates − 3.3 [95% CI − 10.0–3.4]).

The embolic effect of TRF-1 was more persistent than that of TRF-2, and the persistency depended on the type and ratio of TR fluid constituents.

• Animal study
• Intravascular embolic material
• Thermal rheology fluid
• Transarterial embolization

Technological developments have led to an increased usage of external-body radiotherapy (RT) for the treatment of hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) may be required later in patients treated with RT because of the high recurrence rate and multinodular presentation of HCC. However, despite the risk of liver function impairment, the cumulative liver damage correlated with TACE following a hepatic RT has not been adequately assessed.

To evaluate the feasibility of TACE following RT for HCC.

Sixty-seven patients with HCC who underwent TACE after RT were retrospectively evaluated between 2012 and 2018. We assessed increases in Child–Turcotte–Pugh (CTP) by ≥2 points at 1 month, the incidence of major complications, survival duration, and short-term mortality within 6 months after TACE. Furthermore, we evaluated the predictive factors for liver function impairment and short-term mortality.

Eight patients experienced a CTP increase ≥2 points at 1 month. There were no cases of liver abscesses or bilomas. Nine patients died within 6 months following TACE. The mean liver dose (MLD) was a significant predictor of liver function impairment at 1 month (p = 0.042). Low liver functional reserve, distant metastasis (p = 0.037), MLD (p = 0.046), TACE type (p = 0.025), and TACE within 3 months following RT (p = 0.007) were significant predictors of short-term mortality.

Despite the feasibility of TACE following RT, clinicians should pay attention to impaired pretreatment liver function, following high dose RT, and the short duration between RT and TACE.

• Hepatocellular carcinoma
• chemoembolization
• liver dysfunction
• radiation therapy

• Down-staging
• Drug-eluting bead transarterial chemoembolization
• Hepatocellular carcinoma
• Survival profiles
• Treatment response

• BCLC staging
• hepatocellular carcinoma
• intermediate stage
• locoregional therapy
• transarterial chemoembolization

Patients with an intermediate stage of hepatocellular carcinoma (HCC) represent a highly heterogeneous population; therefore, many models have been proposed to predict the survival of these patients. The aim of this study was to evaluate the prognostic performance of a novel subclassification for tumors classified as Barcelona Clinic Liver Cancer (BCLC) stage B using the Model to Estimate Survival in Ambulatory HCC patients (MESIAH).

This analysis was based on 377 patients with HCC treated at Seoul National University Hospital (training cohort) and 189 patients at the Soonchunhyang University Bucheon Hospital (validation cohort). Four subclassification systems were tested: MESIAH; original BCLC B subclassification (B1, B2, B3, and B4); modified model A (B1, B2, and B3+B4); and modified model B (B1, B2+B3, and B4).

Median survival progressively decreased from stage B1 through stages B2 to B3 according to the new MESIAH subclassification (p<0.001). Moreover, significantly different survival among contiguous stages was observed. In the multivariable Cox regression, the MESIAH subclassification was an independent predictor of overall survival (p<0.001). In terms of discrimination and calibration, MESIAH performed better than the original BCLC B subclassification, modified model A and modified model B.

The MESIAH model would be an effective tool for stratifying heterogeneous BCLC stage B cancer, and the ability of this model to predict survival is better than that of the other previously proposed models.

• Carcinoma
• Classification
• Survival
• hepatocellular

In 2012, the Barcelona Clinic Liver Cancer (BCLC) system designated a single large hepatocellular carcinoma (SLHCC) (>5 cm) as BCLC stage A rather than stage B. However, a recent study from western countries reported that prognosis following liver resection (LR) among patients with SLHCC was similar to that among patients with BCLC stage B. We aim to evaluate the prognosis following LR among patients with SLHCC from an Asian high-volume liver surgery center.

Patients who underwent curative-intent LR for histologically proven HCC between 2011 and 2017 were enrolled using an HCC registry database. Overall survival (OS) among patients with BCLC stages 0, A, and B was examined. Patients with a SLHCC were classified as BCLC stage A1.

Among 543 patients, 89 (16.4%) were BCLC stage 0, 289 (53.2%) were BCLC stage A, 92 (16.9%) were BCLC stage A1, and 73 (13.4%) were BCLC stage B. The median follow-up was 38 months. The five-year OS rates among patients with BCLC stages 0, A, A1, and B were 83.5%, 83.7%, 77.4%, and 55.4%, respectively (p<0.001). No difference in OS was noted for patients with BCLC stage A versus A1 (p = 0.11), even after adjusting for competing factors (hazard ratio = 0.97, 95% confidence interval = 0.53–1.79; p = 0.93).

Prognosis following LR among patients with SLHCC was similar to that among patients with BCLC stage A. The prognosis for SLHCC should thus be considered comparable to that for BCLC stage A.

• Aged
• Ambulatory Care Facilities/statistics & numerical data
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Female
• Humans
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Retrospective Studies
• Survival Analysis
• Tumor Burden

• Kaohsiung Chang Gung Memorial Hospital

• Carcinoma, hepatocellular
• Chemoembolization, therapeutic
• Prognosis

Many advances have been made in the imaging diagnosis and in the histopathological evaluation of HCC. However, the classic imaging and histopathological features of HCC are still inadequate to define patient’s prognosis. We aimed to find the link between new proposed morphovascular patterns of hepatocellular carcinoma (HCC) and magnetic resonance imaging (MRI) features to identify pre-operatory markers of biologically aggressive HCC. Thirty-nine liver nodules in 22 patients were consecutively identified. Histopathological analysis and immunohistochemistry for CD34 and Nestin were performed to identify the four different HCC morphovascular patterns. MRI was performed using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid. Three out of four morphovascular HCC patterns showed peculiar MRI features: in particular Pattern D (solid aggressive HCCs with CD34+/Nestin+ new-formed arteries) were isointense on T1-WI in 83% of cases and hyperintense on T2-WI in 50%. Five histologically-diagnosed HCC were diagnosed as non-malignant nodules on MRI due to their early vascularization and low aggressiveness (Pattern A). The comparison between histology and MRI confirms that a subclassification of HCC is possible in a pre-operatory setting. MRI seems to reinforce once more the identity of the different morphovascular HCC patterns and the possibility to pre-operatively identify HCCs with features of biological aggressiveness.

• conventional transarterial chemoembolization
• huge hepatocellular carcinoma
• prognosis

Ultraselective conventional transarterial chemoembolization (cTACE), defined as cTACE at the most distal portion of the subsubsegmental hepatic artery, is mainly performed for hepatocellular carcinoma (HCC) ≤5 cm. Distal advancement of a microcatheter enables injection of a larger volume of iodized oil into the portal vein in the limited area under non-physiological hemodynamics. As a result, the reversed portal flow into the tumor through the drainage route of the tumor that occurs when the hepatic artery is embolized is temporarily blocked. By adding gelatin sponge slurry embolization, both the hepatic artery and portal vein are embolized and not only complete necrosis of can be achieved. Ultraselective cTACE can cure small HCCs including less hypervascular tumor portions and replace surgical resection and radiofrequency ablation in selected patients.

• Chemoembolization, Therapeutic
• Conebeam computed tomography
• Gelatin sponge, Absorbable
• Hepatocellular carcinoma
• Iodized oil

• Advanced-stage hepatocellular carcinoma
• Intermediate-stage hepatocellular carcinoma
• Liver neoplasms
• Portal vein thrombosis
• Subclassifications of Barcelona Clinic Liver Cancer stages B and C

Conditional survival estimates (CSE) can provide additional useful prognostic information on the period of survival after diagnosis, which helps in counseling patients with cancer on their individual prognoses. This study aimed to analyze conditional survival (CS) for hepatocellular carcinoma (HCC) using a Korean national registry.

Patients with HCC, registered in the Korean cancer registry database, were retrospectively reviewed. Overall survival (OS) was calculated using the Kaplan-Meier method. The 1-year CS at X year or month after diagnosis were calculated as CS₁=OS_(X+1)/OS_(X). CS calculations were performed in each Barcelona Clinic Liver Cancer stage, after which patients at stage 0, A, and B underwent subgroup analysis using initial treatment methods.

A total of 4,063 patients diagnosed with HCC from January 2008 to December 2010, and 2,721 who were diagnosed from January 2011 to December 2012, were separately reviewed. In 2008-2010, the 1-year CS of 1, 2, 3, 4, and 5-year survivors was 82.9%, 85.1%, 88.3%, 88.0%, and 88.6%, respectively. Patients demonstrated an increase in CSE over time in subgroup analysis, especially in the advanced stages. In 2011-2012, the 1-year CS of 6, 12, 18, 24, 30, and 36 months was 81.5%, 83.8%, 85.3%, 85.5%, 86.5%, and 88.8%, respectively. The subgroup analysis showed the same tendency towards increased CSE in the advanced stages.

Overall, the CS improved with each additional year after diagnosis in both groups. CSE may therefore provide a more accurate prognosis and hopeful message to patients who are surviving with or after treatment.

• Carcinoma
• Conditional survival estimate
• Demographic
• Hepatocellular
• Prognosis
• Republic of Korea
• Survival

• adjuvant treatment
• hepatocellular carcinoma

• chaperone-mediated autophagy
• chemoresistance
• exosomes
• hepatitis B virus-associated liver cancer

• BCLC-B subclassification
• Hepatocellular carcinoma
• Transarterial chemoembolization
• Transarterial radioembolization

Management of multinodular hepatocellular carcinoma (HCC) in the intermediate Barcelona Clinic Liver Cancer (BCLC)-B stage is controversial. The aim of the present study as to identify the subgroup of patients with BCLC-B HCC who could benefit from liver resection. The present study retrospectively analyzed the outcomes of 65 patients (training cohort) who underwent liver resection for multinodular BCLC-B HCC. Cox's regression analysis was conducted to identify the independent prognostic factors for overall survival and to develop the prognostic score. As some authors have reported that maximum tumor size (cm) plus tumor number (N+S) is a prognostic factor in patients with BCLC-B HCC who undergo chemoembolization, the usefulness of this factor in patients who underwent liver resection was also evaluated. Subsequently, the validity of the prognostic score was assessed in an independent validation cohort (n=132). Multivariate analysis revealed that positivity for hepatitis C virus antibody (HCV-ab), platelet count ≤10¹⁰/l, N+S >8, and des-γ-carboxy prothrombin (DCP) >400 mAU/ml were independent prognostic factors for overall survival. The prognostic score differentiated two groups (≤2, ≥3) with distinct outcomes (median survival time 68.3 months vs. 29.1 months; P<0.0001). This result was confirmed in an external validation cohort. Therefore, surgery can promote long-term survival in patients with multinodular HCC although the indications for surgery are limited. HCV-Ab status, preoperative platelet count, DCP level and N+S may be useful for patient selection.

• Barcelona Clinic Liver Cancer classification
• hepatocellular carcinoma
• intermediate stage
• liver resection

• Intermediate-stage hepatocellular carcinoma
• Kyoto criteria
• Pretreatment
• Transarterial chemoembolization
• Transplantation

• Curative treatment
• Intermediate stage
• Prognosis
• Treatment allocation

• Hepatocellular carcinoma
• Japanese
• maximum tolerated dose
• nintedanib
• phase I

• Aged
• Aged, 80 and over
• Antineoplastic Agents/administration & dosage
• Antineoplastic Agents/adverse effects
• Antineoplastic Agents/pharmacokinetics
• Antineoplastic Agents/therapeutic use
• Biomarkers, Tumor
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/drug therapy
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Drug Monitoring
• Female
• Humans
• Indoles/administration & dosage
• Indoles/adverse effects
• Indoles/pharmacokinetics
• Indoles/therapeutic use
• Liver Function Tests
• Liver Neoplasms/complications
• Liver Neoplasms/drug therapy
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Male
• Maximum Tolerated Dose
• Middle Aged
• Neoplasm Staging
• Treatment Outcome

Hepatocellular carcinoma (HCC), the fifth most common cancer in the world, shows increasing incidence worldwide. Curative treatments such as hepatectomy, liver transplantation, and radiofrequency ablation are applied in only 30%-60% of cases. Most remaining patients receive transarterial chemoembolization (TACE). Patients with intermediate-stage HCCs are regarded as good candidates for TACE. However, the intermediate stage includes non-homogeneous patients. Some movements are underway to stratify patients using prognostic factors to identify patient groups exhibiting greater benefit from TACE than other patient groups. This review describes two substaging systems that subclassify intermediate-stage HCCs and discusses the importance of dividing intermediate-stage patients.

• Hepatocellular carcinoma
• Intermediate-stage
• Chemoembolization
• Child-Pugh score
• Prognosis

• Carcinoma, Hepatocellular/classification
• Carcinoma, Hepatocellular/diagnosis
• Chemoembolization, Therapeutic
• Hepatectomy
• Humans
• Japan
• Liver Neoplasms/classification
• Liver Neoplasms/diagnosis
• Medical Oncology/methods
• Neoplasm Staging/methods
• Prognosis
• Severity of Illness Index
• Societies, Medical

• apoptosis
• astaxanthin
• hepatocellular carcinoma