Purpose: Transarterial chemoembolization (TACE) is recommended in patients with unresectable HCC beyond the Milan criteria (MC). However, the long-term efficacy of TACE remains unsatisfactory. Percutaneous microwave ablation (MWA) is a curative therapy for early-stage HCC that provides better local tumor control than TACE; however, MWA is limited for large or multifocal lesions. We aimed to compare treatment efficacy and downstaging rate following combined TACE-MWA and TACE alone in patients with unresectable HCC beyond the MC. Patients and Methods: Patients with unresectable HCC beyond the MC who underwent either TACE-MWA (n=91) or TACE alone (n=140) at four medical institutions were included. Potential influencing factors on overall survival (OS) and progression-free survival (PFS) were included in the Cox regression analysis. Propensity-score matching of patients treated with TACE-MWA and TACE alone was performed. Differences in OS and PFS were compared with the Log rank test. Patients who met the University of California, San Francisco criteria were eligible for assessment of the probability of downstaging within the MC. Downstaging rate was compared between the two groups. Results: In multivariate analysis, treatment with TACE alone was an independent predictor of poor PFS (P=0.011) and OS (P< 0.001). Both PFS (P=0.043) and OS (P=0.002) were significantly higher in patients treated with TACE-MWA than those treated with TACE alone. The downstaging rate was higher in patients treated with TACE-MWA than those treated with TACE alone (P=0.039). Conclusion: Compared with TACE alone, TACE-MWA may offer a survival benefit in terms of OS and PFS in HCC patients beyond the MC. Additionally, TACE-MWA may provide higher probability of downstaging within the MC than TACE alone, thereby increasing the possibility of liver transplantation.

Purpose: To investigate whether the iodized oil (Lipiodol, Guerbet Group, Villepinte, France) retention pattern influences the treatment efficacy of combined transarterial Lipiodol injection (TLI) and thermal ablation in patients with hepatocellular carcinoma (HCC). Methods: Data of 198 patients (280 HCC lesions), who underwent TLI plus computed tomography (CT)-guided thermal ablation at three separate medical institutions between June 2014 and September 2020, were reviewed and analyzed. The Lipiodol retention pattern was classified as complete or incomplete based on non-enhanced CT at the time of ablation. The primary outcome was local recurrence-free survival (LRFS) for lesions; the secondary outcome was overall survival (OS) for patients. Propensity score matching (PSM) was performed using a caliper width of 0.1 between the two groups. Differences in LRFS and OS between the two groups were compared using the log-rank test. Results: A total of 133 lesions exhibited a complete Lipiodol retention pattern, while 147 exhibited an incomplete pattern. After PSM analysis of baseline characteristics of the lesions, 121 pairs of lesions were matched. LRFS was significantly longer for lesions exhibiting complete retention than for those exhibiting incomplete retention (P = 0.030). After PSM analysis of patient baseline characteristics, 74 pairs of patients were matched. There was no significant difference in OS between the two groups (P = 0.456). Conclusion: Lipiodol retention patterns may influence the treatment efficacy of combined TLI and thermal ablation for HCC lesions. However, a survival benefit for the Lipiodol retention pattern among HCC patients was not observed and needs further confirmation.

Background: Hepatocellular carcinoma (HCC) constitutes approximately 75–85% of primary liver cancers and is a heavy burden on public health. Many innovative prediction systems have integrated radiomics, artificial intelligence, pathological information, or even genetic information for the stratification and prognosis prediction of patients with HCC. However, these systems still lack practical and clinical applications. Classical HCC staging systems remain the mainstream tool for stratification and prediction of treatment efficacy to date; although, variable characteristics and emphases between different classical HCC staging systems render its clinical selection inconsistent and therefore may be unreliable. In this study, we aimed to compare the predictive performance of classical liver cancer staging systems, including China Liver Cancer (CNLC), Barcelona Clinic Liver Cancer (BCLC), Hong Kong Liver Cancer (HKLC), modified Japanese Integrated Staging (mJIS), modified Cancer of the Liver Italian Program (mCLIP), and Tumor-Node-Metastasis (TNM) staging system, for the efficacy and prognosis of transcatheter arterial chemoembolization (TACE) in HCC patients. Methods: A total of 148 patients with HCC who received TACE as the initial therapy between 02/01/2019 and 08/31/2022 were retrospectively included. Patients’ clinical information, laboratory and imaging data, were collected. Cox regression analysis was applied to identify independent risk factors for progression-free survival (PFS) and overall survival (OS). Six liver cancer staging systems, including the CNLC, BCLC, HKLC, mJIS, mCLIP, and TNM staging system, were applied for the staging of every enrolled patient. The PFS and OS of patients with HCC following initial TACE in different staging systems were assessed, and the predictive performance of different systems was evaluated using the concordance index. Results: The presence of portal vein tumor thrombus (PVT), alpha fetoprotein (AFP) ≥400 ng/mL, and ineffective initial TACE treatment were independent risk factors for overall disease progression, while the presence of PVT and ineffective initial TACE treatment were independent risk factors for death. In the prediction of PFS and OS, CNLC, BCLC, HKLC, mJIS, and mCLIP all showed good predictive ability, but the predictive ability of the TNM staging system was relatively poor. Conclusions: The CNLC, BCLC, HKLC, mJIS, and mCLIP staging systems provide comparable predictive value for the prognosis after the initial TACE, while the TNM staging system has poor predictive ability due to its exclusion of hepatic function.

Background: Liver cancer (LC) is a major public health challenge in the Western Pacific Region (WPR), characterized by etiological diversity and increasing burden from both infectious and noninfectious causes. This study aimed to assess the burden of primary LC and its association with health system development indicators across the WPR from 1990 to 2021.Methods: We conducted a secondary analysis using data from the Global Burden of Disease (GBD) Study 2021, covering 31 countries and territories in the WPR. LC burden was evaluated in terms of incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by sex, age, location, and five etiologies: hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol use, nonalcoholic steatohepatitis (NASH), and other causes. Associations with Human Resources for Health (HRH), Universal Health Coverage (UHC) index, and Sociodemographic Index (SDI) were examined using Spearman correlation and generalized linear models.Results: Between 1990 and 2021, age-standardized DALYs rates for LC in the WPR rose from 281.78 to 334.74 per 100,000 population (EAPC: 0.56%). Total incidence nearly doubled, with sharp increases in Mongolia, Australia, and China. HBV remained the leading cause, while burdens from alcohol use and NASH grew markedly. LC burden showed moderate to strong positive correlations with HRH, UHC, and SDI, especially for HCV- and NASH-related cases; HBV-related burden showed weak associations.Conclusions: Despite progress in viral hepatitis control, the LC burden continues to rise in the WPR. Integrated strategies targeting viral, metabolic, and alcohol-related causes are urgently needed.

Introduction: Transcatheter arterial chemoembolization (TACE) is widely applied for locoregional malignant lesions control in intermediate and selected advanced hepatocellular carcinoma (HCC). Various inflammation indices, such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammatory index (SII), and Lymphocyte-to-C Reactive Protein Ratio (LCR) have been explored as tools for predicting the efficacy of TACE. However, the role and predictive value for dynamic changes of peripheral inflammatory indicators pre- and post-TACE remains unclear.Objective: To explore the association between the alteration in inflammatory index and the efficacy and prognosis of TACE and to provide more evidence for early prediction of the efficacy of TACE.Methods: This was a retrospective single-center study. HCC patients who received TACE as initial treatment were enrolled. The relationship between the alteration of inflammation indices (calculated as post-TACE minus pre-TACE measurements) and TACE efficacy and prognosis was investigated. Progression-free survival (PFS) was the primary endpoint, and treatment efficacy was evaluated based on mRECIST criteria.Results: Before propensity score matching (PSM), the change in LMR was significantly associated with treatment effective rate, with the unelevated ΔLMR group achieving a 79.4% treatment effective rate compared to 36.4% in the elevated group (p < 0.001). The estimated median PFS was 9.7 months and 4.5 months in the unelevated and elevated group, with a significant difference (p = 0.016). After PSM, the treatment effective rate was 48.7 and 38.5% (p = 0.214), and the estimated median PFS was 8.9 and 5.5 months (p = 0.173) for the unelevated and elevated group, respectively.Conclusion: Our study demonstrated that alteration of indices of peripheral inflammation, including ΔNLR, ΔLMR, ΔSII, and ΔPLR, may not be valuable prognostic markers for HCC patients who received TACE.

To comprehensively understand the disease burden of NASH-related liver cancer (NRLC) in China, we analyzed and evaluated the disease burden of NRLC in mainland China from 1990 to 2021 and predicted the trend in its health burden over the next 20 years. We characterized the burden of NRLC in China using the Global Burden of Disease (GBD) 2021 method and results based on incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Joinpoint and age-period-cohort (APC) analysis methods were used to interpret the epidemiological characteristics and compare them with global prevalence trends. Moreover, the Bayesian age-period-cohort model was used to predict the incidence of mortality in different age groups over the next 20 years. From 1990 to 2021, the age-standardized incidence rates of males and females in China changed from 4.75 (95% confidence interval [CI]: 3.81–5.81) to 5.42 (95% CI: 4.18–6.85), and the mortality rate changed from 5.02 (95% CI: 4.01–6.14) to 5.06 (3.88, 6.42) per 100,000 people. The age-standardized DALY rate in China has decreased from 133.91 (95% CI: 107.69–163.99) per 100,000 people in 1990 to 122.20 (95% CI: 94.14–154.42) per 100,000 people in 2021. The average annual percentage changes (AAPCs) in the age-standardized incidence, prevalence, and mortality of NRLC in China were 0.44 (95% CI: 0.34–0.54), 1.00 (95% CI: 0.75–1.25), and 0.13 (95% CI: −0.36 to 0.61), respectively. Age, period, and cohort had different effects on the incidence and mortality. Personally, middle-aged and elderly men should pay more attention to the prevention of NRLC. Given the large population, growing SDI index, and aging trend in China, multiple prevention policies and popular education programs should be considered in the near future to minimize the burden of NRLC.