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Liang Y, Wu H, Wei X. Development and validation of a CT-based nomogram for accurate hepatocellular carcinoma detection in high risk patients. Front Oncol 2024; 14:1374373. [PMID: 39165686 PMCID: PMC11333883 DOI: 10.3389/fonc.2024.1374373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/18/2024] [Indexed: 08/22/2024] Open
Abstract
Purpose To establish and validate a CT-based nomogram for accurately detecting HCC in patients at high risk for the disease. Methods A total of 223 patients were divided into training (n=161) and validation (n=62) cohorts between January of 2017 and May of 2022. Logistic analysis was performed, and clinical model and radiological model were developed separately. Finally, a nomogram was established based on clinical and radiological features. All models were evaluated using the area under the curve (AUC). DeLong's test was used to evaluate the differences among these models. Results In the multivariate analysis, gender (p = 0.014), increased Alpha-fetoprotein (AFP) (p = 0.017), non-rim arterial phase hyperenhancement (APHE) (p = 0.011), washout (p = 0.011), and enhancing capsule (p = 0.001) were the independent differential predictors of HCC. A nomogram was formed with well-fitted calibration curves based on these five factors. The area under the curve (AUC) of the nomogram in the training and validation cohorts was 0.961(95%CI: 0.935~0.986) and 0.979 (95% CI: 0.949~1), respectively. The nomogram outperformed the clinical and the radiological models in training and validation cohorts. Conclusion The nomogram incorporating clinical and CT features can be a simple and reliable tool for detecting HCC and achieving risk stratification in patients at high risk for HCC.
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Affiliation(s)
- Yingying Liang
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Hongzhen Wu
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Xinhua Wei
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
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Li N, Sun Y, Ouyang J, Che Y, Chen C, Li W, Wu C. A TiN-based nanophotosensitizer for enhanced photothermal therapy with the aid of ultrasound. Biochem Biophys Res Commun 2023; 679:82-89. [PMID: 37677981 DOI: 10.1016/j.bbrc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/08/2023] [Accepted: 09/02/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND PURPOSE Targeting and uptake are the most important strategies for enhancing the efficacy of cancer photothermal therapy (PTT) and reducing damage to surrounding normal tissues. In this study, a kind of nanophotosensitizer based on nanobubbles and TiN was prepared for synergetic therapy for hepatocellular carcinoma. METHODS The photothermal agent titanium nitride (TiN) was wrapped in nanobubbles by membrane hydration method and verified in cells and animals. CCK-8, cell death staining, and JC-1 were used to verify the pernicious effect of photothermal combined with Ultrasound Targeted Nanobubble Destruction (UTND) and then injected into animals through the tail vein to observe its photothermal effect and in vivo inhibitory effect. A hemolysis test and body weight change verified its safety. RESULTS The average diameter of the novel nanophotosensitizer was 300.3 ± 12.7 nm, with a consistent nanospheres morphology. The UTND technology was utilized to improve the penetration of TiN into tumor cells through the physical energy of ultrasound irradiation. The therapeutic effects of the synergistic therapy of UTND and PTT were verified in vitro and in vivo. CONCLUSION The research has established NBs@C3F8-TiN as a suitable ultrasound photothermal agent due to its appropriate size and efficient photothermal efficacy for visual photothermal therapy for HCC.
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Affiliation(s)
- Nan Li
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, China
| | - Yunfeng Sun
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, China
| | - Jiabao Ouyang
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, China
| | - Yuna Che
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, China
| | - Chen Chen
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, China
| | - Wen Li
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, China
| | - Changjun Wu
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, China.
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Sun Y, Xiong Y, Wang Q, Qiao W, Zhang H, Zhang Y. Development and validation of a nomogram to predict the recurrence of hepatocellular carcinoma patients with dynamic changes in AFP undergoing locoregional treatments. Front Oncol 2023; 13:1206345. [PMID: 37700838 PMCID: PMC10494718 DOI: 10.3389/fonc.2023.1206345] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Serum alpha-fetoprotein (AFP) is an important clinical indicator for screening, diagnosis, and prognosis of primary hepatocellular carcinoma (HCC). Our team's previous study showed that patients with negative AFP at baseline and positive AFP at relapse had a worse prognosis (N-P). Therefore, the aim of our study was to develop and validate a nomogram for this group of patients. Methods A total of 513 patients with HCC who received locoregional treatments at Beijing You'an Hospital, Capital Medical University, from January 2012 to December 2019 were prospectively enrolled. Patients admitted from 2012 to 2015 were assigned to the training cohort (n = 335), while 2016 to 2019 were in the validation cohort (n =183). The clinical and pathological features of patients were collected, and independent risk factors were identified using univariate and multivariate Cox regression analysis as a basis for developing a nomogram. The performance of the nomogram was evaluated by C-index, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves in the training and validation cohorts. Results The content of the nomogram includes gender, tumor number, tumor size, lymphocyte, direct bilirubin (DBIL), gamma-glutamyl transferase (GGT), and prealbumin. The C-index (0.717 and 0.752) and 1-, 3-, and 5-year AUCs (0.721, 0.825, 0.845, and 0.740, 0.868, 0.837) of the training and validation cohorts proved the good predictive performance of the nomogram. Calibration curves and DCA curves suggested accuracy and net clinical benefit rates. The nomogram enabled to classify of patients with dynamic changes in AFP into three groups according to the risk of recurrence: low risk, intermediate risk, and high risk. There was a statistically significant difference in RFS between the three groups in the training and validation cohorts (P<0.001). Conclusion The nomogram developed and validated in this study had good predictive power for patients with dynamic changes in AFP.
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Affiliation(s)
- Yu Sun
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Yiqi Xiong
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Qi Wang
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Wenying Qiao
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Honghai Zhang
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Yonghong Zhang
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
- Research Center for Biomedical Resources, Beijing You’an Hospital, Capital Medical University, Beijing, China
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Verma N, Vinocha A. Role of CA 19.9 and CEA in predicting diagnosis in hepatocellular carcinoma. J Cancer Res Ther 2023; 19:1356-1358. [PMID: 37787308 DOI: 10.4103/jcrt.jcrt_1280_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background Hepatocellular carcinoma (HCC) is responsible for 90% of cases of primary liver cancer and is also responsible for the fourth most common cause of cancer death worldwide. To improve the current scenario for the early diagnosis and management of HCC patients, a better understanding of HCC is required. Hence, serum tumor biomarkers such as CA 19-9 (cancer antigen), CEA (carcinoembryonic antigen), and AFP (alpha-fetoprotein) show promising future, when it comes to early diagnosis of primary liver cancer (PHC), liver cirrhosis, and metastasis. Methods It was a retrospective cross-sectional analysis of patients diagnosed with primary hepatocellular carcinoma, data were collected from the hospital database and included a total of 245 patients of HCC attending the out-patient department and some were admitted for treatment at our institution. Out of 245 patients, 68 patients were selected for the study. We have collected information related to the patient's demographic profile, pathological diagnosis, biochemical profile, and even radiological diagnosis. The sensitivity and specificity of CA 19-9 and CEA were also done. Results Adenocarcinoma is the most common type of liver cancer followed by HCC. We have shown a weak correlation between tumor markers CA 19-9 and CEA for the diagnosis of liver carcinoma. Further our study shows that the sensitivity of tumor marker CA 19-9 for the diagnosis of liver carcinoma is 64.28% and that of CEA is 83.67%. Conclusion The search for a novel biomarker of early liver carcinoma requires further research. Competing Interests The authors declare that they have no competing interests.
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Affiliation(s)
- Nishu Verma
- Department of Microbiology, Delhi State Cancer Institute, Dilshad Garden, Delhi, India
| | - Anjali Vinocha
- Department of Lab Medicine, Delhi State Cancer Institute, Dilshad Garden, Delhi, India
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Ma C, Cao Y, Zhang G, Qiu J, Zhou Y, Wang P, Wang S, Yan D, Ma D, Jiang C, Wang Z. Novel Nomograms Based on Gamma-Glutamyl Transpeptidase-to-Lymphocyte Ratio Predict Prognosis of Hepatocellular Carcinoma Patients After Hepatectomy. J Hepatocell Carcinoma 2023; 10:217-230. [PMID: 36798739 PMCID: PMC9925392 DOI: 10.2147/jhc.s391755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
Background The prediction of prognosis of hepatocellular carcinoma (HCC) is of great significance in improving disease outcome and optimizing clinical management, while reliable prognostic indicators are lacking. This study was conducted to develop readily-to-use nomograms for prognosis prediction of HCC after hepatectomy. Materials and Methods Data of eligible patients were collected and analyzed retrospectively. Independent prognostic factors were identified by Cox regression, and nomograms for the prediction of disease-free survival (DFS) and overall survival (OS) were developed. The performance of the nomograms was evaluated by receiver operating characteristics (ROC) curves, C-indexes and calibration curves and was verified by the validation cohort. The predictive value of the nomograms was also compared with the 8th edition of American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) and the Barcelona Clinic Liver Cancer (BCLC) staging systems. Results In total, 599 patients were enrolled in the analysis: 420 in the training cohort and 179 in the validation cohort. The optimal cut-off value of Gamma-Glutamyl Transpeptidase-to-Lymphocyte Ratio (GLR) was 19.5. GLR contributed significantly to the nomograms with good predictive power. In ROC analyses, the areas under curve (AUCs) of the nomograms for 1-, 3- and 5-year DFS and OS prediction were 0.758, 0.756, 0.734 and 0.810, 0.799, 0.758, respectively. The C-indexes of the DFS nomogram were 0.697 (95% CI 0.665-0.729) in the training cohort and 0.710 (95% CI 0.664-0.756) in the validation cohort. For OS prediction, the C-indexes were 0.741 (95% CI 0.704-0.778) and 0.758 (95% CI 0.705-0.811) in the training and validation cohorts, respectively. The calibration curves demonstrated satisfactory agreement between nomogram predictions and actual observations. The nomograms demonstrated superior predictive performance to the TNM and the BCLC staging systems. Conclusion Our novel nomograms showed adequate performance in the prediction of HCC prognosis after hepatectomy, which may facilitate the risk stratification and individualized management of HCC patients.
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Affiliation(s)
- Cheng Ma
- Department of Hepatobiliary Surgery, Drum Tower Clinical College of Nanjing Medical University, Nanjing, People’s Republic of China,Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Department of Tissue Engineering, Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People’s Republic of China,Department of Gastrointestinal Surgery, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Yin Cao
- Department of Hepatobiliary Surgery, Drum Tower Clinical College of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Guang Zhang
- Department of Hepatobiliary Surgery, Drum Tower Clinical College of Nanjing Medical University, Nanjing, People’s Republic of China,Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Department of Tissue Engineering, Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People’s Republic of China
| | - Jiannan Qiu
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
| | - Yan Zhou
- Department of Hepatobiliary Surgery, Drum Tower Clinical College of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Peng Wang
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
| | - Shuo Wang
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
| | - Dongliang Yan
- Department of Hepatobiliary Surgery, Drum Tower Clinical College of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Ding Ma
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
| | - Chunping Jiang
- Department of Hepatobiliary Surgery, Drum Tower Clinical College of Nanjing Medical University, Nanjing, People’s Republic of China,Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Department of Tissue Engineering, Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People’s Republic of China
| | - Zhongxia Wang
- Department of Hepatobiliary Surgery, Drum Tower Clinical College of Nanjing Medical University, Nanjing, People’s Republic of China,Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Department of Tissue Engineering, Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People’s Republic of China,Correspondence: Zhongxia Wang; Chunping Jiang, Email ;
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Mao S, Shan Y, Yu X, Huang J, Fang J, Wang M, Fan R, Wu S, Lu C. A new prognostic model predicting hepatocellular carcinoma early recurrence in patients with microvascular invasion who received postoperative adjuvant transcatheter arterial chemoembolization. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:129-136. [PMID: 36031472 DOI: 10.1016/j.ejso.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/16/2022] [Accepted: 08/15/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUD In this study, we aimed to develop a prognostic model to predict HCC early recurrence (within 1-year) in patients with microvascular invasion who received postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE). METHODS A total of 148 HCC patients with MVI who received PA-TACE were included in this study. The modes were verified in an internal validation cohort (n = 112) and an external cohort (n = 36). Univariate and multivariate Cox regression analyses were performed to identify the independent prognostic factors relevant to early recurrence. A clinical nomogram prognostic model was established, and nomogram performance was assessed via internal validation and calibration curve statistics. RESULTS After data dimensionality reduction and element selection, multivariate Cox regression analysis indicated that alpha fetoprotein level, systemic inflammation response index, alanine aminotransferase, tumour diameter and portal vein tumour thrombus were independent prognostic factors of HCC early recurrence in patients with MVI who underwent PA-TACE. Nomogram with independent factors was established and achieved a better concordance index of 0.765 (95% CI: 0.691-0.839) and 0.740 (95% CI: 0.583-0.898) for predicting early recurrence in training cohort and validation cohort, respectively. Time-dependent AUC indicated comparative stability and adequate discriminative ability of the model. The DCA revealed that the nomogram could augment net benefits and exhibited a wider range of threshold probabilities than AJCC T stage. CONCLUSIONS The nomogram prognostic model showed adequate discriminative ability and high predictive accuracy.
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Affiliation(s)
- Shuqi Mao
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, China
| | - Yuying Shan
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, China
| | - Xi Yu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, China
| | - Jing Huang
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, China
| | - Jiongze Fang
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, China
| | - Min Wang
- Organ Transplantation Office, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, China
| | - Rui Fan
- Medical Quality Management Office, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, China.
| | - Shengdong Wu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, China.
| | - Caide Lu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, China.
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Mohamed EA, Giama NH, Abdalla AO, Shaleh HM, Oseini AM, Ali HA, Ahmed F, Taha W, Ahmed Mohammed H, Cvinar J, Waaeys IA, Ali H, Allotey LK, Ali AO, Mohamed SA, Harmsen WS, Ahmmad EM, Bajwa NA, Afgarshe MD, Shire AM, Balls-Berry JE, Roberts LR. High prevalence of chronic viral hepatitis B and C in Minnesota Somalis contributes to rising hepatocellular carcinoma incidence. World J Gastroenterol 2022; 28:5217-5229. [PMID: 36188718 PMCID: PMC9516675 DOI: 10.3748/wjg.v28.i35.5217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/28/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are known risk factors for liver disease, cirrhosis and hepatocellular carcinoma (HCC). There is substantial global variation in HBV and HCV prevalence resulting in variations in cirrhosis and HCC. We previously reported high prevalence of HBV and HCV infections in Somali immigrants seen at an academic medical center in Minnesota.
AIM To determine the prevalence of chronic viral hepatitis in Somali immigrants in Minnesota through a community-based screening program.
METHODS We conducted a prospective community-based participatory research study in the Somali community in Minnesota in partnership with community advisory boards, community clinics and local mosques between November 2010 and December 2015 (data was analyzed in 2020). Serum was tested for hepatitis B surface antigen, hepatitis B core antibody, hepatitis B surface antibody and anti-HCV antibody.
RESULTS Of 779 participants, 15.4% tested positive for chronic HBV infection, 50.2% for prior exposure to HBV and 7.6% for chronic HCV infection. Calculated age-adjusted frequencies in males and females for chronic HBV were 12.5% and 11.6%; for prior exposure to HBV were 44.8% and 41.3%; and for chronic HCV were 6.7% and 5.7%, respectively. Seven participants developed incident HCC during follow up.
CONCLUSION Chronic HBV and HCV are major risk factors for liver disease and HCC among Somali immigrants, with prevalence of both infections substantially higher than in the general United States population. Community-based screening is essential for identifying and providing health education and linkage to care for diagnosed patients.
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Affiliation(s)
- Essa A Mohamed
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN 55905, United States
| | - Nasra H Giama
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
- School of Nursing, University of Minnesota, Minneapolis, MN 55455, United States
| | - Abubaker O Abdalla
- Division of Digestive Diseases, Emory School of Medicine, Atlanta, GA 30322, United States
| | - Hassan M Shaleh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - Abdul M Oseini
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Hamdi A Ali
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Fowsiyo Ahmed
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Wesam Taha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
- Department of Internal Medicine, NewYork-Presbyterian Queens, Flushing, NY 11355, United States
| | - Hager Ahmed Mohammed
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
- Department of Pediatrics, University of Nevada Las Vegas, Las Vegas, NV 89154, United States
| | - Jessica Cvinar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Ibrahim A Waaeys
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - Hawa Ali
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Loretta K Allotey
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Abdiwahab O Ali
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - Safra A Mohamed
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - William S Harmsen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| | - Eimad M Ahmmad
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Numra A Bajwa
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Mohamud D Afgarshe
- Department of Medicine, Gargar Urgent Care and Clinic, Minneapolis, MN 55406, United States
| | - Abdirashid M Shire
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
- Office of the Director, Shire Scientific, Minneapolis, MN 55405, United States
| | - Joyce E Balls-Berry
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN 55905, United States
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, MO 63130, United States
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO 63130, United States
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
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Identification of a Two-lncRNA Signature with Prognostic and Diagnostic Value for Hepatocellular Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:2687455. [PMID: 36213826 PMCID: PMC9546683 DOI: 10.1155/2022/2687455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 12/25/2022]
Abstract
Background Accumulating evidence has revealed the important role of long noncoding RNAs (lncRNA) in tumorigenesis and progression of hepatocellular carcinoma (HCC). This study aimed to identify potential lncRNAs that can serve as diagnostic and prognostic signatures for HCC. Methods Expression profiling analysis was performed to identify differentially expressed lncRNAs (DElncRNA) between HCC and matched normal samples by integrating two independent microarray datasets. Functional Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were explored by Gene Set Variation Analysis. The prognostic and diagnostic models were developed based on two DElncRNAs. Real-time PCR was used to quantify the relative expressions of candidate lncRNAs. Results Two robust DElncRNAs were identified and verified by quantitative PCR between HCC and matched normal samples. Function enrichment analysis revealed that they were associated with the wound healing process. The two lncRNAs were subsequently used to construct a prognostic risk model for HCC. Patients with high-risk scores estimated by the model showed a shorter survival time than low-risk patients (P < 0.001). Besides, the two lncRNA-based HCC diagnostic models exhibited good performance in discriminating HCC from normal samples on both training and test sets. The values of area under the curve (AUC) for early (I–II) and late (III–IV) HCC detection were 0.88 and 0.93, respectively. Conclusions The two wound healing-related DElncRNAs showed robust performance for HCC prognostic prediction and detection, implying their potential role as diagnostic and prognostic markers for HCC.
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Liu DM, Leung TW, Chow PK, Ng DC, Lee RC, Kim YH, Mao Y, Cheng YF, Teng GJ, Lau WY. Clinical consensus statement: Selective internal radiation therapy with yttrium 90 resin microspheres for hepatocellular carcinoma in Asia. Int J Surg 2022; 102:106094. [PMID: 35662438 DOI: 10.1016/j.ijsu.2021.106094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is subject to different management approaches and guidelines according to Eastern and Western therapeutic algorithms. Use of selective internal radiation therapy (SIRT) with resin yttrium 90 microspheres for HCC has increased in Asia in recent years, without clearly defined indications for its optimal application. The objective of this systematic review and expert consensus statement is to provide guidance and perspectives on the use of SIRT among patients with HCC in Asia. MATERIALS AND METHODS A systematic literature review identified current publications on HCC management and SIRT recommendations. A group of 10 experts, representing stakeholder specialties and countries, convened between August 2020 and March 2021 and implemented a modified Delphi consensus approach to develop guidelines and indications for use of SIRT for HCC in Asia. Final recommendations were organized and adjudicated based on the level of evidence and strength of recommendation, per approaches outlined by the American College of Cardiology/American Heart Association and Oxford Centre for Evidence-Based Medicine. RESULTS The experts acknowledged a general lack of evidence relating to use of SIRT in Asia and identified as an unmet need the lack of phase 3 randomized trials comparing clinical outcomes and survival following SIRT versus other therapies for HCC. Through an iterative process, the expert group explored areas of clinical relevance and generated 31 guidance statements and a patient management algorithm that achieved consensus. CONCLUSION These recommendations aim to support clinicians in their decision-making and to help them identify and treat patients with HCC using SIRT in Asia. The recommendations also highlight areas in which further clinical trials are needed to define the role of SIRT in management of HCC among Asian populations.
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Affiliation(s)
- David M Liu
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Wt Leung
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong
| | - Pierce Kh Chow
- National Cancer Centre Singapore, Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - David Ce Ng
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Duke-NUS Medical School, Singapore
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun Hwan Kim
- Department of Radiology, Presbyterian Medical Center, Jeonju, South Korea
| | - Yilei Mao
- Department of Liver Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yu-Fan Cheng
- Department of Diagnostic Radiology, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Gao-Jun Teng
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Wan Yee Lau
- Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong.
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Mao S, Yu X, Shan Y, Fan R, Wu S, Lu C. Albumin-Bilirubin (ALBI) and Monocyte to Lymphocyte Ratio (MLR)-Based Nomogram Model to Predict Tumor Recurrence of AFP-Negative Hepatocellular Carcinoma. J Hepatocell Carcinoma 2021; 8:1355-1365. [PMID: 34805014 PMCID: PMC8594894 DOI: 10.2147/jhc.s339707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/30/2021] [Indexed: 01/27/2023] Open
Abstract
Purpose In this study, we aimed to develop a novel liver function and inflammatory markers-based nomogram to predict recurrence-free survival (RFS) for AFP-negative (<20 ng/mL) HCC patients after curative resection. Patients and Methods A total of 166 pathologically confirmed AFP-negative HCC patients were included at the Ningbo Medical Center Lihuili Hospital. A LASSO regression analysis was used for data dimensionality reduction and element selection. Univariate and multivariate Cox regression analyses were performed to identify the independent risk factors relevant to RFS. Finally, clinical nomogram prediction model for RFS of HCC was established. Nomogram performance was assessed via internal validation and calibration curve statistics. Receiver operating characteristic (ROC) and decision curve analysis (DCA) curve were used to validate the performance and clinical utility of the nomogram. Results Multivariate Cox regression analysis indicated that ALBI grade (hazard ratio, [HR] = 2.624, 95% confidence interval [CI]: 1.391-4.949, P = 0.003), INR (HR = 2.605, 95% CI: 1.061-6.396, P = 0.037), MLR (HR = 1.769, 95% CI: 1.073-2.915, P = 0.025) and MVI (HR = 4.726, 95% CI: 2.365-9.444, P < 0.001) were independent prognostic factors of RFS. Nomogram with independent factors was established and achieved a better concordance index of 0.753 (95% CI: 0.672-0.834) for predicting RFS. The ROC found that the area under curve (AUC) was consistent with the C-index and the sensitivity was 85.4%. The risk score calculated by nomogram could divide AFP-negative HCC patients into high-, moderate- and low-risk groups (P < 0.05). DCA analysis revealed that the nomogram could augment net benefits and exhibited a wider range of threshold probabilities by the risk stratification than the AJCC T and BCLC stage in the prediction of AFP-negative HCC recurrence. Conclusion The ALBI grade- and MLR-based nomogram prognostic model for RFS showed high predictive accuracy in AFP-negative HCC patients after surgical resection.
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Affiliation(s)
- Shuqi Mao
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Xi Yu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Yuying Shan
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Rui Fan
- Medical Quality Management Office, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Shengdong Wu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Caide Lu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
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Zahiri M, Taghavi S, Abnous K, Taghdisi SM, Ramezani M, Alibolandi M. Theranostic nanobubbles towards smart nanomedicines. J Control Release 2021; 339:164-194. [PMID: 34592384 DOI: 10.1016/j.jconrel.2021.09.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/04/2023]
Abstract
Targeted therapy and early accurate detection of malignant lesions are essential for the effectiveness of treatment and prognosis in cancer patients. The development of gaseous system as a versatile platform for the fabricated nanobubbles, has attracted much interest in improving the efficacy of ultrasound therapeutic, diagnostic, and theranostic platforms. Nano-sized bubble, as an ultrasound contrast agent, with spherical gas-filled structures exhibited contrast enhancement capability due to their inherent EPR effect. Additionally, nanobubbles exhibited good stability with extended retention time in the blood stream. The current review summarized various nanobubbles and discussed about the crucial parameters affecting the stability of ultrafine bubbles. Furthermore, therapeutic and theranostic gaseous systems for fighting against cancer were described.
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Affiliation(s)
- Mahsa Zahiri
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahar Taghavi
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khalil Abnous
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mohammad Taghdisi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Ramezani
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mona Alibolandi
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Cao X, Cao Z, Ou C, Zhang L, Chen Y, Li Y, Zhu B, Shu H. Combination of serum paraoxonase/arylesterase 1 and antithrombin-III is a promising non-invasion biomarker for discrimination of AFP-negative HCC versus liver cirrhosis patients. Clin Res Hepatol Gastroenterol 2021; 45:101583. [PMID: 33756265 DOI: 10.1016/j.clinre.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE α-fetoprotein is often used in the diagnosis of hepatocellular carcinoma (HCC). However, there are currently less efficient and highly specific biomarkers to distinguish AFP-negative HCC from liver cirrhosis (LC) patients. PATIENTS AND METHODS We retrospectively analyzed the data of patients who were treated in our hospitals. iTRAQ coupled with mass spectrometry was used to identify candidate serum proteins in a discovery set (n = 36) including AFP-negative HCC and LC patients. After Western blot detection, potential serum biomarkers were confirmed using ELISA in a validation set (n = 90). The diagnostic performance of the selected proteins was assessed using receiver operating characteristic (ROC). RESULTS PON1 and ATIII were selected as target proteins and were significantly higher in LC than those in AFP-negative HCC patients as validated by Western blot and ELISA, which was consistent with the result of iTRAQ. The AUC was 0.848 as PON1 and ATIII were combined (sensitivity: 80.0%; specificity: 73.3%), and performed much better than that of a single biomarker. CONCLUSION These findings suggest that PON1 and ATIII have the potential to serve as effective biomarkers for distinguishing AFP-negative HCC from cirrhosis.
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Affiliation(s)
- Xinyi Cao
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China; Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, PR China
| | - Zhao Cao
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China
| | - Chao Ou
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China
| | - Lei Zhang
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, PR China
| | - Yanhua Chen
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China
| | - Yanqiu Li
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China
| | - Bo Zhu
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China.
| | - Hong Shu
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China; Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai 200032, PR China.
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Yang JY, Li M, Zhang CL, Liu D. Pharmacological properties of baicalin on liver diseases: a narrative review. Pharmacol Rep 2021; 73:1230-1239. [PMID: 33595821 PMCID: PMC8460515 DOI: 10.1007/s43440-021-00227-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/22/2021] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
Baicalin is the main active component of Scutellaria baicalensis, widely used in traditional Chinese medicine thanks to its various pharmacological effects, such as anti-tumor, anti-inflammatory, and antibacterial properties, as well as cardiovascular, hepatic, and renal protective effect. Recently, the protective effects of baicalin on liver disease have received much more attention. Several studies showed that baicalin protects against several types of liver diseases including viral hepatitis, fatty liver disease, xenobiotic induced liver injury, cholestatic liver injury, and hepatocellular carcinoma, with a variety of pharmacological mechanisms. A comprehensive understanding of the mechanism of baicalin can provide a valuable reference for its clinical use, but up to now, no narrative review is available that summarizes the pharmacological effects of baicalin to clarify its potential use in the treatment of liver diseases. Therefore, this review summarizes the progress of baicalin research and the underlying mechanism in the treatment of various liver diseases, to promote further research and its clinical application.
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Affiliation(s)
- Jin-Yu Yang
- Department of Pharmacy, Tongji Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang avenue, Wuhan, 430030, Hubei, China
| | - Min Li
- Department of Pharmacy, Tongji Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang avenue, Wuhan, 430030, Hubei, China
| | - Cheng-Liang Zhang
- Department of Pharmacy, Tongji Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang avenue, Wuhan, 430030, Hubei, China.
| | - Dong Liu
- Department of Pharmacy, Tongji Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang avenue, Wuhan, 430030, Hubei, China.
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Tan HL, Goh BKP. Management of recurrent hepatocellular carcinoma after resection. Hepatobiliary Surg Nutr 2020; 9:780-783. [PMID: 33299834 DOI: 10.21037/hbsn.2020.03.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School Singapore, Singapore, Singapore
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Mao M, Wang X, Song Y, Sheng H, Han R, Lin W, Dai S. Novel Prognostic Scores Based on Plasma Prothrombin Time and Fibrinogen Levels in Patients With AFP-Negative Hepatocellular Carcinoma. Cancer Control 2020; 27:1073274820915520. [PMID: 32216575 PMCID: PMC7158590 DOI: 10.1177/1073274820915520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Noninvasive tools for the prognosis of α-fetoprotein negative hepatocellular
carcinoma (HCC) are urgently needed. The present study proposed a prognostic
system based on preoperative plasma prothrombin time and fibrinogen (PT/Fbg
system). With respect to α-fetoprotein (AFP)-negative HCC, we compared the
prognostic value in PT/Fbg system, Glasgow Prognostic Score, and
aminotransferase/aspartate aminotransferase ratio. The present study
retrospectively analyzed patient characteristics, clinicopathological factors,
and the level of pretreatment biomarkers in 628 patients with HCC. Patients with
increased PT and Fbg levels were allocated a score of 2, patients with only one
of these abnormalities were assigned score 1, and patients with neither of these
abnormalities were allocated a score of 0. The following distributions of the
PT/Fbg system scores were observed: 187 (29.78%) patients had a score of 0, 305
(30.65%) had a score of 1, and 134 (22.69%) patients had a preoperative score of
2. The prognostic significance of the PT/Fbg system was determined using
univariate and multivariate Cox hazard analyses in AFP-negative HCC.
Multivariate analysis revealed that patients with a higher PT/Fbg system
exhibited worse overall survival (OS) than patients with a lower PT/Fbg system.
Our study proposes preoperative evaluation of the plasma PT/Fbg system to
predict the OS of patients with AFP-negative HCC.
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Affiliation(s)
- Minjie Mao
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xueping Wang
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yiling Song
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Sheng
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Runkun Han
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Weihong Lin
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shuqin Dai
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Jasirwan COM, Fahira A, Siregar L, Loho I. The alpha-fetoprotein serum is still reliable as a biomarker for the surveillance of hepatocellular carcinoma in Indonesia. BMC Gastroenterol 2020; 20:215. [PMID: 32646378 PMCID: PMC7346661 DOI: 10.1186/s12876-020-01365-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023] Open
Abstract
Background and aims Hepatocellular carcinoma (HCC), the most common type of liver cancer, is one of the leading causes of cancer-related death worldwide with an inferior prognosis. In Indonesia, the average life expectancy is less than 5 months, with most patients being in an advanced stage wherein the survival rate is very low. Early detection through surveillance program is very crucial. HCC guidelines worldwide have provided surveillance recommendation through the examination of α-fetoprotein (AFP) and ultrasound for patients at risk in developing HCC. However, there have been some controversies regarding the usage of AFP concerning its low sensitivity and specificity in detecting HCC. Therefore, the effectiveness of AFP in the surveillance of HCC patients and identifying the parameters most associated with the increase of AFP ≥ 10 ng/ml in Indonesia should be evaluated. Methods We analyzed medical records of HCC patients and those at high risk of developing HCC through cross-sectional study, including patients with cirrhosis and hepatitis B and C, from 2015 to 2017 who underwent treatment at the Cipto Mangunkusumo National General Hospital and Dharmais National Cancer Hospital, Indonesia. Results The sensitivity and specificity of AFP in the surveillance of HCC in Indonesia with a cut-off of 10 ng/ml were 82.6 and 71.2%, respectively. The parameters most associated with the increase of AFP ≥10 ng/ml according to multivariate analysis were the etiology of hepatitis B, the stage of Barcelona Clinic Liver Cancer (BCLC) B and C, and the presence of cirrhosis, respectively. Conclusion AFP can still be used in the surveillance of HCC in Indonesia for its high sensitivity value.
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Affiliation(s)
- Chyntia Olivia Maurine Jasirwan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | - Alessa Fahira
- Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Lianda Siregar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dharmais National Cancer Hospital, Jakarta, Indonesia
| | - Imelda Loho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dharmais National Cancer Hospital, Jakarta, Indonesia
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Gao YX, Yang TW, Yin JM, Yang PX, Kou BX, Chai MY, Liu XN, Chen DX. Progress and prospects of biomarkers in primary liver cancer (Review). Int J Oncol 2020; 57:54-66. [PMID: 32236573 DOI: 10.3892/ijo.2020.5035] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/17/2020] [Indexed: 12/24/2022] Open
Abstract
Tumor biomarkers are important in the early screening, diagnosis, therapeutic evaluation, recurrence and prognosis prediction of tumors. Primary liver cancer is one of the most common malignant tumors; it has high incidence and mortality rates and seriously endangers human health. The main pathological types of primary liver cancer include hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and combined HCC‑cholangiocarcinoma (cHCC‑CC). In the present review, a systematic outline of the current biomarkers of primary liver cancer is presented, from conventional blood biomarkers, histochemical biomarkers and potential biomarkers to resistance‑associated biomarkers. The important relationships are deeply elucidated between biomarkers and diagnosis, prognosis, clinicopathological features and resistance, as well as their clinical significance, in patients with the three main types of primary liver cancer. Moreover, a summary of several important biomarker signaling pathways is provided, which is helpful for studying the biological mechanism of liver cancer. The purpose of this review is to provide help for clinical or medical researchers in the early diagnosis, differential diagnosis, prognosis and treatment of HCC.
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Affiliation(s)
- Yu-Xue Gao
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Tong-Wang Yang
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Ji-Ming Yin
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Peng-Xiang Yang
- Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Bu-Xin Kou
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Meng-Yin Chai
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Xiao-Ni Liu
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - De-Xi Chen
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
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Huang L, Mo Z, Hu Z, Zhang L, Qin S, Qin X, Li S. Diagnostic value of fibrinogen to prealbumin ratio and gamma-glutamyl transpeptidase to platelet ratio in the progression of AFP-negative hepatocellular carcinoma. Cancer Cell Int 2020; 20:77. [PMID: 32190001 PMCID: PMC7066792 DOI: 10.1186/s12935-020-1161-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background This study aimed to comprehensively assess the diagnostic value of fibrinogen to prealbumin ratio (FPR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) as single markers or in combination in patients with alpha-fetoprotein-negative (AFP-negative) hepatocellular carcinoma (HCC). Methods A total of 199 healthy controls and 515 AFP-negative patients were enrolled in this study, including 180 HCC inpatients, 151 liver cirrhosis (LC) patients, and 184 chronic hepatitis (CH) cases. Mann-Whitney U or Kruskal-Wallis H test were used to analyze differences between groups in laboratory parameters and clinicopathological features. The diagnostic value of FPR and GPR, alone or in combination, in AFP-negative HCC (AFP-NHCC) patients was determined via a receiver operating characteristic (ROC) curve. Results The levels of FPR and GPR were gradually increased in the development of AFP-NHCC and positively correlated with the tumor size and Barcelona Clinic Liver Cancer (BCLC) stages. Moreover, GPR was associated with Edmondson-Steiner grades. After univariate logistic regression analysis, FPR and GPR remained independent predictors of adverse outcomes. The combination of FPR and GPR had a good ability to detect AFP-NHCC from the control group (area under curve [AUC] = 0.977), AFP-negative CH (AUC = 0.745), and AFP-negative LC (AUC = 0.666). FPR combined with GPR possessed a larger area (0.943, 0.971) and sensitivity (87.50%, 89.81%) than FPR or GPR alone for differentiating AFP-NHCC with tumor size < 3 cm or at the BCLC-A stage. Conclusions The pretreatment levels of FPR and GPR played vital roles in the development of AFP-NHCC, especially in patients with early or small AFP-NHCC.
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Affiliation(s)
- Li Huang
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Zhuning Mo
- 2Department of Blood Transfusion, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region China
| | - Zuojian Hu
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Linyan Zhang
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Shanzi Qin
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Xue Qin
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Shan Li
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
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Earlier Alanine Aminotransferase Normalization During Antiviral Treatment Is Independently Associated With Lower Risk of Hepatocellular Carcinoma in Chronic Hepatitis B. Am J Gastroenterol 2020; 115:406-414. [PMID: 31895708 DOI: 10.14309/ajg.0000000000000490] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It was suggested that normalization of serum alanine aminotransferase (ALT) levels at 1 year of antiviral treatment is associated with a lower risk of hepatic events in patients with chronic hepatitis B (CHB). However, it remains unclear whether earlier ALT normalization is associated with lower hepatocellular carcinoma (HCC) risk, independent of fatty liver or cirrhosis and on-treatment virological response (VR), in patients with CHB. METHODS We analyzed 4,639 patients with CHB who initiated treatment with entecavir or tenofovir using landmark analysis and time-dependent Cox analysis. We defined normal ALT as ≤35 U/L (men) and ≤25 U/L (women) and VR as serum hepatitis B virus DNA <15 IU/mL. RESULTS During a median 5.6 years of treatment, 509 (11.0%) patients developed HCC. ALT normalization occurred in 65.6% at 1 year and 81.9% at 2 years and was associated with a significantly lower HCC risk in landmark (P < 0.001) and time-dependent Cox analyses (adjusted hazard ratio [AHR] 0.57; P < 0.001). Compared with ALT normalization within 6 months, delayed ALT normalization at 6-12, 12-24, and >24 months was associated with incrementally increasing HCC risk (AHR 1.40, 1.74, and 2.45, respectively; P < 0.001), regardless of fatty liver or cirrhosis at baseline and VR during treatment. By contrast, neither earlier VR (AHR 0.93; P = 0.53) nor earlier hepatitis B e antigen seroclearance (AHR 0.91; P = 0.31) was associated with a significantly lower HCC risk. DISCUSSION In patients with CHB treated with entecavir or tenofovir, earlier ALT normalization was independently associated with proportionally lower HCC risk, regardless of fatty liver or cirrhosis at baseline and on-treatment VR.
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Diagnostische und prognostische Bedeutung des α-Feto-Proteins beim hepatozellulären Karzinom. Chirurg 2020; 91:769-777. [DOI: 10.1007/s00104-020-01118-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Yamamoto G, Taura K, Ikai I, Fujikawa T, Nishitai R, Kaihara S, Zaima M, Terajima H, Yoshimura T, Koyama Y, Tanabe K, Nishio T, Okuda Y, Ikeno Y, Yoshino K, Fukuyama K, Seo S, Hatano E, Uemoto S. ALPlat criterion for the resection of hepatocellular carcinoma based on a predictive model of posthepatectomy liver failure. Surgery 2020; 167:410-416. [DOI: 10.1016/j.surg.2019.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
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Luo CL, Rong Y, Chen H, Zhang WW, Wu L, Wei D, Wei XQ, Mei LJ, Wang FB. A Logistic Regression Model for Noninvasive Prediction of AFP-Negative Hepatocellular Carcinoma. Technol Cancer Res Treat 2019; 18:1533033819846632. [PMID: 31106685 PMCID: PMC6535757 DOI: 10.1177/1533033819846632] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
α-Fetoprotein is commonly used in the diagnosis of hepatocellular carcinoma. However, the diagnostic significance of α-fetoprotein has been questioned because a number of patients with hepatocellular carcinoma are α-fetoprotein negative. It is therefore necessary to develop novel noninvasive techniques for the early diagnosis of hepatocellular carcinoma, particularly when α-fetoprotein level is low or negative. The current study aimed to evaluate the diagnostic efficiency of hematological parameters to determine which can act as surrogate markers in α-fetoprotein-negative hepatocellular carcinoma. Therefore, a retrospective study was conducted on a training set recruited from Zhongnan Hospital of Wuhan University-including 171 α-fetoprotein-negative patients with hepatocellular carcinoma and 102 healthy individuals. The results show that mean values of mean platelet volume, red blood cell distribution width, mean platelet volume-PC ratio, neutrophils-lymphocytes ratio, and platelet count-lymphocytes ratio were significantly higher in patients with hepatocellular carcinoma in comparison to the healthy individuals. Most of these parameters showed moderate area under the curve in α-fetoprotein-negative patients with hepatocellular carcinoma, but their sensitivities or specificities were not satisfactory enough. So, we built a logistic regression model combining multiple hematological parameters. This model presented better diagnostic efficiency with area under the curve of 0.922, sensitivity of 83.0%, and specificity of 93.1%. In addition, the 4 validation sets from different hospitals were used to validate the model. They all showed good area under the curve with satisfactory sensitivities or specificities. These data indicate that the logistic regression model combining multiple hematological parameters has better diagnostic efficiency, and they might be helpful for the early diagnosis for α-fetoprotein-negative hepatocellular carcinoma.
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Affiliation(s)
- Chang-Liang Luo
- 1 Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Yuan Rong
- 1 Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Hao Chen
- 2 Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Wu-Wen Zhang
- 1 Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Long Wu
- 3 Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Diao Wei
- 4 Department of Blood Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xiu-Qi Wei
- 5 Department of Laboratory Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lie-Jun Mei
- 6 Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Fu-Bing Wang
- 1 Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
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Scherber PR, Gäbelein G, Eisele RM, Igna D, Glanemann M. [Early stage liver cancer : Hepatocellular carcinoma]. Chirurg 2019; 89:281-288. [PMID: 29075797 DOI: 10.1007/s00104-017-0538-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hepatocellular carcinoma (HCC) ranks among the most common primary cancers of the liver. The major risk factor for the formation of HCC is liver cirrhosis. The grade of cirrhosis as well as the extent of the tumor itself, can play an important role in the treatment options and patient prognosis. An operation aimed at an R0 resection is the treatment of choice for patients in an early stage of the disease and is associated with favorable long-term and recurrence-free survival. Liver transplantation offers an even better long-term survival rate after 5 years for selected patients with HCC meeting the Milan criteria as the underlying cirrhosis, the major risk factor for HCC recurrence, is simultaneously treated. Local tumor ablation is the least invasive curative surgical treatment, however, it is associated with an increased local recurrence rate; therefore, the early detection of tumors is of essential importance. As tumor-associated symptoms tend to arise only in advanced tumor stages, it is indispensable to identify patients with typical risk factors and to provide closely monitored screening examinations.
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Affiliation(s)
- P R Scherber
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - G Gäbelein
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - R M Eisele
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - D Igna
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland.
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24
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Wang X, Mao M, He Z, Zhang L, Li H, Lin J, He Y, Dai S, Hu W, Liu W. Development and Validation of a Prognostic Nomogram in AFP-negative hepatocellular carcinoma. Int J Biol Sci 2019; 15:221-228. [PMID: 30662361 PMCID: PMC6329916 DOI: 10.7150/ijbs.28720] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/11/2018] [Indexed: 12/27/2022] Open
Abstract
The aim of this study is to establish and validate an effective prognostic nomogram in patients with AFP-negative hepatocellular carcinoma (HCC). The nomogram was based on a primary cohort that consisted of 419 patients with clinicopathologically diagnosed with HCC, all the data was gathered from 2008 to 2014 in Sun Yat-sen University Cancer Center. All the model factors were determined by univariate and multivariate Cox hazard analysis. The concordance index (C-index) and calibration curve were used to determine the predictive accuracy and discriminative ability of the nomogram, and compared with the TNM staging systems on HCC. Internal validation was assessed. An independent validation cohort contained 150 continuous patients from 2014 to 2015. Independent factors for overall survival (OS) were body mass index (BMI), tumor stage, distant metastases, HBs Ag, lactate dehydrogenase (LDH), gamma-glutamyl transpeptidase (GGT), and albumin (ALB), which were all contained into the nomogram. The calibration curve for probability of OS showed good agreement between prediction by nomogram and actual observation. The C-index of nomogram was 0.807 (95% CI: 0.770-0.844), which was superior to the C-index of AJCC TNM Stage (0.697). The AUC was 0.809(95%CI: 0.762-0.857). In the validation cohort, the nomogram still gave good discrimination (C-index: 0.866, 95% CI: 00.796-0.936; AUC: 0.832, 95%CI: 0.747-0.917) and good calibration. Decision curve analysis demonstrated that the nomogram was clinically useful. Moreover, patients were divided into three distinct risk groups for OS by the nomogram: low risk group, middle risk group and a high risk group, respectively. The proposed nomogram presents more accurate and useful prognostic prediction for patients with AFP-negative HCC.
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Affiliation(s)
- Xueping Wang
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Minjie Mao
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhonglian He
- Department of Information section, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lin Zhang
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Huilan Li
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jianhua Lin
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi He
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuqin Dai
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wanming Hu
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wanli Liu
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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25
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Treatment and Cost of Hepatocellular Carcinoma: A Population-Based Cohort Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122655. [PMID: 30486324 PMCID: PMC6313960 DOI: 10.3390/ijerph15122655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 02/07/2023]
Abstract
Hepatitis B virus vaccination and antiviral therapies reduce the risk of hepatocellular carcinoma (HCC). However, the lifetime healthcare expenditure involved in caring for HCC patients remains unclear. We examined the use and direct costs of healthcare services for a cohort of HCC patients to the healthcare system using Taiwan national health insurance program research database between 1997 and 2012. Total medical cost for all reimbursed patient encounters, including hospitalizations and outpatient care was cumulated from HCC onset to the end of follow-up or death. The mean follow-up time was 2.7 years (standard deviation, SD = 3.3) for the entire HCC cohort. Insurance payments of approximately US$92 million were made to 5522 HCC patients, with a mean cost of US$16,711 per patient (21,350). On average, the total cost per patient per month was US$2143 (5184); it was 50% higher for advanced cirrhosis patients at the baseline but 23% lower for mild-to-moderate cirrhotic patients. In the two-part regression, patients’ underlying comorbid conditions, liver transplants, hepatectomy, and transarterial chemoembolization were associated with increased total cost, with liver transplants having the greatest impact over time. Hepatocellular carcinoma imposes substantial burden on the healthcare system. Real-world evidence on treatment and cost outcomes highlighted the needs to expand effective screening strategies and to optimize healthcare delivery to meet HCC patients’ clinical needs.
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Liu Z, Zhang J, Tian Y, Zhang L, Han X, Wang Q, Cheng W. Targeted delivery of reduced graphene oxide nanosheets using multifunctional ultrasound nanobubbles for visualization and enhanced photothermal therapy. Int J Nanomedicine 2018; 13:7859-7872. [PMID: 30538464 PMCID: PMC6255282 DOI: 10.2147/ijn.s181268] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Ultrasound molecular imaging as a promising strategy, which involved the use of molecularly targeted contrast agents, combined the advantages of contrast-enhanced ultrasound with the photothermal effect of reduced graphene oxide (rGO). Methods and results The heparin sulfate proteoglycan glypican-3 (GPC3) is a potential molecular target for hepatocellular carcinoma (HCC). In this study, we covalently linked biotinylated GPC3 antibody to PEGylated nano-rGO to obtain GPC3-modified rGO-PEG (rGO-GPC3), and then combined rGO-GPC3 with avidinylated nanobubbles (NBs) using biotin-avidin system to prepare NBs-GPC3-rGO with photothermal effect and dispersibility, solubility in physiological environment. The average size of NBs-GPC3-rGO complex was 700.4±52.9 nm due to the polymerization of biotin-avidin system. Scanning electron microscope (SEM) showed NBs-GPC3-rGO attached to human hepatocellular carcinoma HepG2 cell. The ultrasound-targeted nanobubble destruction (UTND) technology make use of the physical energy of ultrasound exposure for the improvement of rGO delivery. Compared with other control groups, the highest nanobubble destruction efficiency of NBs-GPC3-rGO was attributed to the dissection effect of rGO on UTND. This is a positive feedback effect that leads to an increase in the concentration of rGO around the HepG2 cell. So NBs-GPC3-rGO using UTND and near-infrared (NIR) irradiation resulted in cell viability within 24 h, 48 h, 72 h lower than other treatment groups. Conclusion This work established NBs-GPC3-rGO as an ultrasonic photothermal agent due to its suitable size, imaging capability, photothermal efficiency for visual photothermal therapy in vitro.
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Affiliation(s)
- Zhao Liu
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Nangang District, Harbin 150080, China,
| | - Jia Zhang
- Key Laboratory of Microsystems and Microstructure Manufacturing, Ministry of Education, Harbin Institute of Technology, Harbin 150080, China
| | - Yuhang Tian
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Nangang District, Harbin 150080, China,
| | - Lei Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Nangang District, Harbin 150080, China,
| | - Xue Han
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Nangang District, Harbin 150080, China,
| | - Qiucheng Wang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Nangang District, Harbin 150080, China,
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Nangang District, Harbin 150080, China,
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27
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Akai H, Yasaka K, Kunimatsu A, Nojima M, Kokudo T, Kokudo N, Hasegawa K, Abe O, Ohtomo K, Kiryu S. Predicting prognosis of resected hepatocellular carcinoma by radiomics analysis with random survival forest. Diagn Interv Imaging 2018; 99:643-651. [DOI: 10.1016/j.diii.2018.05.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/12/2018] [Accepted: 05/15/2018] [Indexed: 12/16/2022]
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Gupta M, Gabriel H, Miller FH. Role of Imaging in Surveillance and Diagnosis of Hepatocellular Carcinoma. Gastroenterol Clin North Am 2018; 47:585-602. [PMID: 30115439 DOI: 10.1016/j.gtc.2018.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The prognosis for hepatocellular carcinoma (HCC) is dependent on tumor stage at diagnosis, with curative treatment options more available to early-detected HCCs. Professional organizations have produced HCC screening guidelines in at-risk groups, with ultrasound the most commonly used screening tool and increased interest in MRI in specific populations. HCC may be diagnosed by imaging features alone and have been universally incorporated into management guidelines. The radiology community has standardized imaging criteria for HCC with the development of the Liver Imaging Reporting and Data System, which has expanded to incorporate computed tomography, MR, and contrast-enhanced ultrasound for diagnostic purposes.
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Affiliation(s)
- Mohit Gupta
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Helena Gabriel
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Body Imaging Section and Fellowship Program, MRI, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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Ricco G, Cavallone D, Cosma C, Caviglia GP, Oliveri F, Biasiolo A, Abate ML, Plebani M, Smedile A, Bonino F, Pontisso P, Brunetto MR. Impact of etiology of chronic liver disease on hepatocellular carcinoma biomarkers. Cancer Biomark 2018; 21:603-612. [PMID: 29278878 DOI: 10.3233/cbm-170551] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The role of serum biomarkers in the surveillance of hepatocellular carcinoma (HCC) is controversial. OBJECTIVE We assessed the diagnostic performances of alpha-fetoprotein (AFP) and protein-induced by vitamin-K-absence/antagonist-II (PIVKA-II) in 388 cirrhotic patients with chronic liver disease (CLD). METHODS Biomarkers were quantified by automated chemiluminescent-enzyme-immunoassays (Fujirebio, Tokyo, Japan) at HCC diagnosis in 258 patients (204 males; median age 66.9 years) and in 130 cirrhotics without HCC (104 males; median-age 60.6 years). CLD etiology in HCC/non-HCC was CHB in 48/35, CHC in 126/56 and Non-Viral in 84/39. RESULTS Overall AUROC values for AFP and PIVKA-II were 0.698 (95%CI = 0.642-0.753, P< 0.001) and 0.780 (95%CI = 0.730-0.831, P< 0.001). AFP/PIVKA-II AUROC (95%CI) were: 0.822 (0.728-0.915)/0.833 (0.739-0.926) in CHB, 0.648 (0.560-0.736)/0.732 (0.650-0.814) in CHC; 0.640 (0.540-0.740)/0.806 (0.722-0.889) in Non-Viral-CLD. AFP/PIVKA-II diagnostic accuracy was 40.5-59.8%/62.7-73.5% and combining both markers 78.2% for CHB, 77% for Non-Viral-CLD and 75% for CHC. AFP correlated with ALT in HCC patients with CHC (ρ= 0.463/P< 0.001) and Non-Viral CLD (ρ= 0.359/P= 0.047), but not in CHB (treated with antivirals). PIVKA-II correlated with tumour size independently of CLD-etiology (P< 0.001) and AFP in CHB patients only (P= 0.007). CONCLUSION The diagnostic performance of AFP and PIVKA-II is significantly influenced by the etiology and activity of CLD; their combination provides a better diagnostic accuracy.
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Affiliation(s)
- Gabriele Ricco
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Centre of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, 56124 Pisa, Italy.,Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, 56127 Pisa, Italy
| | - Daniela Cavallone
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Centre of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, 56124 Pisa, Italy
| | - Chiara Cosma
- Department of Medicine, University of Padua, 35121 Padua, Italy
| | - Gian Paolo Caviglia
- Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy
| | - Filippo Oliveri
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Centre of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, 56124 Pisa, Italy
| | | | - Maria Lorena Abate
- Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy
| | - Mario Plebani
- Department of Medicine, University of Padua, 35121 Padua, Italy
| | - Antonina Smedile
- Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy
| | - Ferruccio Bonino
- Institute of Biostructure and Bioimaging, National Research Council, 80145 Naples, Italy.,University of Pittsburgh Medical Center (UPMC) Institute for Health, 53042 Chianciano Terme, Siena, Italy.,Fondazione Italiana Fegato, Science Park Campus Basovizza, 34149 Trieste, Italy
| | | | - Maurizia Rossana Brunetto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Centre of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, 56124 Pisa, Italy.,Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, 56127 Pisa, Italy
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Song P, Cai Y, Tang H, Li C, Huang J. The clinical management of hepatocellular carcinoma worldwide: A concise review and comparison of current guidelines from 2001 to 2017. Biosci Trends 2018; 11:389-398. [PMID: 28904327 DOI: 10.5582/bst.2017.01202] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the second leading cause of cancer-related mortality worldwide. In this review, we made a review on current guidelines published from January 2001 to June 2017 worldwide with a focus on the clinical management of HCC. The electronic databases MEDLINE, the Chinese SinoMed, and the Japanese CiNii were systematically searched. A total of 18 characteristic guidelines for HCC management were finally included, including 8 guidelines from Asia, 5 from Europe, and 5 from the United States of America (USA). If guidelines were published in multiple versions, the most recent update was included, and surveillance, diagnosis, and treatment were compared. The composition of and recommendations in current guidelines on HCC varied, so these guidelines were regrouped and diagnostic and treatment algorithms were summarized graphically to provide the latest information to clinicians. The diagnostic criteria were grouped into 2 categories of a "Size-based pathway" and a "Non-size-based pathway." The treatment criteria were divided into 4 categories: i) Criteria based on the Barcelona Clinic Liver Cancer staging system; ii) Criteria based on the modified Union of International Cancer Control staging system; iii) Criteria based on the Child-Pugh class of liver function; and iv) Criteria based on tumor resectability. Findings from comparison of current guidelines might help target and concentrate efforts to improve the clinical management of HCC. However, further studies are needed to improve the management and outcomes of HCC. More straightforward or refined guidelines would help guide doctors to make better decisions in the treatment of HCC in the future.
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Affiliation(s)
- Peipei Song
- Graduate School of Frontier Sciences, The University of Tokyo
| | - Yulong Cai
- Department of Bile Duct Surgery, West China Hospital, Sichuan University
| | - Haowen Tang
- Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital
| | - Chuan Li
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University
| | - Jiwei Huang
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University
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31
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Adjuvant systemic therapy after resection of node positive gallbladder cancer: Time for a well-designed trial? (Results of a US-national retrospective cohort study). Int J Surg 2018; 52:171-179. [DOI: 10.1016/j.ijsu.2018.02.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/01/2018] [Accepted: 02/22/2018] [Indexed: 12/29/2022]
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32
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Tang A, Bashir MR, Corwin MT, Cruite I, Dietrich CF, Do RKG, Ehman EC, Fowler KJ, Hussain HK, Jha RC, Karam AR, Mamidipalli A, Marks RM, Mitchell DG, Morgan TA, Ohliger MA, Shah A, Vu KN, Sirlin CB. Evidence Supporting LI-RADS Major Features for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review. Radiology 2018; 286:29-48. [PMID: 29166245 PMCID: PMC6677284 DOI: 10.1148/radiol.2017170554] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- An Tang
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Mustafa R. Bashir
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Michael T. Corwin
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Irene Cruite
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Christoph F. Dietrich
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Richard K. G. Do
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Eric C. Ehman
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Kathryn J. Fowler
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Hero K. Hussain
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Reena C. Jha
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | | | - Adrija Mamidipalli
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Robert M. Marks
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Donald G. Mitchell
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Tara A. Morgan
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Michael A. Ohliger
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Amol Shah
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Kim-Nhien Vu
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Claude B. Sirlin
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - For the LI-RADS Evidence Working Group
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
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Li Q, Li H, He C, Jing Z, Liu C, Xie J, Ma W, Deng H. The use of 5-fluorouracil-loaded nanobubbles combined with low-frequency ultrasound to treat hepatocellular carcinoma in nude mice. Eur J Med Res 2017; 22:48. [PMID: 29162156 PMCID: PMC5698940 DOI: 10.1186/s40001-017-0291-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/06/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the therapeutic effects of 5-fluorouracil (5-FU)-loaded nanobubbles irradiated with low-intensity, low-frequency ultrasound in nude mice with hepatocellular carcinoma (HCC). METHODS A transplanted tumor model of HCC in nude mice was established in 40 mice, which were then randomly divided equally into four groups: group A (saline), group B (5-FU-loaded nanobubbles), group C (5-FU-loaded nanobubbles with non-low-frequency ultrasound), and group D (5-FU-loaded nanobubbles with low-frequency ultrasound). The tumor size in each mouse was observed via ultrasound before and after the treatments. Inhibition of the tumor growth in each group was compared, and survival curves were generated. Tumor tissues were removed to determine the apoptotic index using the TUNEL method and quantitative analysis. Tumor tissues with CD34-positive microvessels were observed by immunohistochemistry, and the tumor microvessel densities were calculated. RESULTS The growth rate of the tumor volumes in group D was significantly slower than that in the other groups, while the tumor inhibition rates and apoptotic index in group D were significantly higher than those of the other groups. The number of microvessels staining positive for CD34 was decreased in group D. Therefore, group D presented the most significant inhibitory effects. CONCLUSIONS Therefore, 5-FU-loaded nanobubbles subjected to irradiation with low-frequency ultrasound could further improve drug targeting and effectively inhibit the growth of transplanted tumors, which is expected to become an ideal drug carrier and targeted drug delivery system for the treatment of HCC in the future.
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Affiliation(s)
- Qiaoya Li
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, People's Republic of China
| | - Hongyang Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Chengjun He
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Zhouhong Jing
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Changan Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Juan Xie
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, People's Republic of China
| | - Wenwen Ma
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, People's Republic of China
| | - Huisheng Deng
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, People's Republic of China.
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Ren B, Zou G, Xu F, Huang Y, Xu G, He J, Li Y, Zhu H, Yu P. Serum levels of anti-sperm-associated antigen 9 antibody are elevated in patients with hepatocellular carcinoma. Oncol Lett 2017; 14:7608-7614. [PMID: 29344208 DOI: 10.3892/ol.2017.7152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 01/19/2017] [Indexed: 02/06/2023] Open
Abstract
At present, there is a high incidence of viral hepatitis and high mortality rates due to hepatocellular carcinoma (HCC) in China. In the current study, the quantification of antibodies against the cancer-testis antigen sperm-associated antigen 9 (SPAG9), alone and combined with α-fetoprotein (AFP), were evaluated as biomarkers for the diagnosis of HCC. The levels of anti-SPAG9 antibody and AFP were quantified in serum samples from patients with HCC and hepatitis or cirrhosis, as well as healthy volunteers. The results revealed that the serum levels of anti-SPAG9 immunoglobulin G antibody in patients with HCC were significantly higher compared with those in patients with hepatitis/cirrhosis and healthy controls. Using receiver operator characteristic curves, the area under the curve (AUC, 0.870) of SPAG9 as a diagnostic marker of HCC was significant [P<0.001; 95% confidence interval (CI), 0.793-0.947], whereas the AUC of AFP was 0.832 (P<0.001; 95% CI, 0.736-0.928). Serum anti-SPAG9 antibody levels exhibited significant potential for the differential diagnosis of HCC, with an AUC value of 0.729, (P=0.008; 95% CI, 0.559-0.899). Similarly, serum AFP levels exhibited significant value for the differential diagnosis of HCC, with an AUC value of 0.842 (P<0.001; 95% CI, 0.732-0.953). When combined with quantification of AFP, the diagnostic sensitivity and specificity of anti-SPAG9 levels were increased. In summary, the results suggested that anti-SPAG9 antibody is a potential early diagnostic marker of HCC.
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Affiliation(s)
- Biqiong Ren
- Clinical Laboratory, Hunan Provincial Second People's Hospital, Changsha, Hunan 410007, P.R. China.,Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Guoying Zou
- Clinical Laboratory, Hunan Provincial Second People's Hospital, Changsha, Hunan 410007, P.R. China.,Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Fei Xu
- Clinical Laboratory, Hunan Provincial Second People's Hospital, Changsha, Hunan 410007, P.R. China.,Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Yiran Huang
- Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Guofeng Xu
- Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Junyu He
- Clinical Laboratory, Hunan Provincial Second People's Hospital, Changsha, Hunan 410007, P.R. China.,Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Yong Li
- Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Haowen Zhu
- Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Ping Yu
- Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
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35
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Liu X, Wang Z, Chen Z, Liu L, Ma L, Dong L, Zhang Z, Zhang S, Yang L, Shi J, Fan J, Wang X, Gao Q. Efficacy and Safety of Transcatheter Arterial Chemoembolization and Transcatheter Arterial Chemotherapy Infusion in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Oncol Res 2017; 26:231-239. [PMID: 28911342 PMCID: PMC7844720 DOI: 10.3727/096504017x15051752095738] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a worldwide health threat with increasing incidence and a high mortality rate. Most HCC patients are diagnosed at an advanced stage and are unable to undergo potential curative surgery. Transcatheter arterial chemoembolization (TACE) and transcatheter arterial chemotherapy infusion (TACI) are two of the main palliative treatments for advanced HCC patients. The clinical efficacy and safety of TACE and TACI are controversial. For this reason, we conducted a systematic review and meta-analysis to summarize the current evidence. We searched for randomized controlled trials (RCTs) and cohort studies that compared the clinical outcomes and adverse effects in HCC patients who received TACE or TACI treatments. The database search was performed and last updated on November 1, 2016. Overall survival and clinical response were compared using a hazard ratio (HR) with a 95% confidence interval (CI). A total of 11 clinical studies that included 13,090 patients were included based on the inclusion/exclusion criteria, of which 9 were cohort studies and 2 were RCTs. TACE was associated with a 23% lower hazard of death compared to TACI (pooled HR = 0.77, 95% CI = 0.67–0.88, p = 0.0002). Patients receiving TACE had a 28% higher disease control rate (DCR) and 162% higher objective response rate (ORR). Only the increase in ORR associated with TACE was statistically significant [DCR: odds ratio (OR) = 1.28, 95% CI = 0.35–4.64, p = 0.71; ORR: OR = 2.62, 95% CI = 1.33–5.15, p = 0.002]. TACE is associated with more favorable survival and response rate than TACI in patients with intermediate or advanced HCC.
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Affiliation(s)
- Xinyang Liu
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Zhichao Wang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Zongwei Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Longzi Liu
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Lijie Ma
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Liangqing Dong
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Zhao Zhang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Shu Zhang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Liuxiao Yang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Jieyi Shi
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Jia Fan
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Xiaoying Wang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
| | - Qiang Gao
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
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Abstract
Hepatocellular carcinoma (HCC) is a major cause of cancer death and is increasing in incidence. This review focuses on HCC surveillance and treatment of early-stage disease, which are essential to improving outcomes. Multiple societies have published HCC surveillance guidelines, but screening efforts have been limited by noncompliance and overall lack of testing for patients with undiagnosed chronic liver disease. Treatment of early-stage HCC has become increasingly complex due to expanding therapeutic options and better outcomes with established treatments. Surgical indications for HCC have broadened with improved preoperative liver testing, neoadjuvant therapy, portal vein embolization, and perioperative care. Advances in post-procedural monitoring have improved efficacies of transarterial chemoembolization and radiofrequency ablation, and novel therapies involving delivery of radiochemicals are being studied in small trials. Finally, advances in liver transplantation have allowed for expanded indications beyond Milan criteria with non-inferior outcomes. More clinical trials evaluating new therapies and multimodal regimens are necessary to help clinicians design better treatment algorithms and improve outcomes.
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Affiliation(s)
| | - Kenneth K Tanabe
- Harvard Medical School.,Division of Surgical Oncology.,Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA
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37
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Ma J, Zeng S, Zhang Y, Deng G, Qu Y, Guo C, Yin L, Han Y, Shen H. BMP4 enhances hepatocellular carcinoma proliferation by promoting cell cycle progression via ID2/CDKN1B signaling. Mol Carcinog 2017; 56:2279-2289. [PMID: 28543546 DOI: 10.1002/mc.22681] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/05/2017] [Accepted: 05/19/2017] [Indexed: 12/18/2022]
Abstract
Bone morphogenetic protein-4 (BMP4) plays a crucial role in carcinogenesis, but the effects and signaling mechanisms of BMP4 in hepatocellular carcinoma (HCC) are not clearly clarified. The present study aimed to identify the roles of BMP4 in the proliferation of human HCC. In this study, BMP4 expression and its correlation with clinicopathological characteristics and the survival of HCC patients were analyzed in two independent cohorts consisting of 310 subjects. Functional analysis of BMP4 on HCC proliferation was performed in vitro and in vivo in human HCC specimens, HCC cells of Bel-7402 and HCCLM3, and subcutaneous tumor model. The downstream signaling targets of BMP4 in HCC were investigated by PCR Array and Western blot. The results indicated that BMP4 expression was significantly increased in HCC tissues and closely related with unfavorable prognosis of HCC. BMP4 treatment increased cell proliferation and promoted G1/S cell cycle progression. In vivo subcutaneous tumor of nude mice model supported that BMP4 overexpression promoted the growth of HCC cells and BMP4 knockdown hold the opposite trend. Id2 was directly upregulated by BMP4, resulting in the mediated expression of cell cycle regulatory protein of CDKN1B. Blocking of Id2 attenuated BMP4-induced proliferation, confirming the important roles of Id2 in BMP4-mediated proliferation in HCC. So BMP4 is overexpressed in HCC tissues and acts as a poor prognostic factor of HCC patients. BMP4-induced ID2/CDKN1B signaling facilitates proliferation of HCC.
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Affiliation(s)
- Junli Ma
- Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shan Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Key Laboratory for Molecular Radiation Oncology of Hunan Province, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Zhang
- Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ganlu Deng
- Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanling Qu
- Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Cao Guo
- Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Key Laboratory for Molecular Radiation Oncology of Hunan Province, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Yin
- Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying Han
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Shen
- Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Key Laboratory for Molecular Radiation Oncology of Hunan Province, Xiangya Hospital, Central South University, Changsha, Hunan, China
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38
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Abstract
There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia–Pacific region, where HCC is one of the leading public health problems. Since the “Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines” meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.
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39
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Zhu HT, Liu RB, Liang YY, Hasan AME, Wang HY, Shao Q, Zhang ZC, Wang J, He CY, Wang F, Shao JY. Serum microRNA profiles as diagnostic biomarkers for HBV-positive hepatocellular carcinoma. Liver Int 2017; 37:888-896. [PMID: 28061012 DOI: 10.1111/liv.13356] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 12/30/2016] [Accepted: 12/31/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The discovery of effective and reliable biomarkers to detect hepatitis B virus (HBV)-positive hepatocellular carcinoma (HCC) at an early stage may improve the survival of HCC. The aim of this study was to establish serum microRNA (miRNA) profiles as diagnostic biomarkers for HBV-positive HCC. METHODS We used deep sequencing to screen serum miRNAs in a discovery cohort (n=100). Quantitative polymerase chain reaction (qPCR) assays were then applied to evaluate the expression of selected miRNAs. A diagnostic 2-miRNA panel was established by a logistic regression model using a training cohort (n=182). The predicted probability of being detected as HCC was used to construct the receiver operating characteristic (ROC) curve. Area under the ROC curve (AUC) was used to assess the diagnostic performance of the selected miRNA panel. RESULTS The predicted probability of being detected as HCC by the 2-miRNA panel was calculated by: logit P=-2.988 + 1.299 × miR-27b-3p + 1.245 × miR-192-5p. These results were further confirmed in a validation cohort (n=246).The miRNA panel provided a high diagnostic accuracy of HCC (AUC=0.842, P<.0001 for training set; AUC=0.836, P<.0001 for validation set respectively). In addition, the miRNA panel showed better prediction of HCC diagnosis than did alpha-foetoprotein (AFP). The miRNA panel also differentiated HCC from healthy (AUC=0.823, P<.0001), and cirrhosis patients (AUC=0.859, P<.0001) respectively. CONCLUSIONS Differentially expressed serum miRNAs may have considerable clinical value in HCC diagnosis, and be particularly helpful for AFP-negative HCC.
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Affiliation(s)
- Hao-Tu Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rong-Bin Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ya-Yong Liang
- Department of paediatrics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Abdulbaqi M E Hasan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hai-Yun Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qiong Shao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zi-Chen Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Cai-Yun He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fang Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jian-Yong Shao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
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Lock MI, Klein J, Chung HT, Herman JM, Kim EY, Small W, Mayr NA, Lo SS. Strategies to tackle the challenges of external beam radiotherapy for liver tumors. World J Hepatol 2017; 9:645-656. [PMID: 28588749 PMCID: PMC5437609 DOI: 10.4254/wjh.v9.i14.645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/20/2016] [Accepted: 04/20/2017] [Indexed: 02/06/2023] Open
Abstract
Primary and metastatic liver cancer is an increasingly common and difficult to control disease entity. Radiation offers a non-invasive treatment alternative for these patients who often have few options and a poor prognosis. However, the anatomy and aggressiveness of liver cancer poses significant challenges such as accurate localization at simulation and treatment, management of motion and appropriate selection of dose regimen. This article aims to review the options available and provide information for the practical implementation and/or improvement of liver cancer radiation programs within the context of stereotactic body radiotherapy and image-guided radiotherapy guidelines. Specific patient inclusion and exclusion criteria are presented given the significant toxicity found in certain sub-populations treated with radiation. Indeed, certain sub-populations, such as those with tumor thrombosis or those with larger lesions treated with transarterial chemoembolization, have been shown to have significant improvements in outcome with the addition of radiation and merit special consideration. Implementing a liver radiation program requires three primary challenges to be addressed: (1) immobilization and motion management; (2) localization; and (3) dose regimen and constraint selection. Strategies to deal with motion include simple internal target volume (ITV) expansions, non-gated ITV reduction strategies, breath hold methods, and surrogate marker methods to enable gating or tracking. Localization of the tumor and organs-at-risk are addressed using contrast infusion techniques to take advantage of different normal liver and cancer vascular anatomy, imaging modalities, and margin management. Finally, a dose response has been demonstrated and dose regimens appear to be converging. A more uniform approach to treatment in terms of technique, dose selection and patient selection will allow us to study liver radiation in larger and, hopefully, multicenter randomized studies.
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41
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Tumor response assessment by MRI following stereotactic body radiation therapy for hepatocellular carcinoma. PLoS One 2017; 12:e0176118. [PMID: 28441447 PMCID: PMC5404860 DOI: 10.1371/journal.pone.0176118] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 04/05/2017] [Indexed: 02/07/2023] Open
Abstract
Background To evaluate the MRI features of a tumor response, local control, and predictive factors of local control after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC). Methods Thirty-five consecutive patients with 48 HCCs who were treated by SBRT were included in this retrospective study. All patients provided written informed consent to be treated by SBRT, and prior to inclusion they authorized use of the treatment data for further studies. The assessment was made using MRI, with determination of local and hepatic responses according to Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) criteria during a two-year follow-up. Results The local response rate according to mRECIST was higher than with RECIST. A tumor diameter less than 20 mm at baseline was an independent predictive factor for RECIST and mRECIST responses, as was diffusion-weighted signal for RECIST. During follow-up, a tumor diameter of <20 mm (p = 0.034) and absence of a high intensity on T2-weighted (p = 0.006) and diffusion-weighted images (p = 0.039) were associated with a better response according to RECIST. Post-treatment changes include peritumoral ring-like enhanced changes with high intensity on T2-weighted images. Conclusions SBRT is a promising technique for the treatment of inoperable HCC. Post-treatment changes on MRI images can resemble tumor progression and as such must be adequately distinguished. The regression of tumorous enhancement is variable over time, although diffusion-weighted and T2-weighted intensities are predictive factors for tumor RECIST responses on subsequent MRIs. They hence provide a way to reliably predict treatment responses.
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42
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Fan SS, Liao CS, Cao YD, Xiao PL, Deng T, Luo RC, Duan HX. A low serum Tat-interacting protein 30 level is a diagnostic and prognostic biomarker for hepatocellular carcinoma. Oncol Lett 2017; 13:4208-4214. [PMID: 28599422 PMCID: PMC5453031 DOI: 10.3892/ol.2017.6024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 01/26/2017] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to evaluate the diagnostic and prognostic value of Tat-interacting protein 30 (HTATIP2/TIP30) levels alone and in combination with α-fetoprotein (AFP) for the evaluation of hepatocellular carcinoma (HCC) patients. ELISA and immunohistochemical measurements on the serum and tissue of HTATIP2/TIP30 protein from HCC patients and normal controls were made. Receiver operating characteristic (ROC) curve analyses of AFP and HTATIP2/TIP30 were performed, as well as logistic regression analysis of APF combined with HTATIP2/TIP30. Log-rank analysis was used to correlate the prognosis with various levels of HTATIP2/TIP30. HTATIP2/TIP30 levels were significantly lower in the HCC group compared with the control group (4.50±2.63 vs. 9.50±2.04 ng/ml, P<0.001). ROC analysis revealed an optimal cut-off point at 7.27 ng/ml HTATIP2/TIP30 for separating the HCC from the control groups. The sensitivity and specificity were 84.6 and 93.7% (P<0.001), respectively. ROC areas of HTATIP2/TIP30 (0.928, P<0.001) were significantly higher than those for AFP (P<0.001). The area under the curve of the HTATIP2/TIP30 and AFP combination was 0.950 (P<0.001). Log-rank tests revealed that the recurrence-free survival time of the group with HTATIP2/TIP30>5.71 ng/ml was significantly higher than that of the control group (P<0.001). This is the first study to demonstrate that HTATIP2/TIP30 levels in serum may be an effective biomarker for the diagnosis and prognosis of HCC.
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Affiliation(s)
- Sha-Sha Fan
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China.,Department of Oncology, Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou, Guangdong 510315, P.R. China
| | - Chu-Shu Liao
- Blood Disease Laboratory, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - You-De Cao
- Medical Clinical Laboratory, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Pei-Ling Xiao
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Tan Deng
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Rong-Cheng Luo
- Department of Oncology, Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou, Guangdong 510315, P.R. China
| | - Hua-Xin Duan
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
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Understanding LI-RADS, Its Relationship to AASLD and OPTN, and the Challenges of Its Adoption. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s11901-017-0337-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Johnson P, Berhane S, Kagebayashi C, Satomura S, Teng M, Fox R, Yeo W, Mo F, Lai P, Chan SL, Tada T, Toyoda H, Kumada T. Impact of disease stage and aetiology on survival in hepatocellular carcinoma: implications for surveillance. Br J Cancer 2017; 116:441-447. [PMID: 28081537 PMCID: PMC5318967 DOI: 10.1038/bjc.2016.422] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/08/2016] [Accepted: 11/28/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Variation in survival in hepatocellular carcinoma (HCC) has been attributed to different aetiologies or disease stages at presentation. While international guidelines recommend surveillance of high-risk groups to permit early diagnosis and curative treatment, the evidence that surveillance decreases disease-specific mortality is weak. METHODS We compared HCC survival figures from Japan (n=1174) and Hong Kong (n=1675) over similar time periods (Japan 2000-2013, Hong Kong, China 2003-2014). The former has an intensive national surveillance programme, while the latter has none. We also analysed changes in survival in Japan over a 50-year period including data from before and after institution of a national HCC surveillance programme. RESULTS In Japan, over 75% of cases are currently detected by surveillance, whereas in Hong Kong <20% of cases are detected presymptomatically. Median survival was 52 months in Japan and 17.8 months in Hong Kong; this survival advantage persisted after allowance for lead-time bias. Sixty-two per cent of Japanese patients had early disease at diagnosis and 63% received curative treatment. The comparable figures for Hong Kong were 31.7% and 44.1%, respectively. These differences could not be accounted for by disease aetiology, and patients in Hong Kong who were detected at an early stage had a similar survival to the analogous patients in Japan. CONCLUSIONS The variation in survival is largely accounted for by stage at diagnosis, which in turn relates to the intensity of surveillance programmes and the consequent variation in curative therapeutic options.
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Affiliation(s)
- Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool and Clatterbridge Cancer Centre NHS Foundation Trust, Sherrington Building, Ashton Street, Liverpool, Merseyside L69 3GA, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK
| | - Sarah Berhane
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool and Clatterbridge Cancer Centre NHS Foundation Trust, Sherrington Building, Ashton Street, Liverpool, Merseyside L69 3GA, UK
| | - Chiaki Kagebayashi
- Department of Molecular Biochemistry and Clinical Investigation, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinji Satomura
- Department of Molecular Biochemistry and Clinical Investigation, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mabel Teng
- Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
| | - Richard Fox
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Winnie Yeo
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China
| | - Frankie Mo
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China
| | - Paul Lai
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Stephen L Chan
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China
| | - Toshifumi Tada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan
| | - Takashi Kumada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan
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Yu Z, Luo X, Wang C, Ye J, Liu S, Xie L, Wang F, Bao J. Baicalin promoted site-2 protease and not site-1 protease in endoplasmic reticulum stress-induced apoptosis of human hepatocellular carcinoma cells. FEBS Open Bio 2016; 6:1093-1101. [PMID: 27833850 PMCID: PMC5095147 DOI: 10.1002/2211-5463.12130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/13/2022] Open
Abstract
Baicalin (5,6-dihydroxy-7-o-glucuronide flavone) is an extract from the roots of Chinese herb Huang Qin (Scutellaria baicalensis Georgi) and is reported to have antioxidative, antiproliferative, anti-inflammatory, and anticancer activities. This study aimed to investigate the inhibitory effect of baicalin on human hepatocellular carcinoma (HCC) cells and the involvement of endoplasmic reticulum stress-induced cell apoptosis. Two human HCC cell lines, HepG2 and SMMC7221, were used in this study. The cells were incubated with baicalin solutions at various concentrations. A 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to assess cell proliferation inhibition; a TUNEL assay was used to evaluate cell apoptosis; small RNA interference was applied to silence IRE1, ATF6, and protein kinase R-like ER kinase (PERK), which are transmembrane proteins inducing cell apoptosis, and two proteases (S1P and S2P) which cleave ATF6. Real-time PCR was used to evaluate the silencing effects of specific siRNA. Expression levels of specific proteins were analyzed by western blotting. Baicalin was found to inhibit the proliferation of HCC cells by inducing apoptosis in a concentration-dependent manner. Elevated expression levels of GRP78, CHOP, p50-ATF6, and caspase12 were found after baicalin incubation. Compared with IRE1 and PERK silencing, ATF6 knockdown dramatically impaired baicalin's apoptosis-inducing activity. Furthermore, S2P silencing, rather than S1P silencing, was also found to impair baicalin-induced HCC cell apoptosis significantly. In conclusion, (a) baicalin inhibits human HCC cells by inducing apoptosis; (b) baicalin induces cell apoptosis by activating ATF6 signaling pathway in endoplasmic reticulum (ER) stress;
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Affiliation(s)
- Zhe Yu
- Department of Hepatic Diseases Hangzhou Xixi Hospital China
| | - Xin Luo
- Department of Hepatic Diseases Hangzhou Xixi Hospital China
| | - Chen Wang
- Department of Hepatic Diseases Hangzhou Xixi Hospital China
| | - Jianhong Ye
- Department of Hepatic Diseases Hangzhou Xixi Hospital China
| | - Shourong Liu
- Department of Hepatic Diseases Hangzhou Xixi Hospital China
| | - Lei Xie
- Department of Hepatic Diseases Hangzhou Xixi Hospital China
| | - Fei Wang
- Department of Hepatic Diseases Hangzhou Xixi Hospital China
| | - Jianfeng Bao
- Department of Hepatic Diseases Hangzhou Xixi Hospital China
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Vickress J, Lock M, Lo S, Gaede S, Leung A, Cao J, Barnett R, Yartsev S. A multivariable model to predict survival for patients with hepatic carcinoma or liver metastasis receiving radiotherapy. Future Oncol 2016; 13:19-30. [PMID: 27582002 DOI: 10.2217/fon-2016-0252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM New parameters that correlate with overall survival were identified in patients with liver lesions treated with radiation therapy. METHODS Pretreatment information and parameters of radiation treatment plans for 129 metastatic and 66 hepatocellular carcinoma liver cancer patients were analyzed. Study end points included overall survival collected from patient charts and electronic records. RESULTS Two practical nomograms were constructed for primary hepatocellular carcinoma and liver metastasis patients. For patients with a Child-Pugh A, radiation dose escalation provided a significant survival benefit. However, for those with Child-Pugh B or C, increasing dose does not impact on survival. CONCLUSION The developed models can potentially guide dose selection and provide prognostic information but still require external validation.
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Affiliation(s)
- Jason Vickress
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Michael Lock
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Simon Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Stewart Gaede
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Aaron Leung
- Department of Oncology, Western University, London, ON, Canada
| | - Jeff Cao
- Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Rob Barnett
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Slav Yartsev
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
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Antiangiogenic and antihepatocellular carcinoma activities of the Juniperus chinensis extract. Altern Ther Health Med 2016; 16:277. [PMID: 27502492 PMCID: PMC4977662 DOI: 10.1186/s12906-016-1250-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
Background To identify a novel therapeutic agent for hepatocellular carcinoma (HCC), for which no promising therapeutic agent exists, we screened a panel of plants and found that Juniperus chinensis exhibited potential antiangiogenic and anti-HCC activities. We further investigated the antiangiogenic and anti-HCC effects of the active ingredient of J. chinensis extract, CBT-143-S-F6F7, both in vitro and in vivo. Methods A tube formation assay conducted using human umbilical vein endothelial cells (HUVECs) was first performed to identify the active ingredient of CBT-143-S-F6F7. A series of angiogenesis studies, including HUVEC migration, Matrigel plug, and chorioallantoic membrane (CAM) assays, were then performed to confirm the effects of CBT-143-S-F6F7 on angiogenesis. The effects of CBT-143-S-F6F7 on tumor growth were investigated using a subcutaneous and orthotopic mouse model of HCC. In vitro studies were performed to investigate the effects of CBT-143-S-F6F7 on the cell cycle and apoptosis in HCC cells. Moreover, protein arrays for angiogenesis and apoptosis were used to discover biomarkers that may be influenced by CBT-143-S-F6F7. Finally, nuclear magnetic resonance analysis was conducted to identify the compounds of CBT-143-S-F6F7. Results CBT-143-S-F6F7 showed significantly antiangiogenic activity in various assays, including HUVEC tube formation and migration, CAM, and Matrigel plug assays. In in vivo studies, gavage with CBT-143-S-F6F7 significantly repressed subcutaneous Huh7 tumor growth in severe combined immunodeficient (SCID) mice, and prolonged the survival of orthotopic Huh7 tumor-bearing SCID mice (a 40 % increase in median survival duration compared with the vehicle-treated mice). Immunohistochemical staining of subcutaneous Huh7 tumors in CBT-143-S-F6F7-treated mice showed a significantly decrease in the cell cycle regulatory protein cyclin D1, cellular proliferation marker Ki-67, and endothelial marker CD31. CBT-143-S-F6F7 caused arrest of the G2/M phase and induced Huh7 cell apoptosis, possibly contributing to the inhibition of HCC tumors. Protein array analysis revealed that several angiogenic and antiapoptotic factors were suppressed in CBT-143-S-F6F7-treated Huh7 cells. Finally, five compounds from CBT-143-S-F6F7 were identified. Conclusions According to these results, we report for the first time the antiangiogenic and anti-HCC activities of CBT-143-S-F6F7, the active fractional extract of J. chinensis. We believe that CBT-143-S-F6F7 warrants further evaluation as a new anti-HCC drug. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1250-6) contains supplementary material, which is available to authorized users.
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Lee JM, Kim MJ, Phongkitkarun S, Sobhonslidsuk A, Holtorf AP, Rinde H, Bergmann K. Health economic evaluation of Gd-EOB-DTPA MRI vs ECCM-MRI and multi-detector computed tomography in patients with suspected hepatocellular carcinoma in Thailand and South Korea. J Med Econ 2016; 19:759-68. [PMID: 27026278 DOI: 10.3111/13696998.2016.1171230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The effectiveness of treatment decisions and economic outcomes of using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) were compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and multi-detector computed tomography (MDCT) as initial procedures in patients with suspected hepatocellular carcinoma (HCC) in South Korea and Thailand. METHODS A decision-tree model simulated the clinical pathway for patients with suspected HCC from the first imaging procedure to a confirmed treatment decision. Input data (probabilities and resource consumptions) were estimated and validated by clinical experts. Costs for diagnostic alternatives and related treatment options were derived from published sources, taking into account both payer's and hospital's perspectives. RESULTS All experts from Korea and Thailand agreed that Gd-EOB-DTPA-MRI yields the highest diagnostic certainty and minimizes the need for additional confirmatory diagnostic procedures in HCC. In Korea, from the payer's perspective, total cost was USD $3087/patient to reach a confirmed treatment decision using Gd-EOB-DTPA-MRI (vs $3205/patient for MDCT and $3403/patient for ECCM-MRI). From the hospital's perspective, Gd-EOB-DTPA-MRI incurred the lowest cost ($2289/patient vs $2320/patient and $2528/patient, respectively). In Thailand, Gd-EOB-DTPA-MRI was the least costly alternative for the payer ($702/patient vs $931/patient for MDCT and $873/patient for ECCM-MRI). From the hospital's perspective, costs were $1106/patient, $1178/patient, and $1087/patient for Gd-EOB-DTPA-MRI, MDCT, and ECCM-MRI, respectively. CONCLUSIONS Gd-EOB-DTPA-MRI as an initial imaging procedure in patients with suspected HCC provides better diagnostic certainty and relevant statutory health insurance cost savings in Thailand and Korea, compared with ECCM-MRI and MDCT.
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Affiliation(s)
- Jeong-Min Lee
- a Department of Radiology , Seoul National University College of Medicine and Institute of Radiation Medicine , Seoul , Korea
| | - Myeong-Jin Kim
- b Department of Radiology , Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine , Seoul , South Korea
| | - Sith Phongkitkarun
- c Department of Radiology, Faculty of Medicine, Ramathibodi Hospital , Mahidol University , Bangkok , Thailand
| | - Abhasnee Sobhonslidsuk
- d Department of Medicine, Faculty of Medicine , Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
| | | | - Harald Rinde
- e Health Outcomes Strategies LLC , Basel , Switzerland
| | - Karsten Bergmann
- f Clinical Supply Management , Bayer Pharma AG , Berlin , Germany
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49
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Song P, Tang Q, Feng X, Tang W. Biomarkers: evaluation of clinical utility in surveillance and early diagnosis for hepatocellular carcinoma. Scand J Clin Lab Invest Suppl 2016; 245:S70-6. [PMID: 27438343 DOI: 10.1080/00365513.2016.1210328] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second most common cause of death from cancer worldwide. Strategies to surveil and diagnose HCC in an earlier stage are urgently needed since this is when curable interventions can be offered to achieve long-term disease-free survival. Over the past few decades, research has suggested measuring alpha-fetoprotein (AFP) concentration and performing abdominal ultrasound (US) as part of routine surveillance of HCC every 6 months for high-risk patients, and many HCC guidelines worldwide have also recommended these examinations. Over the past 5 years, however, the role of serum biomarkers in HCC surveillance and diagnosis has diminished due to advances in imaging modalities. AFP was excluded from the surveillance and/or diagnostic criteria in the HCC guidelines published by some Western countries. In Asian countries, serum biomarkers such as AFP, the Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), and des-γ-carboxyprothrombin (DCP) are still recommended for HCC surveillance and are being used as an adjunctive diagnostic tool in accordance with HCC guidelines. Moreover, novel biomarkers including Dickkopf-1 (DKK1), midkine (MDK), and microRNA (miRNA) are being studied in this regard. China accounts for 50% of HCC cases worldwide, so identifying biomarkers of HCC is paramount. Recent studies have indicated the clinical utility of simultaneous measurement of AFP and DCP for the early detection of HCC in China. They are predominantly used for cases caused by HBV infection. Additional large-scale prospective studies should be conducted to establish the utility of these biomarkers.
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Affiliation(s)
- Peipei Song
- a Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences , The University of Tokyo , Kashiwa-Shi , Chiba , Japan ;,b Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Qi Tang
- b Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Xiaobin Feng
- c Department of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , China
| | - Wei Tang
- b Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan ;,c Department of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , China
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50
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Ohri N, Dawson LA, Krishnan S, Seong J, Cheng JC, Sarin SK, Kinkhabwala M, Ahmed MM, Vikram B, Coleman CN, Guha C. Radiotherapy for Hepatocellular Carcinoma: New Indications and Directions for Future Study. J Natl Cancer Inst 2016; 108:djw133. [PMID: 27377923 DOI: 10.1093/jnci/djw133] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/18/2016] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide; its incidence is increasing in the United States. Depending on disease extent and underlying liver status, patients may be treated with local, locoregional, and/or systemic therapy. Recent data indicates that radiotherapy (RT) can play a meaningful role in the management of HCC. Here, we review published experiences using RT for HCC, including the use of radiosensitizers and stereotactic RT. We discuss methods for performing preclinical studies of RT for HCC and biomarkers of response. As a part of the HCC Working Group, an informal committee of the National Cancer Institute's Radiation Research Program, we suggest how RT should be implemented in the management of HCC and identify future directions for the study of RT in HCC.
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Affiliation(s)
- Nitin Ohri
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Laura A Dawson
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sunil Krishnan
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jinsil Seong
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jason C Cheng
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Shiv K Sarin
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Milan Kinkhabwala
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mansoor M Ahmed
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bhadrasain Vikram
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - C Norman Coleman
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Chandan Guha
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD.
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