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Management of Hepatocellular Carcinoma
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Management of Hepatocellular Carcinoma

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (31 January 2021) | Viewed by 7807

Special Issue Editors

Prof. Giuseppe Mazzella

E-Mail Website
Guest Editor
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Gastroenterology and Hepatology Unit, S. Orsola- Malpighi University Hospital, Bologna, Italy
Interests: cholestasis; NAFLD; viral hepatitis; hepatocellular carcinoma; cirrhosis
Prof. Dr. Francesco Azzaroli

E-Mail Website
Guest Editor
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Gastroenterology and Hepatology Unit, S. Orsola- Malpighi University Hospital, 40138 Bologna, Italy
Interests: cholestasis; NAFLD; viral hepatitis; hepatocellular carcinoma; cirrhosis

Special Issue Information

Dear Colleagues,

Hepatocellular carcinoma (HCC) is the most common liver malignancy. Despite significant advances in the treatment of chronic liver diseases, it still remains a major cause of cancer-related mortality. In recent years, the advent of immunological therapies has widened the therapeutic scenario and helps clinicians’ management of these difficult patients. This Special Issue aims to cover the most relevant information currently available both on the basic science and on the clinical side, ranging from the microbiota to liver transplantation (OLT) with a focus also on grey areas (i.e., differential diagnosis between HCC and cholangiocarcinoma in cirrhotic patients, direct acting antiviral treatment and HCC recurrence post-OLT or downstaging/superdownstaging for HCC in OLT).

Prof. Giuseppe Mazzella
Prof. Francesco Azzaroli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Hepatocellular carcinoma
  • Liver Transplantation
  • Treatment
  • Immunology
  • Radiology

Published Papers (3 papers)

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Research

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11 pages, 1209 KiB  
Article
Indication of Liver Transplantation for Hepatocellular Carcinoma Should Be Reconsidered in Case of Microvascular Invasion and Multilocular Tumor Occurrence
by Jan-Paul Gundlach, Stephan Schmidt, Alexander Bernsmeier, Rainer Günther, Victor Kataev, Jens Trentmann, Jost Philipp Schäfer, Christoph Röcken, Thomas Becker and Felix Braun
J. Clin. Med. 2021, 10(6), 1155; https://doi.org/10.3390/jcm10061155 - 10 Mar 2021
Cited by 11 | Viewed by 1535
Abstract
Liver transplantation (LT) is routinely performed for hepatocellular carcinoma (HCC) in cirrhosis without major vascular invasion. Although the adverse influence of microvascular invasion is recognized, its occurrence does not contraindicate LT. We retrospectively analyzed in our LT cohort the significance of microvascular invasion [...] Read more.
Liver transplantation (LT) is routinely performed for hepatocellular carcinoma (HCC) in cirrhosis without major vascular invasion. Although the adverse influence of microvascular invasion is recognized, its occurrence does not contraindicate LT. We retrospectively analyzed in our LT cohort the significance of microvascular invasion on survival and demonstrate bridging procedures. At our hospital, 346 patients were diagnosed with HCC, 171 patients were evaluated for LT, and 153 were listed at Eurotransplant during a period of 11 years. Among these, 112 patients received LT and were included in this study. Overall survival after 1, 3 and 5 years was 86.3%, 73.9%, and 67.9%, respectively. Microvascular invasion led to significantly reduced overall (p = 0.030) and disease-free survival (p = 0.002). Five-year disease-free survival with microvascular invasion was 10.5%. Multilocular tumor occurrence with simultaneous microvascular invasion revealed the worst prognosis. In our LT cohort, predominant bridging treatment was transarterial chemoembolization (TACE) and the number of TACE significantly correlated with poorer overall survival after LT (p = 0.028), which was confirmed in multiple Cox regression analysis for overall and disease-free survival (p = 0.015 and p = 0.011). Microvascular tumor invasion is significantly associated with reduced prognosis after LT, which is aggravated by simultaneous occurrence of multiple lesions. Therefore, indication strategies for LT should be reconsidered. Full article
(This article belongs to the Special Issue Management of Hepatocellular Carcinoma)
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Review

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14 pages, 1619 KiB  
Review
Prognostic Value of the Albumin-Bilirubin Grade for the Prediction of Post-Hepatectomy Liver Failure: A Systematic Review and Meta-Analysis
by Giovanni Marasco, Luigina Vanessa Alemanni, Antonio Colecchia, Davide Festi, Franco Bazzoli, Giuseppe Mazzella, Marco Montagnani and Francesco Azzaroli
J. Clin. Med. 2021, 10(9), 2011; https://doi.org/10.3390/jcm10092011 - 8 May 2021
Cited by 21 | Viewed by 2557
Abstract
(1) Introduction: Liver resection (LR) for hepatocellular carcinoma (HCC) is often burdened by life-threatening complications, such as post-hepatectomy liver failure (PHLF). The albumin-bilirubin (ALBI) score can accurately evaluate liver function and the long-term prognosis of HCC patients, including PHLF. We aimed to evaluate [...] Read more.
(1) Introduction: Liver resection (LR) for hepatocellular carcinoma (HCC) is often burdened by life-threatening complications, such as post-hepatectomy liver failure (PHLF). The albumin-bilirubin (ALBI) score can accurately evaluate liver function and the long-term prognosis of HCC patients, including PHLF. We aimed to evaluate the diagnostic value of the ALBI grade in predicting PHLF in HCC patients undergoing LR. (2) Methods: MEDLINE, Embase, and Scopus were searched through January 17th, 2021. Studies reporting the ALBI grade and PHLF occurrence in HCC patients undergoing LR were included. The Odds Ratio (OR) prevalence with 95% confidence intervals (CI) was pooled, and the heterogeneity was expressed as I2. The quality of the studies was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). (3) Results: Seven studies met the inclusion criteria and were included in the analysis. A total of 5377 patients who underwent LR for HCC were considered, of whom 718 (13.4%) developed PHLF. Patients with ALBI grades 2 and 3 before LR showed increased rates of PHLF compared to ALBI grade 1 patients. The pooled OR was 2.572 (95% CI, 1.825 to 3.626, p < 0.001), with substantial heterogeneity between the studies (I2 = 69.6%) and no publication bias (Begg’s p = 0.764 and Egger’s p = 0.851 tests). All studies were at a ‘low risk’ or ‘unclear risk’ of bias. Univariate meta-regression analysis showed that heterogeneity was not dependent on the country of study, the age and sex of the participants, the definition of PHLF used, the rate of patients in Child–Pugh class A or undergoing major hepatectomy. (4) Conclusions: In this meta-analysis of published studies, individuals with ALBI grades of 2 and 3 showed increased rates of PHLF compared to ALBI grade 1 patients. Full article
(This article belongs to the Special Issue Management of Hepatocellular Carcinoma)
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15 pages, 2787 KiB  
Review
Hepatocellular Carcinoma Recurrence after Hepatitis C Virus Therapy with Direct-Acting Antivirals. A Systematic Review and Meta-Analysis
by Leonardo Frazzoni, Usama Sikandar, Flavio Metelli, Sinan Sadalla, Giuseppe Mazzella, Franco Bazzoli, Lorenzo Fuccio and Francesco Azzaroli
J. Clin. Med. 2021, 10(8), 1694; https://doi.org/10.3390/jcm10081694 - 15 Apr 2021
Cited by 20 | Viewed by 3198
Abstract
Background: Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality among patients with cirrhosis. The risk of HCC recurrence after a complete response among patients treated with direct-acting antivirals (DAAs) has not been fully elucidated yet. Aim: To assess the risk [...] Read more.
Background: Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality among patients with cirrhosis. The risk of HCC recurrence after a complete response among patients treated with direct-acting antivirals (DAAs) has not been fully elucidated yet. Aim: To assess the risk of HCC recurrence after DAA therapy for hepatitis C virus (HCV). Methods: A systematic review across PubMed, Scopus and Scholar up to November 2020, including full-text studies that assessed the pattern of HCC recurrence after DAA therapy for HCV. Random-effect meta-analysis and univariable metaregression were applied to obtain pooled estimates for proportions and relative risk (RR) and variables influential for the outcome, respectively. Results: Thirty-one studies with 2957 patients were included. Overall, 30% (CI, 26–34%) of the patients with a history of HCC experienced HCC recurrence after DAA therapy, at mean time intervals ranging from 4 to 21 months. This result increased when going from European studies (23%, CI, 17–28%) to US studies (34%, CI, 30–38%), to Egyptian studies (37%, CI, 27–47%), and to Asian studies (33%, CI, 27–40%). Sixty-eight percent (CI, 45–91%) of recurrent HCCs developed within 6 months of follow-up since DAA treatment, among the eight studies providing stratified data. Among the studies providing head-to-head comparisons, the HCC recurrence risk was significantly lower after DAA therapy than IFN (RR, 0.64; CI, 0.51–0.81), and after DAA therapy than no intervention (RR, 0.68; CI, 0.49–0.94). Conclusions: The recurrence of HCC after DAA is not negligible, being higher soon after the end of treatment and among non-European countries. DAA therapy seems to reduce the risk of HCC recurrence compared to an IFN regimen and no intervention. Full article
(This article belongs to the Special Issue Management of Hepatocellular Carcinoma)
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