Hepatocellular Carcinoma

Orimo and colleagues addressed the use of liver resection in patients with more than one HCC in the liver. Patients with no or Child-Pugh A/B cirrhosis were included in this single-center retrospective study of 1088 patients who underwent hepatectomy for Barcelona Clinic Liver Cancer (BCLC) stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B subcategorized into A1 (single nodule 2-5 cm or ≤ 3 nodules ≤ 3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥ 10 cm), B1 (2-3 nodules > 3 cm), and B2 (≥ 4 nodules). The 5-year overall survival (OS) rates for stage 0, A1, A2, A3, B1, and B2 patients were 70.4%, 74.2%, 63.8%, 47.7%, 47.5%, and 31.9%, respectively (P < .0001). Significant differences in overall survival (OS) were found between stages A1 and A2 (P = .0118), A2 and A3 (P = .0013), and B1 and B2 (P = .0050), but not between stages A3 and B1 (P = .4742). In stage B1 patients, Child-Pugh B cirrhosis was the only independent prognostic factor for OS. The authors concluded that hepatectomy is beneficial in patients with three or fewer hepatocellular carcinomas and either no or Child-Pugh class A cirrhosis, with the long-term results being comparable to those in patients who underwent a resection of a single HCC. Therefore, resection of up to three HCC is safe and should be considered in clinically appropriate patients.

Many patients with multifocal HCC are not eligible for liver-directed therapies. The standard of care for first-line systemic therapy is the combination of atezolizumab and bevacizumab, as reported in the IMbrave150 clinical trial. Fulgenzi and colleagues published the results of a multicenter prospective observational study, AB-Real, that included 433 patients who received atezolizumab and bevacizumab in routine clinical practice. The investigators confirmed the efficacy of the combination and found that portal vein tumor thrombosis and worse albumin-bilirubin grade were independent prognostic factors for poor OS and were associated with an increased risk for hemorrhagic events. In addition, the authors reported that the overall response rate (ORR) predicted better outcomes, including longer OS. Therefore, atezolizumab and bevacizumab remains a safe and effective first-line treatment for many patients with unresectable HCC.

Finally, Finn and colleagues reported the results of an open-label, noncomparative cohort of the REACH-2 study of ramucirumab in 47 patients with advanced HCC and an alpha-fetoprotein (AFP) level ≥ 400 ng/mL. These patients had previously received one to two lines of systemic therapy, excluding sorafenib or chemotherapy. Lenvatinib was the most common prior systemic therapy (n = 20; 43%). Others included immune checkpoint inhibitor (CPI) monotherapies (n = 11), CPI/antiangiogenic therapy (n = 14), or dual CPI therapy (n = 5). The ORR was 10.6% (95% CI 1.8-19.5) and disease control rate was 46.8% (95% CI 32.5-61.1), with a median duration of response of 8.3 months [95% CI 2.4 to not reached). The grade 3 or more adverse event rate was 57%, with hypertension (11%) being the most common, allowing the authors to conclude that ramucirumab offers clinically significant efficacy with no new safety signals in this setting. Therefore, ramucirumab remains as a safe and effective later-line treatment option for patients with unresectable HCC and an AFP ≥ 400 ng/mL.

Orimo and colleagues addressed the use of liver resection in patients with more than one HCC in the liver. Patients with no or Child-Pugh A/B cirrhosis were included in this single-center retrospective study of 1088 patients who underwent hepatectomy for Barcelona Clinic Liver Cancer (BCLC) stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B subcategorized into A1 (single nodule 2-5 cm or ≤ 3 nodules ≤ 3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥ 10 cm), B1 (2-3 nodules > 3 cm), and B2 (≥ 4 nodules). The 5-year overall survival (OS) rates for stage 0, A1, A2, A3, B1, and B2 patients were 70.4%, 74.2%, 63.8%, 47.7%, 47.5%, and 31.9%, respectively (P < .0001). Significant differences in overall survival (OS) were found between stages A1 and A2 (P = .0118), A2 and A3 (P = .0013), and B1 and B2 (P = .0050), but not between stages A3 and B1 (P = .4742). In stage B1 patients, Child-Pugh B cirrhosis was the only independent prognostic factor for OS. The authors concluded that hepatectomy is beneficial in patients with three or fewer hepatocellular carcinomas and either no or Child-Pugh class A cirrhosis, with the long-term results being comparable to those in patients who underwent a resection of a single HCC. Therefore, resection of up to three HCC is safe and should be considered in clinically appropriate patients.

Many patients with multifocal HCC are not eligible for liver-directed therapies. The standard of care for first-line systemic therapy is the combination of atezolizumab and bevacizumab, as reported in the IMbrave150 clinical trial. Fulgenzi and colleagues published the results of a multicenter prospective observational study, AB-Real, that included 433 patients who received atezolizumab and bevacizumab in routine clinical practice. The investigators confirmed the efficacy of the combination and found that portal vein tumor thrombosis and worse albumin-bilirubin grade were independent prognostic factors for poor OS and were associated with an increased risk for hemorrhagic events. In addition, the authors reported that the overall response rate (ORR) predicted better outcomes, including longer OS. Therefore, atezolizumab and bevacizumab remains a safe and effective first-line treatment for many patients with unresectable HCC.

Finally, Finn and colleagues reported the results of an open-label, noncomparative cohort of the REACH-2 study of ramucirumab in 47 patients with advanced HCC and an alpha-fetoprotein (AFP) level ≥ 400 ng/mL. These patients had previously received one to two lines of systemic therapy, excluding sorafenib or chemotherapy. Lenvatinib was the most common prior systemic therapy (n = 20; 43%). Others included immune checkpoint inhibitor (CPI) monotherapies (n = 11), CPI/antiangiogenic therapy (n = 14), or dual CPI therapy (n = 5). The ORR was 10.6% (95% CI 1.8-19.5) and disease control rate was 46.8% (95% CI 32.5-61.1), with a median duration of response of 8.3 months [95% CI 2.4 to not reached). The grade 3 or more adverse event rate was 57%, with hypertension (11%) being the most common, allowing the authors to conclude that ramucirumab offers clinically significant efficacy with no new safety signals in this setting. Therefore, ramucirumab remains as a safe and effective later-line treatment option for patients with unresectable HCC and an AFP ≥ 400 ng/mL.

Orimo and colleagues addressed the use of liver resection in patients with more than one HCC in the liver. Patients with no or Child-Pugh A/B cirrhosis were included in this single-center retrospective study of 1088 patients who underwent hepatectomy for Barcelona Clinic Liver Cancer (BCLC) stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B subcategorized into A1 (single nodule 2-5 cm or ≤ 3 nodules ≤ 3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥ 10 cm), B1 (2-3 nodules > 3 cm), and B2 (≥ 4 nodules). The 5-year overall survival (OS) rates for stage 0, A1, A2, A3, B1, and B2 patients were 70.4%, 74.2%, 63.8%, 47.7%, 47.5%, and 31.9%, respectively (P < .0001). Significant differences in overall survival (OS) were found between stages A1 and A2 (P = .0118), A2 and A3 (P = .0013), and B1 and B2 (P = .0050), but not between stages A3 and B1 (P = .4742). In stage B1 patients, Child-Pugh B cirrhosis was the only independent prognostic factor for OS. The authors concluded that hepatectomy is beneficial in patients with three or fewer hepatocellular carcinomas and either no or Child-Pugh class A cirrhosis, with the long-term results being comparable to those in patients who underwent a resection of a single HCC. Therefore, resection of up to three HCC is safe and should be considered in clinically appropriate patients.

Many patients with multifocal HCC are not eligible for liver-directed therapies. The standard of care for first-line systemic therapy is the combination of atezolizumab and bevacizumab, as reported in the IMbrave150 clinical trial. Fulgenzi and colleagues published the results of a multicenter prospective observational study, AB-Real, that included 433 patients who received atezolizumab and bevacizumab in routine clinical practice. The investigators confirmed the efficacy of the combination and found that portal vein tumor thrombosis and worse albumin-bilirubin grade were independent prognostic factors for poor OS and were associated with an increased risk for hemorrhagic events. In addition, the authors reported that the overall response rate (ORR) predicted better outcomes, including longer OS. Therefore, atezolizumab and bevacizumab remains a safe and effective first-line treatment for many patients with unresectable HCC.

Finally, Finn and colleagues reported the results of an open-label, noncomparative cohort of the REACH-2 study of ramucirumab in 47 patients with advanced HCC and an alpha-fetoprotein (AFP) level ≥ 400 ng/mL. These patients had previously received one to two lines of systemic therapy, excluding sorafenib or chemotherapy. Lenvatinib was the most common prior systemic therapy (n = 20; 43%). Others included immune checkpoint inhibitor (CPI) monotherapies (n = 11), CPI/antiangiogenic therapy (n = 14), or dual CPI therapy (n = 5). The ORR was 10.6% (95% CI 1.8-19.5) and disease control rate was 46.8% (95% CI 32.5-61.1), with a median duration of response of 8.3 months [95% CI 2.4 to not reached). The grade 3 or more adverse event rate was 57%, with hypertension (11%) being the most common, allowing the authors to conclude that ramucirumab offers clinically significant efficacy with no new safety signals in this setting. Therefore, ramucirumab remains as a safe and effective later-line treatment option for patients with unresectable HCC and an AFP ≥ 400 ng/mL.

Orimo and colleagues addressed the use of liver resection in patients with more than one HCC in the liver. Patients with no or Child-Pugh A/B cirrhosis were included in this single-center retrospective study of 1088 patients who underwent hepatectomy for Barcelona Clinic Liver Cancer (BCLC) stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B subcategorized into A1 (single nodule 2-5 cm or ≤ 3 nodules ≤ 3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥ 10 cm), B1 (2-3 nodules > 3 cm), and B2 (≥ 4 nodules). The 5-year overall survival (OS) rates for stage 0, A1, A2, A3, B1, and B2 patients were 70.4%, 74.2%, 63.8%, 47.7%, 47.5%, and 31.9%, respectively (P < .0001). Significant differences in overall survival (OS) were found between stages A1 and A2 (P = .0118), A2 and A3 (P = .0013), and B1 and B2 (P = .0050), but not between stages A3 and B1 (P = .4742). In stage B1 patients, Child-Pugh B cirrhosis was the only independent prognostic factor for OS. The authors concluded that hepatectomy is beneficial in patients with three or fewer hepatocellular carcinomas and either no or Child-Pugh class A cirrhosis, with the long-term results being comparable to those in patients who underwent a resection of a single HCC. Therefore, resection of up to three HCC is safe and should be considered in clinically appropriate patients.

Many patients with multifocal HCC are not eligible for liver-directed therapies. The standard of care for first-line systemic therapy is the combination of atezolizumab and bevacizumab, as reported in the IMbrave150 clinical trial. Fulgenzi and colleagues published the results of a multicenter prospective observational study, AB-Real, that included 433 patients who received atezolizumab and bevacizumab in routine clinical practice. The investigators confirmed the efficacy of the combination and found that portal vein tumor thrombosis and worse albumin-bilirubin grade were independent prognostic factors for poor OS and were associated with an increased risk for hemorrhagic events. In addition, the authors reported that the overall response rate (ORR) predicted better outcomes, including longer OS. Therefore, atezolizumab and bevacizumab remains a safe and effective first-line treatment for many patients with unresectable HCC.

Finally, Finn and colleagues reported the results of an open-label, noncomparative cohort of the REACH-2 study of ramucirumab in 47 patients with advanced HCC and an alpha-fetoprotein (AFP) level ≥ 400 ng/mL. These patients had previously received one to two lines of systemic therapy, excluding sorafenib or chemotherapy. Lenvatinib was the most common prior systemic therapy (n = 20; 43%). Others included immune checkpoint inhibitor (CPI) monotherapies (n = 11), CPI/antiangiogenic therapy (n = 14), or dual CPI therapy (n = 5). The ORR was 10.6% (95% CI 1.8-19.5) and disease control rate was 46.8% (95% CI 32.5-61.1), with a median duration of response of 8.3 months (95% CI 2.4 to not reached). The grade 3 or more adverse event rate was 57%, with hypertension (11%) being the most common, allowing the authors to conclude that ramucirumab offers clinically significant efficacy with no new safety signals in this setting. Therefore, ramucirumab remains as a safe and effective later-line treatment option for patients with unresectable HCC and an AFP ≥ 400 ng/mL.

Orimo and colleagues addressed the use of liver resection in patients with more than one HCC in the liver. Patients with no or Child-Pugh A/B cirrhosis were included in this single-center retrospective study of 1088 patients who underwent hepatectomy for Barcelona Clinic Liver Cancer (BCLC) stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B subcategorized into A1 (single nodule 2-5 cm or ≤ 3 nodules ≤ 3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥ 10 cm), B1 (2-3 nodules > 3 cm), and B2 (≥ 4 nodules). The 5-year overall survival (OS) rates for stage 0, A1, A2, A3, B1, and B2 patients were 70.4%, 74.2%, 63.8%, 47.7%, 47.5%, and 31.9%, respectively (P < .0001). Significant differences in overall survival (OS) were found between stages A1 and A2 (P = .0118), A2 and A3 (P = .0013), and B1 and B2 (P = .0050), but not between stages A3 and B1 (P = .4742). In stage B1 patients, Child-Pugh B cirrhosis was the only independent prognostic factor for OS. The authors concluded that hepatectomy is beneficial in patients with three or fewer hepatocellular carcinomas and either no or Child-Pugh class A cirrhosis, with the long-term results being comparable to those in patients who underwent a resection of a single HCC. Therefore, resection of up to three HCC is safe and should be considered in clinically appropriate patients.

Many patients with multifocal HCC are not eligible for liver-directed therapies. The standard of care for first-line systemic therapy is the combination of atezolizumab and bevacizumab, as reported in the IMbrave150 clinical trial. Fulgenzi and colleagues published the results of a multicenter prospective observational study, AB-Real, that included 433 patients who received atezolizumab and bevacizumab in routine clinical practice. The investigators confirmed the efficacy of the combination and found that portal vein tumor thrombosis and worse albumin-bilirubin grade were independent prognostic factors for poor OS and were associated with an increased risk for hemorrhagic events. In addition, the authors reported that the overall response rate (ORR) predicted better outcomes, including longer OS. Therefore, atezolizumab and bevacizumab remains a safe and effective first-line treatment for many patients with unresectable HCC.

Finally, Finn and colleagues reported the results of an open-label, noncomparative cohort of the REACH-2 study of ramucirumab in 47 patients with advanced HCC and an alpha-fetoprotein (AFP) level ≥ 400 ng/mL. These patients had previously received one to two lines of systemic therapy, excluding sorafenib or chemotherapy. Lenvatinib was the most common prior systemic therapy (n = 20; 43%). Others included immune checkpoint inhibitor (CPI) monotherapies (n = 11), CPI/antiangiogenic therapy (n = 14), or dual CPI therapy (n = 5). The ORR was 10.6% (95% CI 1.8-19.5) and disease control rate was 46.8% (95% CI 32.5-61.1), with a median duration of response of 8.3 months (95% CI 2.4 to not reached). The grade 3 or more adverse event rate was 57%, with hypertension (11%) being the most common, allowing the authors to conclude that ramucirumab offers clinically significant efficacy with no new safety signals in this setting. Therefore, ramucirumab remains as a safe and effective later-line treatment option for patients with unresectable HCC and an AFP ≥ 400 ng/mL.

Orimo and colleagues addressed the use of liver resection in patients with more than one HCC in the liver. Patients with no or Child-Pugh A/B cirrhosis were included in this single-center retrospective study of 1088 patients who underwent hepatectomy for Barcelona Clinic Liver Cancer (BCLC) stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B subcategorized into A1 (single nodule 2-5 cm or ≤ 3 nodules ≤ 3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥ 10 cm), B1 (2-3 nodules > 3 cm), and B2 (≥ 4 nodules). The 5-year overall survival (OS) rates for stage 0, A1, A2, A3, B1, and B2 patients were 70.4%, 74.2%, 63.8%, 47.7%, 47.5%, and 31.9%, respectively (P < .0001). Significant differences in overall survival (OS) were found between stages A1 and A2 (P = .0118), A2 and A3 (P = .0013), and B1 and B2 (P = .0050), but not between stages A3 and B1 (P = .4742). In stage B1 patients, Child-Pugh B cirrhosis was the only independent prognostic factor for OS. The authors concluded that hepatectomy is beneficial in patients with three or fewer hepatocellular carcinomas and either no or Child-Pugh class A cirrhosis, with the long-term results being comparable to those in patients who underwent a resection of a single HCC. Therefore, resection of up to three HCC is safe and should be considered in clinically appropriate patients.

Many patients with multifocal HCC are not eligible for liver-directed therapies. The standard of care for first-line systemic therapy is the combination of atezolizumab and bevacizumab, as reported in the IMbrave150 clinical trial. Fulgenzi and colleagues published the results of a multicenter prospective observational study, AB-Real, that included 433 patients who received atezolizumab and bevacizumab in routine clinical practice. The investigators confirmed the efficacy of the combination and found that portal vein tumor thrombosis and worse albumin-bilirubin grade were independent prognostic factors for poor OS and were associated with an increased risk for hemorrhagic events. In addition, the authors reported that the overall response rate (ORR) predicted better outcomes, including longer OS. Therefore, atezolizumab and bevacizumab remains a safe and effective first-line treatment for many patients with unresectable HCC.

Finally, Finn and colleagues reported the results of an open-label, noncomparative cohort of the REACH-2 study of ramucirumab in 47 patients with advanced HCC and an alpha-fetoprotein (AFP) level ≥ 400 ng/mL. These patients had previously received one to two lines of systemic therapy, excluding sorafenib or chemotherapy. Lenvatinib was the most common prior systemic therapy (n = 20; 43%). Others included immune checkpoint inhibitor (CPI) monotherapies (n = 11), CPI/antiangiogenic therapy (n = 14), or dual CPI therapy (n = 5). The ORR was 10.6% (95% CI 1.8-19.5) and disease control rate was 46.8% (95% CI 32.5-61.1), with a median duration of response of 8.3 months (95% CI 2.4 to not reached). The grade 3 or more adverse event rate was 57%, with hypertension (11%) being the most common, allowing the authors to conclude that ramucirumab offers clinically significant efficacy with no new safety signals in this setting. Therefore, ramucirumab remains as a safe and effective later-line treatment option for patients with unresectable HCC and an AFP ≥ 400 ng/mL.

Key clinical point: In patients receiving atezolizumab and bevacizumab for unresectable hepatocellular carcinoma (HCC), alpha-fetoprotein (AFP) responses of 50% and 20% served as predictors of overall response rate (ORR) and disease control rate (DCR), respectively, with both responses being associated with progression-free survival (PFS).

Major finding: An AFP relative decrease of ≥50% was associated with ORR (odds ratio 5.7; 95% CI 1.9-17) and PFS (hazard ratio [HR] 5.60; P  =  .006), whereas that of ≥20% was associated with DCR (positive predictive value 100%; sensitivity 52.0%) and PFS (HR 4.44; P < .001).

Study details: This multicenter prospective study included 91 patients with unresectable HCC and AFP ≥10 ng/mL who were treated with atezolizumab and bevacizumab.

Disclosures: This study was supported by the Japan Agency for Medical Research and Development. Two authors declared receiving lecture fees from a pharmaceutical company.

Source: Tamaki N et al. Optimal threshold of alpha-fetoprotein response in patients with unresectable hepatocellular carcinoma treated with atezolizumab and bevacizumab. Invest New Drugs. 2022 (Sep 24). Doi: 10.1007/s10637-022-01303-w

Key clinical point: In patients receiving atezolizumab and bevacizumab for unresectable hepatocellular carcinoma (HCC), alpha-fetoprotein (AFP) responses of 50% and 20% served as predictors of overall response rate (ORR) and disease control rate (DCR), respectively, with both responses being associated with progression-free survival (PFS).

Major finding: An AFP relative decrease of ≥50% was associated with ORR (odds ratio 5.7; 95% CI 1.9-17) and PFS (hazard ratio [HR] 5.60; P  =  .006), whereas that of ≥20% was associated with DCR (positive predictive value 100%; sensitivity 52.0%) and PFS (HR 4.44; P < .001).

Study details: This multicenter prospective study included 91 patients with unresectable HCC and AFP ≥10 ng/mL who were treated with atezolizumab and bevacizumab.

Disclosures: This study was supported by the Japan Agency for Medical Research and Development. Two authors declared receiving lecture fees from a pharmaceutical company.

Source: Tamaki N et al. Optimal threshold of alpha-fetoprotein response in patients with unresectable hepatocellular carcinoma treated with atezolizumab and bevacizumab. Invest New Drugs. 2022 (Sep 24). Doi: 10.1007/s10637-022-01303-w

Key clinical point: In patients receiving atezolizumab and bevacizumab for unresectable hepatocellular carcinoma (HCC), alpha-fetoprotein (AFP) responses of 50% and 20% served as predictors of overall response rate (ORR) and disease control rate (DCR), respectively, with both responses being associated with progression-free survival (PFS).

Major finding: An AFP relative decrease of ≥50% was associated with ORR (odds ratio 5.7; 95% CI 1.9-17) and PFS (hazard ratio [HR] 5.60; P  =  .006), whereas that of ≥20% was associated with DCR (positive predictive value 100%; sensitivity 52.0%) and PFS (HR 4.44; P < .001).

Study details: This multicenter prospective study included 91 patients with unresectable HCC and AFP ≥10 ng/mL who were treated with atezolizumab and bevacizumab.

Disclosures: This study was supported by the Japan Agency for Medical Research and Development. Two authors declared receiving lecture fees from a pharmaceutical company.

Source: Tamaki N et al. Optimal threshold of alpha-fetoprotein response in patients with unresectable hepatocellular carcinoma treated with atezolizumab and bevacizumab. Invest New Drugs. 2022 (Sep 24). Doi: 10.1007/s10637-022-01303-w

Key clinical point: Cirrhosis is often unrecognized in patients diagnosed with hepatocellular carcinoma (HCC). Unrecognized cirrhosis is associated with more advanced HCC at diagnosis and a worse prognosis.

Major finding: Patients with unrecognized cirrhosis vs those with known cirrhosis diagnosed with HCC under surveillance had a significantly shorter median survival (0.89 years [95% CI 0.78-1.01] vs 3.79 years [95% CI 3.19-4.39]) and a higher mortality rate (adjusted hazard ratio 2.36; 95% CI 2.09-2.66).

Study details: This retrospective cohort study included 2670 adult patients with HCC and liver cirrhosis, of which 1033 had unrecognized cirrhosis at HCC diagnosis and 901 had known cirrhosis with HCC diagnosed under surveillance.

Disclosures: No source of funding was disclosed. The authors declared no conflicts of interest.

Source: Vaz J et al. Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients. J Intern Med. 2022 (Sep 27). Doi: 10.1111/joim.13570

Key clinical point: Cirrhosis is often unrecognized in patients diagnosed with hepatocellular carcinoma (HCC). Unrecognized cirrhosis is associated with more advanced HCC at diagnosis and a worse prognosis.

Major finding: Patients with unrecognized cirrhosis vs those with known cirrhosis diagnosed with HCC under surveillance had a significantly shorter median survival (0.89 years [95% CI 0.78-1.01] vs 3.79 years [95% CI 3.19-4.39]) and a higher mortality rate (adjusted hazard ratio 2.36; 95% CI 2.09-2.66).

Study details: This retrospective cohort study included 2670 adult patients with HCC and liver cirrhosis, of which 1033 had unrecognized cirrhosis at HCC diagnosis and 901 had known cirrhosis with HCC diagnosed under surveillance.

Disclosures: No source of funding was disclosed. The authors declared no conflicts of interest.

Source: Vaz J et al. Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients. J Intern Med. 2022 (Sep 27). Doi: 10.1111/joim.13570

Key clinical point: Cirrhosis is often unrecognized in patients diagnosed with hepatocellular carcinoma (HCC). Unrecognized cirrhosis is associated with more advanced HCC at diagnosis and a worse prognosis.

Major finding: Patients with unrecognized cirrhosis vs those with known cirrhosis diagnosed with HCC under surveillance had a significantly shorter median survival (0.89 years [95% CI 0.78-1.01] vs 3.79 years [95% CI 3.19-4.39]) and a higher mortality rate (adjusted hazard ratio 2.36; 95% CI 2.09-2.66).

Study details: This retrospective cohort study included 2670 adult patients with HCC and liver cirrhosis, of which 1033 had unrecognized cirrhosis at HCC diagnosis and 901 had known cirrhosis with HCC diagnosed under surveillance.

Disclosures: No source of funding was disclosed. The authors declared no conflicts of interest.

Source: Vaz J et al. Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients. J Intern Med. 2022 (Sep 27). Doi: 10.1111/joim.13570

Key clinical point: In patients with chronic hepatitis B virus (HBV) infection who have undergone curative liver resection for hepatocellular carcinoma (HCC), concurrent metabolic syndrome is associated with poorer long-term oncological outcomes.

Major finding: Patients with vs without metabolic syndrome had significantly lower 5-year overall survival (OS; P  =  .010) and recurrence-free survival (RFS; P  =  .003) rates and higher 5-year overall recurrence rate (P  =  .024). Concurrent metabolic syndrome was independently associated with poorer OS (adjusted hazard ratio [aHR] 1.300; P  =  .036) and RFS (aHR 1.314; P  =  .012) rates and increased late recurrence rate (aHR 1.470; P  =  .047).

Study details: Findings are from a multicenter cohort study including 1753 patients who underwent liver resection for HBV-related HCC, of which 163 patients had concurrent metabolic syndrome.

Disclosures: This study was funded by the National Natural Science Foundation of China, among others. No information on conflicts of interest was available.

Source: Wang MD et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: A multicenter study of 1753 patients. Ann Surg Oncol. 2022 (Sep 16). Doi: 10.1245/s10434-022-12529-6

Key clinical point: In patients with chronic hepatitis B virus (HBV) infection who have undergone curative liver resection for hepatocellular carcinoma (HCC), concurrent metabolic syndrome is associated with poorer long-term oncological outcomes.

Major finding: Patients with vs without metabolic syndrome had significantly lower 5-year overall survival (OS; P  =  .010) and recurrence-free survival (RFS; P  =  .003) rates and higher 5-year overall recurrence rate (P  =  .024). Concurrent metabolic syndrome was independently associated with poorer OS (adjusted hazard ratio [aHR] 1.300; P  =  .036) and RFS (aHR 1.314; P  =  .012) rates and increased late recurrence rate (aHR 1.470; P  =  .047).

Study details: Findings are from a multicenter cohort study including 1753 patients who underwent liver resection for HBV-related HCC, of which 163 patients had concurrent metabolic syndrome.

Disclosures: This study was funded by the National Natural Science Foundation of China, among others. No information on conflicts of interest was available.

Source: Wang MD et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: A multicenter study of 1753 patients. Ann Surg Oncol. 2022 (Sep 16). Doi: 10.1245/s10434-022-12529-6

Key clinical point: In patients with chronic hepatitis B virus (HBV) infection who have undergone curative liver resection for hepatocellular carcinoma (HCC), concurrent metabolic syndrome is associated with poorer long-term oncological outcomes.

Major finding: Patients with vs without metabolic syndrome had significantly lower 5-year overall survival (OS; P  =  .010) and recurrence-free survival (RFS; P  =  .003) rates and higher 5-year overall recurrence rate (P  =  .024). Concurrent metabolic syndrome was independently associated with poorer OS (adjusted hazard ratio [aHR] 1.300; P  =  .036) and RFS (aHR 1.314; P  =  .012) rates and increased late recurrence rate (aHR 1.470; P  =  .047).

Study details: Findings are from a multicenter cohort study including 1753 patients who underwent liver resection for HBV-related HCC, of which 163 patients had concurrent metabolic syndrome.

Disclosures: This study was funded by the National Natural Science Foundation of China, among others. No information on conflicts of interest was available.

Source: Wang MD et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: A multicenter study of 1753 patients. Ann Surg Oncol. 2022 (Sep 16). Doi: 10.1245/s10434-022-12529-6

Key clinical point: Abdominal ultrasonography (US) blind spots affect the initially detected hepatocellular carcinoma (HCC) tumor size, treatment strategy, and overall survival (OS) in patients with HCC who undergo regular surveillance.

Major finding: A significantly higher proportion of HCC tumors >2 cm were detected in blind vs non-blind spots (60.3% vs 47.1%; P  =  .001), with most being treated with hepatectomy (P < .001) vs radiofrequency ablation, respectively. Patients with HCC located in a blind spot in the US-detected vs US-missed group had a significantly better OS (P  =  .008).

Study details: This retrospective study included 1289 patients who underwent 6-month interval surveillance using US and serum alpha-fetoprotein and were eventually diagnosed with single-nodular Barcelona Clinic Liver Cancer stage 0-A HCC that was detected (n = 1062) or missed (n = 227) by US.

Disclosures: This study was supported by a grant from the Medical Science Research Institute, Kyung Hee University Hospital at Gangdong, South Korea. The authors declared no conflicts of interest.

Source: Lee J, Park SB, et al. Impact of ultrasonographic blind spots for early-stage hepatocellular carcinoma during surveillance. PLoS One. 2022;17(9):e0274747 (Sep 16). Doi: 10.1371/journal.pone.0274747

Key clinical point: Abdominal ultrasonography (US) blind spots affect the initially detected hepatocellular carcinoma (HCC) tumor size, treatment strategy, and overall survival (OS) in patients with HCC who undergo regular surveillance.

Major finding: A significantly higher proportion of HCC tumors >2 cm were detected in blind vs non-blind spots (60.3% vs 47.1%; P  =  .001), with most being treated with hepatectomy (P < .001) vs radiofrequency ablation, respectively. Patients with HCC located in a blind spot in the US-detected vs US-missed group had a significantly better OS (P  =  .008).

Study details: This retrospective study included 1289 patients who underwent 6-month interval surveillance using US and serum alpha-fetoprotein and were eventually diagnosed with single-nodular Barcelona Clinic Liver Cancer stage 0-A HCC that was detected (n = 1062) or missed (n = 227) by US.

Disclosures: This study was supported by a grant from the Medical Science Research Institute, Kyung Hee University Hospital at Gangdong, South Korea. The authors declared no conflicts of interest.

Source: Lee J, Park SB, et al. Impact of ultrasonographic blind spots for early-stage hepatocellular carcinoma during surveillance. PLoS One. 2022;17(9):e0274747 (Sep 16). Doi: 10.1371/journal.pone.0274747

Key clinical point: Abdominal ultrasonography (US) blind spots affect the initially detected hepatocellular carcinoma (HCC) tumor size, treatment strategy, and overall survival (OS) in patients with HCC who undergo regular surveillance.

Major finding: A significantly higher proportion of HCC tumors >2 cm were detected in blind vs non-blind spots (60.3% vs 47.1%; P  =  .001), with most being treated with hepatectomy (P < .001) vs radiofrequency ablation, respectively. Patients with HCC located in a blind spot in the US-detected vs US-missed group had a significantly better OS (P  =  .008).

Study details: This retrospective study included 1289 patients who underwent 6-month interval surveillance using US and serum alpha-fetoprotein and were eventually diagnosed with single-nodular Barcelona Clinic Liver Cancer stage 0-A HCC that was detected (n = 1062) or missed (n = 227) by US.

Disclosures: This study was supported by a grant from the Medical Science Research Institute, Kyung Hee University Hospital at Gangdong, South Korea. The authors declared no conflicts of interest.

Source: Lee J, Park SB, et al. Impact of ultrasonographic blind spots for early-stage hepatocellular carcinoma during surveillance. PLoS One. 2022;17(9):e0274747 (Sep 16). Doi: 10.1371/journal.pone.0274747

Key clinical point: Survival outcomes are unaffected by postoperative opioid use in patients who have undergone hepatectomy or liver transplantation for hepatocellular carcinoma (HCC).

Major finding: Patients who did vs did not receive opioids had no significant difference in overall survival (adjusted hazard ratio [aHR] 1.10; P  =  .478) or recurrence-free survival (aHR 1.15; P  =  .229).

Study details: This retrospective cohort study included 812 patients aged >20 years with HCC who underwent hepatectomy and did (n = 530) or did not (n = 282) receive opioids during the postoperative period.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Yeh PH et al. No association of postoperative opioid usage with long-term surgery outcomes in patients with liver cancer: A population-based retrospective cohort study. Pain. 2022 (Sep 8). Doi: 10.1097/j.pain.0000000000002776

Key clinical point: Survival outcomes are unaffected by postoperative opioid use in patients who have undergone hepatectomy or liver transplantation for hepatocellular carcinoma (HCC).

Major finding: Patients who did vs did not receive opioids had no significant difference in overall survival (adjusted hazard ratio [aHR] 1.10; P  =  .478) or recurrence-free survival (aHR 1.15; P  =  .229).

Study details: This retrospective cohort study included 812 patients aged >20 years with HCC who underwent hepatectomy and did (n = 530) or did not (n = 282) receive opioids during the postoperative period.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Yeh PH et al. No association of postoperative opioid usage with long-term surgery outcomes in patients with liver cancer: A population-based retrospective cohort study. Pain. 2022 (Sep 8). Doi: 10.1097/j.pain.0000000000002776

Key clinical point: Survival outcomes are unaffected by postoperative opioid use in patients who have undergone hepatectomy or liver transplantation for hepatocellular carcinoma (HCC).

Major finding: Patients who did vs did not receive opioids had no significant difference in overall survival (adjusted hazard ratio [aHR] 1.10; P  =  .478) or recurrence-free survival (aHR 1.15; P  =  .229).

Study details: This retrospective cohort study included 812 patients aged >20 years with HCC who underwent hepatectomy and did (n = 530) or did not (n = 282) receive opioids during the postoperative period.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Yeh PH et al. No association of postoperative opioid usage with long-term surgery outcomes in patients with liver cancer: A population-based retrospective cohort study. Pain. 2022 (Sep 8). Doi: 10.1097/j.pain.0000000000002776

Key clinical point: The long-term therapeutic outcomes of microwave ablation (MWA) are comparable to those of surgical resection (SR) in patients with subcapsular hepatocellular carcinoma (HCC).

Major finding: The MWA vs SR group had significantly lower complication rates (51.2% vs 70.2%; P  =  .011), with no significant difference in the 5-year cumulative local tumor progression (16.4% vs 10.6%; P  =  .31), 5-year overall survival (73.0% vs 72.1%; P  =  .89), or 5-year disease-free survival (38.1% vs 32.3%; P  =  .43) rate.

Study details: This multicenter retrospective study included 84 patients with subcapsular HCC meeting the Milan criteria who underwent MWA and 84 propensity score-matched patients who underwent SR.

Disclosures: This study was sponsored by the Natural Science Foundation of Shandong Province, China. The authors declared no conflicts of interest.

Source: Liu K et al. Microwave ablation versus surgical resection for subcapsular hepatocellular carcinoma: A propensity score-matched study of long-term therapeutic outcomes. Eur Radiol. 2022 (Sep 17). Doi: 10.1007/s00330-022-09135-1

Key clinical point: The long-term therapeutic outcomes of microwave ablation (MWA) are comparable to those of surgical resection (SR) in patients with subcapsular hepatocellular carcinoma (HCC).

Major finding: The MWA vs SR group had significantly lower complication rates (51.2% vs 70.2%; P  =  .011), with no significant difference in the 5-year cumulative local tumor progression (16.4% vs 10.6%; P  =  .31), 5-year overall survival (73.0% vs 72.1%; P  =  .89), or 5-year disease-free survival (38.1% vs 32.3%; P  =  .43) rate.

Study details: This multicenter retrospective study included 84 patients with subcapsular HCC meeting the Milan criteria who underwent MWA and 84 propensity score-matched patients who underwent SR.

Disclosures: This study was sponsored by the Natural Science Foundation of Shandong Province, China. The authors declared no conflicts of interest.

Source: Liu K et al. Microwave ablation versus surgical resection for subcapsular hepatocellular carcinoma: A propensity score-matched study of long-term therapeutic outcomes. Eur Radiol. 2022 (Sep 17). Doi: 10.1007/s00330-022-09135-1

Key clinical point: The long-term therapeutic outcomes of microwave ablation (MWA) are comparable to those of surgical resection (SR) in patients with subcapsular hepatocellular carcinoma (HCC).

Major finding: The MWA vs SR group had significantly lower complication rates (51.2% vs 70.2%; P  =  .011), with no significant difference in the 5-year cumulative local tumor progression (16.4% vs 10.6%; P  =  .31), 5-year overall survival (73.0% vs 72.1%; P  =  .89), or 5-year disease-free survival (38.1% vs 32.3%; P  =  .43) rate.

Study details: This multicenter retrospective study included 84 patients with subcapsular HCC meeting the Milan criteria who underwent MWA and 84 propensity score-matched patients who underwent SR.

Disclosures: This study was sponsored by the Natural Science Foundation of Shandong Province, China. The authors declared no conflicts of interest.

Source: Liu K et al. Microwave ablation versus surgical resection for subcapsular hepatocellular carcinoma: A propensity score-matched study of long-term therapeutic outcomes. Eur Radiol. 2022 (Sep 17). Doi: 10.1007/s00330-022-09135-1

Key clinical point: Antiplatelet therapy (APT) reduces the risk for hepatocellular carcinoma (HCC) incidence by 40% and for all-cause mortality by 50% in patients with HCC treated with curative or palliative strategies.

Major finding: APT was associated with a significant reduction in the risk for HCC incidence (odds ratio [OR] 0.63; P < .0001) and post-treatment mortality (OR 0.54; P  =  .006).

Study details: This study was a meta-analysis of 15 studies that investigated the impact of APT on HCC incidence in 2,685,009 individuals and five studies that investigated post-treatment mortality in 3281 patients with HCC, both with respect to APT use.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Lai Q et al and the Associazione Italiana per lo Studio del Fegato (AISF) HCC Special Interest Group. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma. Eur J Clin Invest. 2022:e13870 (Sep 8). Doi: 10.1111/eci.13870

Key clinical point: Antiplatelet therapy (APT) reduces the risk for hepatocellular carcinoma (HCC) incidence by 40% and for all-cause mortality by 50% in patients with HCC treated with curative or palliative strategies.

Major finding: APT was associated with a significant reduction in the risk for HCC incidence (odds ratio [OR] 0.63; P < .0001) and post-treatment mortality (OR 0.54; P  =  .006).

Study details: This study was a meta-analysis of 15 studies that investigated the impact of APT on HCC incidence in 2,685,009 individuals and five studies that investigated post-treatment mortality in 3281 patients with HCC, both with respect to APT use.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Lai Q et al and the Associazione Italiana per lo Studio del Fegato (AISF) HCC Special Interest Group. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma. Eur J Clin Invest. 2022:e13870 (Sep 8). Doi: 10.1111/eci.13870

Key clinical point: Antiplatelet therapy (APT) reduces the risk for hepatocellular carcinoma (HCC) incidence by 40% and for all-cause mortality by 50% in patients with HCC treated with curative or palliative strategies.

Major finding: APT was associated with a significant reduction in the risk for HCC incidence (odds ratio [OR] 0.63; P < .0001) and post-treatment mortality (OR 0.54; P  =  .006).

Study details: This study was a meta-analysis of 15 studies that investigated the impact of APT on HCC incidence in 2,685,009 individuals and five studies that investigated post-treatment mortality in 3281 patients with HCC, both with respect to APT use.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Lai Q et al and the Associazione Italiana per lo Studio del Fegato (AISF) HCC Special Interest Group. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma. Eur J Clin Invest. 2022:e13870 (Sep 8). Doi: 10.1111/eci.13870

Key clinical point: Hepatectomy is beneficial in patients with ≤3 hepatocellular carcinomas (HCC) and no or Child-Pugh (CP) class A cirrhosis, with the long-term results being comparable to those in patients with single HCC.

Major finding: The overall survival was significantly different between patients with Barcelona Clinic Liver Cancer (BCLC) stages A1 and A2 (P  =  .0118), A2 and A3 (P  =  .0013), and B1 and B2 (P  =  .0050) but not between stages A3 and B1 (P  =  .4742). CP class B cirrhosis was an independent prognostic factor for overall survival.

Study details: This single-center retrospective study included 1088 patients who underwent hepatectomy for BCLC stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B categorized into A1 (single nodule 2-5 cm or ≤3 nodules ≤3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥10 cm), B1 (2-3 nodules >3 cm), and B2 (≥4 nodules).

Disclosures: No information on funding source was available. The authors declared no conflicts of interest.

Source: Orimo T et al. Hepatectomy is beneficial in select patients with multiple hepatocellular carcinomas. Ann Surg Oncol. 2022 (Sep 13). Doi: 10.1245/s10434-022-12495-z

Key clinical point: Hepatectomy is beneficial in patients with ≤3 hepatocellular carcinomas (HCC) and no or Child-Pugh (CP) class A cirrhosis, with the long-term results being comparable to those in patients with single HCC.

Major finding: The overall survival was significantly different between patients with Barcelona Clinic Liver Cancer (BCLC) stages A1 and A2 (P  =  .0118), A2 and A3 (P  =  .0013), and B1 and B2 (P  =  .0050) but not between stages A3 and B1 (P  =  .4742). CP class B cirrhosis was an independent prognostic factor for overall survival.

Study details: This single-center retrospective study included 1088 patients who underwent hepatectomy for BCLC stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B categorized into A1 (single nodule 2-5 cm or ≤3 nodules ≤3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥10 cm), B1 (2-3 nodules >3 cm), and B2 (≥4 nodules).

Disclosures: No information on funding source was available. The authors declared no conflicts of interest.

Source: Orimo T et al. Hepatectomy is beneficial in select patients with multiple hepatocellular carcinomas. Ann Surg Oncol. 2022 (Sep 13). Doi: 10.1245/s10434-022-12495-z

Key clinical point: Hepatectomy is beneficial in patients with ≤3 hepatocellular carcinomas (HCC) and no or Child-Pugh (CP) class A cirrhosis, with the long-term results being comparable to those in patients with single HCC.

Major finding: The overall survival was significantly different between patients with Barcelona Clinic Liver Cancer (BCLC) stages A1 and A2 (P  =  .0118), A2 and A3 (P  =  .0013), and B1 and B2 (P  =  .0050) but not between stages A3 and B1 (P  =  .4742). CP class B cirrhosis was an independent prognostic factor for overall survival.

Study details: This single-center retrospective study included 1088 patients who underwent hepatectomy for BCLC stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B categorized into A1 (single nodule 2-5 cm or ≤3 nodules ≤3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥10 cm), B1 (2-3 nodules >3 cm), and B2 (≥4 nodules).

Disclosures: No information on funding source was available. The authors declared no conflicts of interest.

Source: Orimo T et al. Hepatectomy is beneficial in select patients with multiple hepatocellular carcinomas. Ann Surg Oncol. 2022 (Sep 13). Doi: 10.1245/s10434-022-12495-z