Review
Gastroenterology & Hepatology
Leana Frankul, Catherine Frenette
Summary: Downstaging treatment is crucial for patients with unresectable hepatocellular carcinoma who are not eligible for liver transplantation, but severe organ shortage limits its broader application. Debate over the optimal treatment protocol and assessment method for downstaging treatment is pushing the boundaries of liver transplantation candidate selection.
JOURNAL OF CLINICAL AND TRANSLATIONAL HEPATOLOGY
(2021)
Review
Oncology
Qimeng Gao, Imran J. Anwar, Nader Abraham, Andrew S. Barbas
Summary: Immune checkpoint inhibitors have transformed the treatment of hepatocellular carcinoma, with increasing interest in using them in the neoadjuvant setting prior to liver transplantation. While liver transplant offers excellent outcomes for HCC patients, further research is needed to assess the safety and efficacy of using ICIs as bridging or downstaging therapies. Minimal washout periods between ICI use and liver transplantation are crucial factors to consider for successful transplant outcomes.
Article
Oncology
Alessandro Vitale, Federica Scolari, Alessandra Bertacco, Enrico Gringeri, Francesco D'Amico, Domenico Bassi, Francesco Enrico D'Amico, Paolo Angeli, Patrizia Burra, Quirino Lai, Umberto Cillo
Summary: This study demonstrates that aggressive surgical downstaging can reduce the failure rate of downstaging, and that applying a wait and see policy can avoid immediate prioritization of transplantation for patients with sustained complete response to downstaging, saving organs without worsening patient outcomes.
Review
Oncology
Laura Crocetti, Elena Bozzi, Paola Scalise, Irene Bargellini, Giulia Lorenzoni, Davide Ghinolfi, Daniela Campani, Emanuele Balzano, Paolo De Simone, Roberto Cioni
Summary: Liver transplantation is the primary treatment for patients with unresectable early-stage hepatocellular carcinoma and cirrhosis. While traditional Milan criteria are restrictive, there is a trend towards expanding inclusion criteria due to a limited organ supply. Locoregional therapies play a crucial role in selecting patients who will benefit the most from transplantation and meet the criteria for transplantation.
Article
Surgery
Marco Petrus Adrianus Wilhelmus Claasen, Dimitri Sneiders, Yannick Sebastiaan Rakke, Rene Adam, Sherrie Bhoori, Umberto Cillo, Constantino Fondevila, Maria Reig, Gonzalo Sapisochin, Parissa Tabrizian, Christian Toso
Summary: Liver transplantation offers the best chance of cure for most non-metastatic hepatocellular carcinoma patients. Downstaging and bridging therapies, such as ablation and transarterial chemoembolization, can be used to lower the patient's condition and keep them within transplant criteria. Immunotherapy shows great potential in supporting downstaging and bridging therapies.
TRANSPLANT INTERNATIONAL
(2023)
Review
Surgery
Daniel Seehofer, Henrik Petrowsky, Stefan Schneeberger, Eric Vibert, Jens Ricke, Gonzalo Sapisochin, Jean-Charles Nault, Thomas Berg
Summary: Patients with HCC outside the Milan criteria require more detailed patient selection, with additional parameters such as AFP levels, new criteria like WE/Metroticket 2.0, PET scans, and tumor biopsies playing a crucial role in the selection process. The clinical course during downstaging, especially tumor and AFP response, is of paramount importance as a final selection tool.
TRANSPLANT INTERNATIONAL
(2022)
Article
Surgery
Parissa Tabrizian, Matthew L. Holzner, Neil Mehta, Karim Halazun, Vatche G. Agopian, Francis Yao, Ronald W. Busuttil, John Roberts, Jean C. Emond, Benjamin Samstein, Robert S. Brown, Marc Najjar, William C. Chapman, Majella Mb Doyle, Sander S. Florman, Myron E. Schwartz, Josep M. Llovet
Summary: This study aimed to investigate the 10-year outcomes of patients with hepatocellular carcinoma (HCC) after liver transplant (LT), particularly those who were downstaged to meet the transplant criteria. The results showed that patients who successfully downstaged their disease had better overall survival rates, validating the effectiveness of downstaging and highlighting the importance of individualized decision-making when choosing surgical management for HCC recurrence after LT.
Article
Surgery
Ola Ahmed, Neeta Vachharajani, Kris P. Croome, Parissa Tabrizian, Vatche Agopian, Karim Halazun, Johnny C. Hong, Leigh Anne Dageforde, William C. Chapman, Mb Majella Doyle
Summary: This study assessed liver transplantation outcomes for hepatocellular carcinoma (HCC) patients initially presenting beyond the expanded University of California San Francisco (B-eUCSF) criteria. The results showed that patients initially presenting beyond B-eUCSF criteria achieved comparable survival rates to those meeting the criteria (W-eUCSF) after transplantation.
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
(2022)
Review
Oncology
Marcello Di Martino, Alessandro Vitale, Daniele Ferraro, Marilisa Maniscalco, Donatella Pisaniello, Giuseppe Arenga, Federica Falaschi, Alfonso Terrone, Alessandro Iacomino, Alfonso Galeota Lanza, Ciro Esposito, Umberto Cillo, Giovanni Vennarecci
Summary: This systematic review evaluates the effectiveness of downstaging therapies for hepatocellular carcinoma (HCC) patients beyond the listing criteria. The results suggest that patients who are successfully downstaged and transplanted have a longer overall survival compared to those who are not transplanted. However, there are no significant differences in the survival rates between these two groups based on an intention-to-treat analysis.
Article
Surgery
Lauren Matevish, Madhukar S. Patel, Parsia A. Vagefi
Summary: Downstaging has been shown to be feasible within UNOS-DS criteria, with successful long-term outcomes. Interventional liver-directed therapies have been the standard, but systemic therapies are becoming more effective. Immunotherapy holds promise in downstaging, but further trials are needed to assess feasibility and safety. Individual expertise will continue to guide treatment until more data is available.
SURGICAL CLINICS OF NORTH AMERICA
(2024)
Review
Oncology
Marco Biolato, Tiziano Galasso, Giuseppe Marrone, Luca Miele, Antonio Grieco
Summary: In recent years, an increasing number of hepatocellular carcinoma patients responding to downstaging procedures have been included in the waitlist for liver transplantation, but face a higher risk of dropout and recurrence if not transplanted in a timely manner. Therefore, timely transplantation is crucial for post-downstaging patients.
Review
Radiology, Nuclear Medicine & Medical Imaging
Giuseppe Mamone, Settimo Caruso, Mariapina Milazzo, Giorgia Porrello, Ambra Di Piazza, Giovanni Gentile, Vincenzo Carollo, Francesca Crino, Gianluca Marrone, Gianvincenzo Sparacia, Luigi Maruzzelli, Roberto Miraglia, Salvatore Gruttadauria
Summary: Liver transplantation provides the best survival benefit for hepatocellular carcinoma (HCC) patients who cannot undergo resection. The Milan criteria have been developed to select suitable candidates for transplantation, aiming to improve survival and reduce the risk of HCC recurrence. However, up to 20% of cases experience HCC recurrence after transplantation, posing a significant challenge due to poor prognosis. Various extended criteria have been proposed to accommodate the increasing demand for organs and the associated higher risk of recurrence. Radiologists need to be aware of the possibility of HCC recurrence involving multiple organs after transplantation. Understanding the location and radiologic appearance of recurrent HCC is crucial for choosing the most appropriate therapy.
INSIGHTS INTO IMAGING
(2023)
Review
Biochemistry & Molecular Biology
Zurabi Lominadze, Kareen Hill, Mohammed Rifat Shaik, Justin P. Canakis, Mohammad Bourmaf, Cyrus Adams-Mardi, Ameer Abutaleb, Lopa Mishra, Kirti Shetty
Summary: The emerging field of immuno-oncology has brought exciting developments in the treatment of hepatocellular carcinoma (HCC), with potential benefits in liver transplantation settings. Immune therapeutic agents have shown promise in down-staging advanced HCCs pre-transplant and managing recurrent HCC post-transplant. This review discusses optimal regimens in the context of liver transplantation.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2023)
Review
Oncology
Filippo Pelizzaro, Martina Gambato, Enrico Gringeri, Alessandro Vitale, Umberto Cillo, Fabio Farinati, Patrizia Burra, Francesco Paolo Russo
Summary: Recurrence of hepatocellular carcinoma after liver transplantation is a major concern, with poor prognosis and uncertainty in management. There is currently lack of specific surveillance strategy and sufficient data to support immunosuppressive drugs and adjuvant therapy.
Article
Medicine, General & Internal
Indah Jamtani, Kwang-Woong Lee, Yunhee Choi, YoungRok Choi, Jeong-Moo Lee, Eui-Soo Han, Kwangpyo Hong, Gyu-Seong Choi, Jong Man Kim, Nam-Joon Yi, Suk Kyun Hong, Jeik Byun, Su Young Hong, Sanggyeun Suh, Jae-Won Joh, Kyung-Suk Suh
Summary: This study aimed to develop a tailored prediction model of HCC-specific survival after transplantation, validated internally and externally. By combining multiple risk factors, the model showed good accuracy in predicting HCC-specific survival tailored for patients undergoing transplantation. The calculated SALT predictor provided accurate information on expected survival rates based on risk scores and specific characteristics.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Gastroenterology & Hepatology
Jing-Houng Wang, Hsin-You Ou, Yi-Hao Yen, Chien-Hung Chen, Sheng-Nan Lu
DIGESTIVE DISEASES AND SCIENCES
(2020)
Article
Immunology
Cheng-Kang Wang, Yu-Fan Cheng, Chao-Long Chen, Hsin-You Ou
TRANSPLANTATION PROCEEDINGS
(2020)
Article
Radiology, Nuclear Medicine & Medical Imaging
Sieh-Yang Lee, Hsin-You Ou, Chun-Yen Yu, Tung-Liang Huang, Leo Leung-Chit Tsang, Yu-Fan Cheng
DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY
(2020)
Article
Immunology
An-Ni Lin, Hsin-You Ou, Tung-Liang Huang, Leung-Chit Tsang, Chao-Long Chen, Yu-Fan Cheng
TRANSPLANTATION PROCEEDINGS
(2020)
Article
Radiology, Nuclear Medicine & Medical Imaging
Hsin-You Ou, Ying-Nong Wu, Chun-Yen Yu, Chao-Long Chen, Hsien-Wen Hsu, Ching-Chun Weng, Leo Leung-Chit Tsang, Tung-Liang Huang, Yu-Shun Tong, Wei-Xiong Lim, Yu-Fan Cheng
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
(2020)
Article
Medicine, General & Internal
Wen-Fan Chen, Hsin-You Ou, Keng-Hao Liu, Zhi-Yun Li, Chien-Chang Liao, Shao-Yu Wang, Wen Huang, Yu-Fan Cheng, Cheng-Tang Pan
Summary: The paper proposes a deep learning method (SED) for automatic liver lesion/tumor segmentation through CT images. The method improves the accuracy of liver segmentation and tumor prediction effectively.
Article
Pharmacology & Pharmacy
Cheng-Tang Pan, Ruei-Siang Yu, Chih-Jung Yang, Lih-Ren Chen, Zhi-Hong Wen, Nai-Yu Chen, Hsin-You Ou, Chun-Yen Yu, Yow-Ling Shiue
Summary: This study successfully developed biodegradable calcium alginate microspheres carrying doxorubicin for sustained release and pH regulation therapy. Microspheres with high NaHCO3 concentrations demonstrated enhanced cytotoxicity effects in vitro experiments.
Article
Medicine, General & Internal
Wen-Fan Chen, Hsin-You Ou, Cheng-Tang Pan, Chien-Chang Liao, Wen Huang, Han-Yu Lin, Yu-Fan Cheng, Chia-Po Wei
Summary: This study investigates the improvement of recognition rate through deep learning-based liver lesion segmentation with the incorporation of hospital data. By mixing LiTS database with hospital data for training, the recognition output accuracy can be significantly enhanced.
Article
Immunology
Yueh-Sheng Chen, Wei-Xiong Lim, An-Ni Lin, Chao-Long Chen, Leung-Chit Leo Tsang, Chun-Yen Yu, Hsien-Wen Hsu, Yi-Hsuan Chuang, Yu-Fan Cheng, Hsin-You Ou
Summary: Gd-EOB-DTPA-enhanced MRI plays an important role in the diagnosis and treatment of hepatocellular carcinoma (HCC) patients undergoing living donor liver transplant (LDLT), as it improves the detection rate of HCC, leads to changes in treatment decisions, and lowers the recurrence rate after transplantation.
TRANSPLANTATION PROCEEDINGS
(2022)
Article
Medicine, General & Internal
Chien-Chang Liao, Yu-Fan Cheng, Chun-Yen Yu, Leung-Chit Leo Tsang, Chao-Long Chen, Hsien-Wen Hsu, Wan-Ching Chang, Wei-Xiong Lim, Yi-Hsuan Chuang, Po-Hsun Huang, Hsin-You Ou
Summary: This study integrated diffusion-weighted imaging and magnetic resonance imaging findings to develop a scoring system for predicting microvascular invasion in hepatocellular carcinoma. The scoring model showed high sensitivity and negative predictive value in MVI prediction.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Medicine, General & Internal
Wen-Fan Chen, Hsin-You Ou, Han-Yu Lin, Chia-Po Wei, Chien-Chang Liao, Yu-Fan Cheng, Cheng-Tang Pan
Summary: The research utilizes AI image recognition technology to assist physicians in making accurate decisions. A proposed RDA U-Net model is used to identify and segment liver organs and lesions. The study achieves high accuracy without contrast and reduces computation time, demonstrating good recognition results for various types of lesions.
Article
Oncology
Yi-Hsuan Chuang, Yu-Fan Cheng, Leo Leung-Chit Tsang, Hsin-You Ou, Hsien-Wen Hsu, Wei-Xiong Lim, Po-Hsun Huang, Ching-Chun Weng, Chun-Yen Yu
Summary: The purpose of this study was to evaluate the treatment response, survival, and safety of a novel TACE using a combination of ethanol-Lipiodol mixture and drug-eluting beads in patients with large unresectable HCC. The results demonstrated favorable tumor response rates and control rates, as well as longer survival time for the patients. Therefore, the combined DEB-TACE treatment can be an effective option for patients with large unresectable HCC.
JOURNAL OF HEPATOCELLULAR CARCINOMA
(2023)
Article
Oncology
Chun-Yen Yu, Po-Hsun Huang, Leo Leung-Chit Tsang, Hsien-Wen Hsu, Wei-Xiong Lim, Ching-Chun Weng, Tung-Liang Huang, Chien-Chin Hsu, Chao-Long Chen, Hsin-You Ou, Yu-Fan Cheng
Summary: This study aimed to evaluate the safety and efficacy of Yttrium-90 radioembolization in unresectable hepatocellular carcinoma. The results showed that Yttrium-90 radioembolization effectively controlled hepatocellular carcinoma, especially in advanced cases. Patients successfully bridging to surgical resection or transplantation had excellent overall survival.
JOURNAL OF HEPATOCELLULAR CARCINOMA
(2023)
Article
Gastroenterology & Hepatology
Jing-Houng Wang, Hsin-You Ou, Yi-Hao Yen, Chao-Hung Hung, Sheng-Nan Lu
Summary: This study evaluates the usefulness of controlled attenuation parameter (CAP) in monitoring the clinically relevant outcome by MRI-PDFF for NAFLD patients. The results show that CAP exhibits good performance in monitoring clinically relevant decline of hepatic steatosis in MRI-PDFF.
LIVER INTERNATIONAL
(2023)
Article
Surgery
Pi-Ling Chiang, Yu-Fan Cheng, Tung-Liang Huang, Hsin-You Ou, Chun-Yen Yu, Hsien-Wen Hsu, Wei-Xiong Lim, Chao-Long Chen, Chee-Chien Yong, Leo Leung-Chit Tsang
ANNALS OF TRANSPLANTATION
(2020)