Epidemiology, pathogenesis, diagnosis, surveillance, and management of hepatocellular carcinoma associated with vascular liver disease

Focal nodular hyperplasia-like nodules arising in the setting of hepatic vascular disorders with portosystemic shunting show β-catenin activation

Hepatocellular nodules can develop in the setting of chronic hepatic vascular disorders including those characterized by portosystemic shunts such as Abernethy malformation and post-Fontan procedure. The nodules can range from benign lesions such as regenerative nodules, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA) to malignant neoplasms such as hepatocellular carcinoma (HCC). In many instances, these nodules are difficult to place into well-defined categories based on radiologic or histologic features. Nodular lesions that resemble FNH are common in this context and have been described as FNH-like nodules, the nature of which is not well-established. This study examines 6 liver resections from patients with vascular disease characterized by portosystemic shunts. A wide range of nodules were present in these cases, including regenerative nodules (n = 2), FNH and FNH-like (n = 30), HCA (n = 10), HCA-like (n = 13), and HCC (n = 2). Six nodules from 3 patients were categorized as FNH-like due to one or more features such as nodular architecture, fibrous septa, and ductular reaction, but lack of typical map-like glutamine synthetase (GS) staining. Further characterization of these 6 FNH-like nodules showed diffuse GS staining in all nodules (3 diffuse homogeneous, 3 diffuse heterogeneous). Targeted next-generation sequencing identified CTNNB1 alterations in all tested FNH-like nodules (n = 4). These results indicate that FNH-like nodules in the setting of chronic hepatic vascular disorders can be neoplastic. Since the presence of β-catenin activation portends a potential risk for malignant progression, GS and β-catenin immunohistochemistry should be obtained in all cases showing FNH-like morphology, with molecular analysis performed in cases with indeterminate staining pattern.

Significant association between high neutrophil-lymphocyte ratio and poor prognosis in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Objective

Whether neutrophil-lymphocyte ratio (NLR) is an applicative predictor of poor prognosis in patients with hepatocellular carcinoma (HCC) remains controversial. In response to the current conflicting data, this meta-analysis was conducted to gain a comprehensive and systematic understanding of prognostic value of NLR in HCC.

Methods

Several English databases, including PubMed, EMBASE, and the Cochrane Library, with an update date of February 25, 2023, were systematically searched. We set the inclusion criteria to include randomized controlled trial (RCT) studies that reported the prognostic value of serum NLR levels in patients with HCC receiving treatment. Both the combined ratio (OR) and the diagnosis ratio (DOR) were used to assess the prognostic performance of NLR. Additionally, we completed the risk of bias assessment by Cochrane Risk of Bias Assessment Tool.

Results

This meta-analysis ultimately included 16 studies with a total of 4654 patients with HCC. The results showed that high baseline NLR was significantly associated with poor prognosis or recurrence of HCC. The sensitivity of 0.67 (95% confidence interval [CI]. 0.59-0.73); specificity of 0.723 (95% CI: 0.64-0.78) and DOR of 5.0 (95% CI: 4.0-7.0) were pooled estimated from patient-based analyses. Subsequently, the combined positive likelihood ratio (PLR) and negative likelihood ratio (NLHR) were calculated with the results of 2.4 (95% CI: 1.9-3.0) and 0.46 (95% CI: 0.39-0.56), respectively. In addition, area under the curve (AUC) of the summary receiver operating characteristic (SROC) reflecting prognostic accuracy was calculated to be 0.75 (95% CI: 0.71-0.78). The results of subgroup analysis suggested that high NLR was an effective predictive factor of poor prognosis in HCC in mainland China as well as in the northern region.

Conclusion

Our findings suggest that high baseline NLR is an excellent predictor of poor prognosis or relapse in patients with HCC, especially those from high-incidence East Asian populations.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42023440640.

HEPATOSPLENIC SCHISTOSOMIASIS-ASSOCIATED CHRONIC PORTAL VEIN THROMBOSIS: RISK FACTOR FOR HEPATOCELLULAR CARCINOMA?

BACKGROUND

Hepatosplenic schistosomiasis is an endemic disease prevalent in tropical countries and is associated with a high incidence of portal vein thrombosis. Inflammatory changes caused by both parasitic infection and portal thrombosis can lead to the development of chronic liver disease with potential carcinogenesis.

AIMS

To assess the incidence of portal vein thrombosis and hepatocellular carcinoma in patients with schistosomiasis during long-term follow-up.

METHODS

A retrospective study was conducted involving patients with schistosomiasis followed up at our institution between 1990 and 2021.

RESULTS

A total of 126 patients with schistosomiasis were evaluated in the study. The mean follow-up time was 16 years (range 5-31). Of the total, 73 (57.9%) patients presented portal vein thrombosis during follow-up. Six (8.1%) of them were diagnosed with hepatocellular carcinoma, all with portal vein thrombosis diagnosed more than ten years before.

CONCLUSIONS

The incidence of hepatocellular carcinoma in patients with schistosomiasis and chronic portal vein thrombosis highlights the importance of a systematic long-term follow-up in this group of patients.

Exosomal lncRNA HMMR-AS1 mediates macrophage polarization through miR-147a/ARID3A axis under hypoxia and affects the progression of hepatocellular carcinoma

BACKGROUND

At present, the role of lncRNA in different kinds of tumors has been widely reported, but its role with hypoxic environment and macrophage polarization is still unclear. Therefore, this study tried to clarify the role of exosomal lncRNA in tumor hypoxic environment and macrophage polarization in the process of hepatocellular carcinoma (HCC), and provide a basis for targeted therapy of HCC.

METHODS

Bioinformatics screening of differentially expressed lncRNA and mRNA was carried out through GEO database, and the expression of lncRNA HMMR-AS1 in tumor tissues was detected and verified in HCC tissues. The effects of HMMR-AS1 on proliferation, migration, apoptosis, and macrophage polarization were determined by in vitro and in vivo experiments. Perform luciferase reporter gene detection and RNA immunoprecipitation to reveal the interaction between HMMR-AS1, miR-147a, and ARID3A. At the same time, the JASPAR database and dual luciferase report were used to detect the relationship between HIF-1α and HMMR-AS1 transcription regulation. Finally, nanoparticle tracking technology, transmission electron microscopy, and western blot were used to detect the effect of hypoxic environment on exosome secretion.

RESULTS

LncRNA HMMR-AS1 was significantly up-regulated in HCC tissues and HCC cells and was related to the poor prognosis. Inhibiting the expression of HMMR-AS1 could significantly inhibit tumor growth in vitro and in vivo. Further study of the mechanism showed that HMMR-AS1 could competitively bind to miR-147a to prevent the degradation of ARID3A. Exosomes carrying HMMR-AS1 could promote the M2 polarization of macrophages mediated by this pathway and further accelerate the progression of HCC. In addition, in the hypoxic environment, HIF-1α promotes its transcription by binding to the HMMR-AS1 promoter and induces an increase in the number of exosomes secreted.

CONCLUSION

In summary, we first discovered and verified the role of lncRNA HMMR-AS1 in HCC. In terms of mechanism, the promotion of exosomal HMMR-AS1 competitive adsorption of miR-147a under hypoxic environment affects ARID3A-mediated macrophage polarization. These data provide a new direction for the research on the pathogenesis of HCC and the development of targeted therapy.