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Volume 22(1); March 2022
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Editorial
Is multidisciplinary treatment effective for hepatocellular carcinoma with portal vein tumor thrombus?
Won Hyeok Choe
J Liver Cancer. 2022;22(1):1-3.   Published online March 31, 2022
DOI: https://doi.org/10.17998/jlc.2022.03.15
  • 1,743 Views
  • 57 Downloads
PDF
Review Articles
Radioembolization for hepatocellular carcinoma: what clinicians need to know
Jin Woo Choi, Hyo-Cheol Kim
J Liver Cancer. 2022;22(1):4-13.   Published online February 23, 2022
DOI: https://doi.org/10.17998/jlc.2022.01.16
  • 2,564 Views
  • 137 Downloads
AbstractAbstract PDF
Transarterial radioembolization (TARE) with yttrium 90 (90Y) has been used in the management of hepatocellular carcinoma (HCC) for more than 10 years in Korea. There are two types of 90Y radioactive microspheres available, namely, glass and resin microspheres, with comparable clinical outcomes. In general, TARE outperforms transarterial chemoembolization regarding post-embolization syndrome, time to progression, tumor downsizing for liver transplantation, and hospitalization stay. Although TARE is commonly recommended for patients with unresectable large HCCs, it can be an alternative to or performed in combination with ablation, surgical resection, and systemic treatment. This review aimed to address 90Y radioactive microspheres, patient selection, clinical outcomes, simulation tests, radioembolization procedures, follow-up imaging, and complications.
A clinical and pathological update on hepatocellular carcinoma
Salvatore Lorenzo Renne, Luca Di Tommaso
J Liver Cancer. 2022;22(1):14-22.   Published online March 31, 2022
DOI: https://doi.org/10.17998/jlc.2022.03.18
  • 2,752 Views
  • 196 Downloads
  • 2 Citations
AbstractAbstract PDF
It is estimated that more than 1 million individuals will be affected annually by hepatocellular carcinoma (HCC) by 2025. HCC can be broadly grouped into two major molecular subgroups, each of which is characterized by specific morphological and phenotypic features that mirror the genetic background. The use of these tissue biomarkers in the daily practice of pathologists promises to better allocate patients with HCC with adequate treatments. In turn, this will likely boost the attitude of clinicians toward obtaining a pre-treatment biopsy.

Citations

Citations to this article as recorded by  
  • Identification of gallbladder cancer by direct near-infrared measurement of raw bile combined with two-trace two-dimensional correlation analysis
    Eunjin Jang, Woosuk Sohng, Dongho Choi, Hoeil Chung
    The Analyst.2023; 148(2): 374.     CrossRef
  • Measurement of Heavy Metal and Antioxidant-Oxidant Levels in Tissues Obtained From Three Different Localizations of Explant Hepatectomy of Patients With Hepatocellular Carcinoma
    Cemalettin Koc, Sami Akbulut, Kemal Baris Sarici, Muhammed Mehdi Uremis, Ufuk Gunay Dogan, Zeynep Kucukakcali, Ibrahim Umar Garzali, Ertugrul Karabulut, Yusuf Turkoz, Sezai Yilmaz
    Transplantation Proceedings.2023;[Epub]     CrossRef
Recent updates on the classification of hepatoblastoma according to the International Pediatric Liver Tumors Consensus
Se Un Jeong, Hyo Jeong Kang
J Liver Cancer. 2022;22(1):23-29.   Published online March 17, 2022
DOI: https://doi.org/10.17998/jlc.2022.02.24
  • 2,024 Views
  • 164 Downloads
AbstractAbstract PDF
Hepatoblastoma is the most common pediatric liver malignancy and usually occurs within the first 3 years of life. In recent years, the overall incidence of hepatoblastoma has exhibited the greatest increase among all pediatric malignancies worldwide. The diagnosis of hepatoblastoma may be challenging due to the lack of a current consensus classification system. The International Pediatric Liver Tumors Consensus introduced guidelines and a consensus classification for the diagnosis of hepatoblastoma as either epithelial or mixed epithelial and mesenchymal and in the updated 5th edition of the World Health Organization Classification of Digestive System Tumors.
Original Articles
Diagnostic performance of serum exosomal miRNA-720 in hepatocellular carcinoma
Jeong Won Jang, Ji Min Kim, Hye Seon Kim, Jin Seoub Kim, Ji Won Han, Soon Kyu Lee, Heechul Nam, Pil Soo Sung, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon
J Liver Cancer. 2022;22(1):30-39.   Published online March 21, 2022
DOI: https://doi.org/10.17998/jlc.2022.02.25
  • 1,939 Views
  • 89 Downloads
AbstractAbstract PDFSupplementary Material
Background
/Aim: Hepatocellular carcinoma (HCC) is associated with poor prognosis, largely due to late detection. Highly accurate biomarkers are urgently needed to detect early-stage HCC. Our study aims to explore the diagnostic performance of serum exosomal microRNA (miR)-720 in HCC.
Methods
Exosomal miRNA was measured via quantitative real-time PCR. A correlation analysis of exosomal miR-720 and tumor or clinico-demographic data of patients with HCC was performed. The receiver operating characteristic (ROC) curve was used to assess the diagnostic capacity of serum exosomal miR-720 for HCC, in comparison with α-fetoprotein (AFP) and prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II).
Results
MiR-720 was chosen as a potential HCC marker via miR microarray based on significant differential expression between tumor and non-tumor samples. Serum exosomal miR-720 was significantly upregulated in patients with HCC (n=114) versus other liver diseases (control, n=30), with a higher area under the ROC curve (AUC=0.931) than the other markers. Particularly, serum exosomal miR-720 showed superior performance in diagnosing small HCC (< 5 cm; AUC=0.930) compared with AFP (AUC=0.802) or PIVKA-II (AUC=0.718). Exosomal miR-720 levels showed marginal correlation with tumor size. The proportion of elevated miR-720 also increased with intrahepatic tumor stage progression. Unlike AFP or PIVKA-II showing a significant correlation with aminotransferase levels, the exosomal miR-720 level was not affected by aminotransferase levels.
Conclusions
Serum exosomal miR-720 is an excellent biomarker for the diagnosis of HCC, with better performance than AFP or PIVKA-II. Its diagnostic utility is maintained even in small HCC and is unaffected by aminotransferase levels.
The effects of immune checkpoint modulators on the clinical course of patients with resectable hepatocellular carcinoma
Jihyun An, Hyo Jeong Kang, Eunsil Yu, Han Chu Lee, Ju Hyun Shim
J Liver Cancer. 2022;22(1):40-50.   Published online March 17, 2022
DOI: https://doi.org/10.17998/jlc.2022.03.06
  • 1,560 Views
  • 82 Downloads
AbstractAbstract PDFSupplementary Material
Background
/Aim: Immune checkpoint proteins regulating T-cell mediated anti-tumor immunity have been reported to affect clinical outcomes in multiple malignancies. This study aimed to investigate the prognostic effect of histological expression of immune checkpoint proteins in patients with resected hepatocellular carcinoma (HCC).
Methods
A total of 221 patients with HCC who underwent curative resection were included. Expression of programmed-cell death ligand-1 (PD-L1) in tumor cells (tPD-L1) and tumor infiltrating mononuclear cells (TIMCs) (iPD-L1), programmed-cell death-1 in TIMCs (iPD-1), and cytotoxic T lymphocyte antigen-4 in TIMCs (iCTLA-4) were measured immunohistochemically.
Results
Histo-positivity for iCTLA-4, iPD-1, iPD-L1, and tPD-L1 was 32.1%, 42.5%, 35.3%, and 14.9%, respectively. Multivariate logistic analyses revealed that male sex and tumor >5 cm were variables related to iCTLA-4 positivity (odds ratio [OR], 0.46 and 1.94, respectively; P<0.05). Poor differentiation was related to PD-L1 expression in both tumor cells and TIMCs (OR, 2.88 and 3.46, respectively; P<0.05). Microvascular invasion was significantly associated only with iPD-L1 (OR, 2.24; P<0.05). In time-dependent outcome analyses, expression of immune checkpoint proteins in TIMCs (i.e., iCTLA-4, iPD-1, and iPD-L1) was significantly related to longer overall survival and non-cancer-related survival (all P<0.05), but not to time-to-recurrence or cancer-specific deaths. Concurrent activation of the PD-1:PD-L1 and CTLA-4 pathways predicted improved outcomes in terms of overall survival and non-cancer related survival (P=0.06 and P=0.03, respectively).
Conclusions
Immune checkpoint proteins upregulated in TIMCs in HCC tissues have individual and additive effects in prolonging the survival of patients, specifically in terms of survival not related to cancer recurrence.
Case Reports
Complete response to local therapy for advanced hepatocellular carcinoma with lung metastasis: a case report
Daeun Kim, Seiyeon Park, Won Sohn, Hyun Pyo Hong, Byung Ik Kim
J Liver Cancer. 2022;22(1):51-56.   Published online January 27, 2022
DOI: https://doi.org/10.17998/jlc.2021.12.28
  • 1,453 Views
  • 59 Downloads
AbstractAbstract PDF
The concept of oligometastasis is widely accepted for various types of solid tumors; accordingly, better outcomes can be anticipated with aggressive local interventions. The treatment of advanced hepatocellular carcinoma (HCC) with extrahepatic metastasis is systemic therapy. However, treatment responses to systemic therapy are poor. Recently, a small number of metastatic cancers (oligometastasis) have been controlled by local therapy rather than systemic therapy. Our study reports a case of a 66-year-old male patient with advanced HCC with lung metastasis, which was treated with local therapy. There were less than four metastases in the lungs, which were treated with wedge resection, radiofrequency, and radiation therapy. He repeatedly underwent local therapy for lung oligometastasis and locoregional therapy for intrahepatic HCC rather than systemic therapy; control by local therapy was possible as his liver function was preserved with Child-Turcotte-Pugh class A.
A case report of advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy and sorafenib combination therapy followed by metastasectomy of lung and muscle metastases
Sang Yi Moon, Sang Young Han, Yang-Hyun Baek
J Liver Cancer. 2022;22(1):57-62.   Published online January 6, 2022
DOI: https://doi.org/10.17998/jlc.2021.12.20
  • 2,331 Views
  • 62 Downloads
AbstractAbstract PDF
Currently, various tyrosine kinase inhibitors and immune checkpoint inhibitors have been suggested in the treatment guidelines for advanced hepatocellular carcinoma (HCC). However, sorafenib was the only systemic drug approved 10 years ago. In 2010, a woman diagnosed with HCC rupture and multiple lung metastases visited our hospital. At the time of visiting our hospital, she had undergone transarterial chemoembolization at another hospital to control bleeding due to HCC rupture. We treated her with hepatic arterial infusion chemotherapy and sorafenib combination therapy to increase the control of intrahepatic tumors in consideration of the modest efficacy of sorafenib. The intrahepatic tumor was almost controlled. Metastasectomy was performed to control lung oligometastasis. Subsequently, additional muscle metastasis was confirmed, and metastasectomy was performed. Although this is a very rare case, it shows that a multidisciplinary approach can improve the prognosis of patients with HCC.
Sorafenib combined with radiation therapy for advanced hepatocellular carcinoma with portal and hepatic vein invasion extending to the inferior vena cava: a complete response case according to modified RECIST criteria
Yuri Cho, Bo Hyun Kim, Tae Hyun Kim, Young Hwan Koh, Joong-Won Park
J Liver Cancer. 2022;22(1):63-68.   Published online February 14, 2022
DOI: https://doi.org/10.17998/jlc.2022.01.18
  • 1,435 Views
  • 65 Downloads
  • 1 Citation
AbstractAbstract PDF
The prognosis of patients with advanced hepatocellular carcinoma (HCC) with tumor thrombus extending to the inferior vena cava (IVC) is extremely poor. Herein, we present a rare case of advanced HCC that was treated with sorafenib and radiotherapy, leading to complete remission. This patient had a 9 cm infiltrative HCC occupying almost the entire left lobe with a tumor thrombus extending through the hepatic vein, IVC, and left portal vein. The patient received 400 mg sorafenib twice daily. One year after the start of sorafenib, intensity-modulated radiation therapy for viable HCC and tumor thrombus was performed with a dose of 5,500 cGy. Twenty-seven months after the starting date of sorafenib, there was no intratumoral arterial enhancement, which suggested a complete response according to the modified RECIST criteria. This case suggests that the combination of sorafenib and radiotherapy might provide clinical benefits in patients with advanced HCC with IVC tumor thrombus.

Citations

Citations to this article as recorded by  
  • Is multidisciplinary treatment effective for hepatocellular carcinoma with portal vein tumor thrombus?
    Won Hyeok Choe
    Journal of Liver Cancer.2022; 22(1): 1.     CrossRef
Concurrent transarterial radioembolization and combination atezolizumab/ bevacizumab treatment of infiltrative hepatocellular carcinoma with portal vein tumor thrombosis: a case report
Min Kyung Park, Su Jong Yu
J Liver Cancer. 2022;22(1):69-74.   Published online March 21, 2022
DOI: https://doi.org/10.17998/jlc.2022.03.09
  • 1,628 Views
  • 54 Downloads
  • 1 Citation
AbstractAbstract PDF
Treatment options for advanced hepatocellular carcinoma (HCC) have been rapidly evolving. Herein, we describe a patient with advanced HCC and portal vein tumor thrombosis (PVTT) who responded decisively to a multidisciplinary approach. The patient had an ill-defined infiltrative HCC (diffuse subtype), with several intrahepatic metastasis and tumor invasion of left portal vein. Concurrent use of transarterial radioembolization (TARE) and systemic therapeutics (atezolizumab + bevacizumab) ultimately proved successful. There was marked reduction in tumor volume after TARE and an additional three cycles of atezolizumab plus bevacizumab. This concurrent treatment was well tolerated, without adverse events during immunotherapy. The impressive results achieved suggest that concurrent TARE and combination atezolizumab/bevacizumab is a promising treatment approach for advanced HCC with PVTT.

Citations

Citations to this article as recorded by  
  • Is multidisciplinary treatment effective for hepatocellular carcinoma with portal vein tumor thrombus?
    Won Hyeok Choe
    Journal of Liver Cancer.2022; 22(1): 1.     CrossRef
Multidisciplinary treatment with immune checkpoint inhibitors for advanced stage hepatocellular carcinoma
Ahlim Lee, Jaejun Lee, Hyun Yang, Soo-Yoon Sung, Chang Ho Jeon, Su Ho Kim, Moon Hyung Choi, Young Joon Lee, Ho Jong Chun, Si Hyun Bae
J Liver Cancer. 2022;22(1):75-83.   Published online March 18, 2022
DOI: https://doi.org/10.17998/jlc.2022.03.04
  • 1,814 Views
  • 56 Downloads
  • 1 Citation
AbstractAbstract PDF
Hepatocellular carcinoma (HCC) is a cytotoxic chemotherapy-resistant tumor and most HCCs arise in a background of liver cirrhosis of various causes. Although the IMBrave150 trial showed remarkable advancements in the treatment of unresectable HCC with atezolizumab plus bevacizumab (AteBeva), therapeutic outcomes were unsatisfactory in more than half of the patients. Accordingly, many ongoing trials combine conventional modalities with new drugs such as immune checkpoint inhibitors for better treatment outcomes, and they are expected to benefit patients with limited responses to conventional treatment. Here, two patients with advanced stage HCC with preserved liver function and good performance status showed partial response after treatment with combination or sequential therapy of AteBeva, hepatic arterial infusion chemotherapy, radiation therapy, and transarterial chemoembolization. These findings indicate the efficacy of multidisciplinary treatment against advanced HCC. Additional studies are required to establish optimal treatment strategies.

Citations

Citations to this article as recorded by  
  • Is multidisciplinary treatment effective for hepatocellular carcinoma with portal vein tumor thrombus?
    Won Hyeok Choe
    Journal of Liver Cancer.2022; 22(1): 1.     CrossRef
Long-term survival after CCRT and HAIC followed by ALPPS for hepatocellular carcinoma with portal vein invasion: a case report
In-Jung Kim, Sung Hwan Yoo, Jung Il Lee, Kwan Sik Lee, Hyun Woong Lee, Jin Hong Lim
J Liver Cancer. 2022;22(1):84-90.   Published online March 22, 2022
DOI: https://doi.org/10.17998/jlc.2022.03.07
  • 1,225 Views
  • 46 Downloads
  • 1 Citation
AbstractAbstract PDF
There are various methods for treating advanced hepatocellular carcinoma with portal vein invasion, such as systemic chemotherapy, transarterial chemoembolization, transarterial radioembolization, and concurrent chemoradiotherapy. These methods have similar clinical efficacy but are designed with a palliative aim. Herein, we report a case that experienced complete remission through “associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)” after concurrent chemoradiotherapy and hepatic artery infusion chemotherapy. In this patient, concurrent chemoradiotherapy and hepatic artery infusion chemotherapy induced substantial tumor shrinkage, and hypertrophy of the nontumor liver was sufficiently induced by portal vein ligation (stage 1 surgery) followed by curative resection (stage 2 surgery). Using this approach, long-term survival with no evidence of recurrence was achieved at 16 months. Therefore, the optimal use of ALPPS requires sufficient consideration in cases of significant hepatocellular carcinoma shrinkage for curative purposes.

Citations

Citations to this article as recorded by  
  • Is multidisciplinary treatment effective for hepatocellular carcinoma with portal vein tumor thrombus?
    Won Hyeok Choe
    Journal of Liver Cancer.2022; 22(1): 1.     CrossRef

JLC : Journal of Liver Cancer