Background Hepatocellular carcinomas (HCCs) can be divided into proliferative and nonproliferative types, which may have implications for outcomes after conventional transarterial chemoembolization (cTACE). Biopsy to identify proliferative HCC is not routinely performed before cTACE. Purpose To develop and validate a predictive model for identifying proliferative HCCs using CT imaging features and to compare therapeutic outcomes between predicted proliferative and nonproliferative HCCs after cTACE according to this model. Materials and Methods This retrospective multicenter study included adults with HCC who underwent liver resection or cTACE between August 2013 and December 2020. A CT-based predictive model for identifying proliferative HCCs was developed and externally validated in a cohort that underwent resection. Diagnostic performance was calculated for the model. Thereafter, patients in the cTACE cohort were stratified into groups with predicted proliferative or nonproliferative HCCs according to the model. The primary outcome was overall survival (OS), and the secondary outcomes were tumor response rate and progression-free survival (PFS). These were compared between the two groups with use of the χ² test and the log-rank test. Results A total of 1194 patients (1021 men; mean age, 54 years ± 12 [SD]; median follow-up time, 29.1 months) were included. The predictive model, named the SMARS score, incorporated lobulated shape, mosaic architecture, α-fetoprotein levels, rim arterial phase hyperenhancement, and satellite lesions. The area under the receiver operating characteristic curve for the SMARS score was 0.83 for the training cohort and 0.80 for the validation cohort. According to the SMARS score, patients with predicted proliferative HCCs (n = 114) had lower tumor response rate (48% vs 71%; P < .001) and worse PFS (6.6 months vs 12.4 months; P < .001) and OS (14.4 months vs 38.7 months; P < .001) than those with nonproliferative HCCs (n = 263). Conclusion The predictive model demonstrated good performance for identifying proliferative HCCs. According to the SMARS score, patients with predicted proliferative HCCs have worse prognosis than those with predicted nonproliferative HCCs after cTACE. © RSNA, 2023 Supplemental material is available for this article.

Purpose To investigate the efficacy and safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) for hepatocellular carcinoma (HCC) with different types of portal vein tumor thrombosis (PVTT). Patients and methods Fifty patients with HCC complicated with PVTT from August 2016 to January 2021 were selected as subjects, all of whom were treated with DEB-TACE. According to PVTT classification, the patients were divided into type I (n = 10), type II (n = 16) and type III (n = 24). The therapeutic efficacy was evaluated after 1 month of treatment, the changes in liver function indexes and tumor markers were statistically analyzed, and patients’ prognosis was evaluated. Results The three groups manifested no difference in disease response rate and disease control rate (P > 0.05). Before DEB-TACE, albumin (ALB), total bilirubin (TBIL), alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) in type III and type II groups were higher than those in type I group, and ALB and ALT in type III group were higher than those in type II group (P < 0.05). After DEB-TACE, ALB, TBIL, ALT, and AST in type III and type II groups were lowered, as well as TBIL, ALT, and AST in type I group (P < 0.05). Before DEB-TACE, α-fetoprotein (AFP) and PIVKA-II in type I group were the lowest, followed by type II and type III groups (P < 0.05). AFP and PIVKA-II in patients with different PVTT types after DEB-TACE were lower than those before DEB-TACE (P < 0.05). The survival rates of type I, type II, and type III groups were 70.00% (7/10), 31.25% (5/16), and 28.00% (7/24), respectively. The survival rates of type II and type III PVTT patients were lower than those of type I patients (P < 0.05). No significant difference was shown in the survival rates of type II and type III PVTT patients (P > 0.05). The median survival time of type II group was 17 months, which was higher than that of type III group (12.5 months) (the survival rate of type I group was higher than 50%, with no median survival time). Conclusion DEB-TACE has high clinical efficacy on HCC complicated with PVTT, which can improve liver function and suppress tumor markers. The survival rate of type II and type III PVTT patients after DEB-TACE is lower than that of type I PVTT patients.

Breast cancer is among the most common forms of cancer in women worldwide and continues to be a major challenge in medical science and clinical care because of the complexity of its biological nature and common resistance to treatment. Nanoparticles for treating breast cancer are becoming a new-generation approach to induce the death of breast cancer cells because of their favorable physicochemical properties and excellent targeting ability. Recent studies have shown that nanoparticles can significantly increase anticancer activity by activating several cell death mechanisms, such as pyroptosis, apoptosis, necroptosis, autophagy, ferroptosis, cuproptosis, and disulfidptosis. The present review focuses on the molecular processes that lead to cell death in breast cancer models due to nanoparticle exposure. Such mechanisms have also been documented in other solid tumors, suggesting the possible universality of the cell death induced by nanoparticles. In the current review, we systematically summarize the molecular mechanisms underlying the various forms of cell death caused by nanoparticles in breast cancer cells to provide a theoretical background for the translational use of nanotechnology in precise breast cancer treatment and a cross-validation model for future mechanistic research on various types of cancer.

Letter “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”