Journal of Liver Cancer

Original Article

Downstaging with atezolizumab-bevacizumab: a case series: Anand V. Kulkarni, Parthasarathy Kumaraswamy, Balachandran Menon, Anuradha Sekaran, Anuhya Rambhatla, Sowmya Iyengar, Manasa Alla, Shantan Venishetty, Sumana Kolar Ramachandra, Giri V. Premkumar, Mithun Sharma, P. Nagaraja Rao, Duvvur Nageshwar Reddy, Amit G. Singal; J Liver Cancer. 2024;24(2):224-233. Published online May 27, 2024; DOI: https://doi.org/10.17998/jlc.2024.05.12

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Backgrounds/Aims
Hepatocellular carcinoma (HCC) is generally diagnosed at an advanced stage, which limits curative treatment options for these patients. Locoregional therapy (LRT) is the standard approach to bridge and downstage unresectable HCC for liver transplantation (LT). Atezolizumab-bevacizumab (atezo-bev) can induce objective responses in nearly one-third of patients; however, the role and outcomes of downstaging using atezo-bev remains unknown.
Methods
In this retrospective single-center study, we included consecutive patients between November 2020 and August 2023, who received atezo-bev with or without LRT and were subsequently considered for resection/LT after downstaging.
Results
Of the 115 patients who received atezo-bev, 12 patients (10.4%) achieved complete or partial response and were willing to undergo LT; they (age, 58.5 years; women, 17%; Barcelona Clinic Liver Cancer stage system B/C, 5/7) had received 3-12 cycles of atezo- bev, and four of them had received prior LRT. Three patients died before LT, while three were awaiting LT. Six patients underwent curative therapies: four underwent living donor LT after a median of 79.5 days (range, 54-114) following the last atezo-bev dose, one underwent deceased donor LT 38 days after the last dose, and one underwent resection. All but one patient had complete pathologic response with no viable HCC. Three patients experienced wound healing complications, and one required re-exploration and succumbed to sepsis. After a median follow-up of 10 months (range, 4-30), none of the alive patients developed HCC recurrence or graft rejection.
Conclusions
Surgical therapy, including LT, is possible after atezo-bev therapy in well-selected patients after downstaging.

Citations

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Case Report

Metastatic papillary renal cell carcinoma with portal vein tumor thrombosis confirmed on blind liver biopsy: Hun Kim, Tae Hoon Roh, Jun Seop Lee, Min Seong Kim, Beom Kyung Kim; J Liver Cancer. 2024;24(1):113-117. Published online November 29, 2023; DOI: https://doi.org/10.17998/jlc.2023.11.05

5,813 Views
127 Downloads
2 Citations

Abstract PDF

Portal vein tumor thrombosis (PVTT) is an uncommon condition in which tumor cells expand into the vessels, causing blood clot formation in the portal vein. PVTT is mainly associated with hepatocellular carcinoma, leading to an unfavorable prognosis; however, it can also develop in patients with other cancer types. Herein, we report a case of metastatic renal cell carcinoma diagnosed by a blind liver biopsy in a patient with dynamic computed tomography-confirmed portal vein thrombosis and cholangiopathy. This case illustrates the importance of systematic surveillance with routine laboratory tests and contrast-enhanced imaging studies on patients with cancer to detect potential liver infiltration of metastatic cancer.

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Review Articles

Liquid biopsy for early detection and therapeutic monitoring of hepatocellular carcinoma: Eun-Ji Choi, Young-Joon Kim; J Liver Cancer. 2022;22(2):103-114. Published online September 22, 2022; DOI: https://doi.org/10.17998/jlc.2022.09.08

14,318 Views
235 Downloads
15 Citations

Abstract PDF Supplementary Material

Advances in our knowledge of the molecular characteristics of hepatocellular carcinoma (HCC) have enabled significant progress in the detection and therapeutic prediction of HCC. As a non-invasive alternative to tissue biopsy, liquid biopsy examines circulating cellular components such as exosomes, nucleic acids, and cell-free DNA found in body fluids (e.g., urine, saliva, ascites, and pleural effusions) and provides information about tumor characteristics. Technical advances in liquid biopsy have led to the increasing adoption of diagnostic and monitoring applications for HCC. This review summarizes the various analytes, ongoing clinical trials, and case studies of United States Food and Drug Administrationapproved in vitro diagnostic applications for liquid biopsy, and provides insight into its implementation in managing HCC.

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Update on Pathologic and Radiologic Diagnosis of Combined Hepatocellular-Cholangiocarcinoma: Hyungjin Rhee, Jae Hyon Park, Young Nyun Park; J Liver Cancer. 2021;21(1):12-24. Published online March 31, 2021; DOI: https://doi.org/10.17998/jlc.21.1.12

10,521 Views
369 Downloads
5 Citations

Abstract PDF

Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a malignant primary liver carcinoma characterized by the unequivocal presence of both hepatocytic and cholangiocytic differentiation within the same tumor. Recent research has highlighted that cHCC-CCAs are more heterogeneous than previously expected. In the updated consensus terminology and WHO 2019 classification, “classical type” and “subtypes with stem-cell features” of the WHO 2010 classification are no longer recommended. Instead, it is recommended that the presence and percentages of various histopathologic components and stem-cell features be mentioned in the pathologic report. The new terminology and classification enable the exchange of clearer and more objective information about cHCC-CCAs, facilitating multi-center and multinational research. However, there are limitations to the diagnosis of cHCC-CCA by imaging and biopsy. cHCC-CCAs showing typical imaging findings of HCC could be misdiagnosed as HCC and subjected to inappropriate treatment, if other clinical findings are not sufficiently considered. cHCC-CCAs showing at least one of the CCA-like imaging features or unusual clinical features should be subjected to biopsy. There may be a sampling error for the biopsy diagnosis of cHCC-CCA. An optimized diagnostic algorithm integrating clinical, radiological, and histopathologic information of biopsy is required to resolve these diagnostic pitfalls.

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Case Reports

A Case of Benign Hepatic Nodule Difficult to Differenciate from Hepatocellular Carcinoma: Byoung Kuk Jang, Woo Jin Chung, Kyung Sik Park, Kwang Bum Cho, Jae Seok Hwang, Sung Hoon Ahn, Young Hwan Kim, Jung Hyeok Kwon, Yu Na Kang; Journal of the Korean Liver Cancer Study Group. 2007;7(1):45-48. Published online June 30, 2007

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Abstract PDF: Improved imaging techniques have led to increasing detection of hepatic nodules incidentally. In many cases, a lesion that has been detected by imaging studies is not sufficiently characteristic, or there are other clinical concern, so that an imaging guided percutaneous needle biopsy is performed for definitive diagnosis. But sometimes, there are diagnostic difficulty due to limited diagnostic samples. We report a case of diagnosis to benign nodule, but not confirmed specific disease, by repeated CT guided fine needle biopsy.

Treatment of Hepatocellular Carcinoma with Arterioportal Shunt after Percutaneous Needle Biopsy: Sang-Hyung Cho, Jae-Hee Cheon, Hong-Suk Park, Seong-Hoon Kim, Sang-Jae Park, Woo-Jin Lee, Eun-Kyung Hong, Joong-Won Park, Chang-Min Kim; Journal of the Korean Liver Cancer Study Group. 2004;4(1):20-23. Published online June 30, 2004

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6 Downloads

Abstract PDF: A 51-year-old male was referred to our hospital for further evaluation and treatment of a liver mass. He was a heavy alcoholic. Laboratory findings revealed that anti-HCV was positive, and AFP is below 400 ng/mL. We performed CT scan that showed multiple nodules in the right lobe. Among them, the nodule in the segment Ⅷ showed incomplete enhancement at the arterial phase. Hence, we performed percutaneous needle biopsy for this nodule, and pathologically proved to hepatocellular carcinoma of Edmonson-Steiner grade Ⅱ/Ⅳ. We performed transcatheter arterial chemoembolization(TACE) for multiple hepatocellular carcinomas. Angiography showed nodular tumor staining and arterioportal shunt and arteriovenous shunts at the biopsy site in the segment Ⅷ. We occluded the shunts by using Lipiodol and gelform mixtures and then performed TACE. After TACE, angiography did not show either residual tumor staining or arterioportal and arteriovenous shunts.

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