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Cancers
Special Issues
Predictors, Presentation, and Treatment Outcomes in Hepatocellular Carcinoma and Cirrhosis
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Predictors, Presentation, and Treatment Outcomes in Hepatocellular Carcinoma and Cirrhosis

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (15 August 2022) | Viewed by 10205

Special Issue Editor

Dr. Roberto Lezzi

E-Mail Website
Guest Editor
Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
Interests: cancer treatments; locoregional therapies; predictive models; radiomics; interventional oncology; liver cancer; hepatocellular carcinoma; overall survival; radiology

Special Issue Information

Dear Colleagues,

In recent years, new diagnostic, interventional options in terms of techniques, as well as new devices or technological improvements have emerged for patients with hepatic disorders and lesions. In detail, new imaging modalities have allowed for improvements in detection, characterization, as well as planning for eventual treatment and evaluation of results. However, despite continuous innovation, conventional imaging assessment may provide limited information. New research has also focused on quantitative imaging analysis techniques, with the increasing role of radiomics as an efficient tool promising to aid in personalized diagnosis and treatment decision making. Radiomics could also be combined with big data analysis and machine learning algorithms to create clinical-target‐oriented imaging biomarkers to assist in disease management.

On the other hand, there have been several advances in treating liver lesions, with new locoregional treatments, innovative mini-invasive surgical techniques, and new systemic options, including immunotherapy, which is revolutionizing cancer care.

This Special Issue of Cancers welcomes articles on innovations in diagnostics and interventions for cirrhosis, as well as hepatocellular carcinoma, with a multidisciplinary approach that could lead to the development of predictive and personalized therapies for effective and affordable cancer care.

Dr. Roberto Lezzi
Guest Editor

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 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. Cancers 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 2900 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

  • cirrhosis
  • liver function
  • MRI
  • dynamic CT
  • US
  • transient elastography
  • fibroscan
  • contrast enhanced US
  • fusion imaging
  • ablation
  • chemoembolization
  • radioembolization
  • systemic treatments
  • immunotherapy
  • combined treatment
  • contrast medium
  • stereotactic radiotherapy
  • robotic devices
  • hepatocellular carcinoma (HCC)
  • radiomics
  • imaging predictors
  • biomarkers

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Published Papers (5 papers)

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Research

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15 pages, 4219 KiB  
Article
Machine Learning to Predict the Response to Lenvatinib Combined with Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma
by Jun Ma, Zhiyuan Bo, Zhengxiao Zhao, Jinhuan Yang, Yan Yang, Haoqi Li, Yi Yang, Jingxian Wang, Qing Su, Juejin Wang, Kaiyu Chen, Zhengping Yu, Yi Wang and Gang Chen
Cancers 2023, 15(3), 625; https://doi.org/10.3390/cancers15030625 - 19 Jan 2023
Cited by 10 | Viewed by 2171
Abstract
Background: Lenvatinib and transarterial chemoembolization (TACE) are first-line treatments for unresectable hepatocellular carcinoma (HCC), but the objective response rate (ORR) is not satisfactory. We aimed to predict the response to lenvatinib combined with TACE before treatment for unresectable HCC using machine learning (ML) [...] Read more.
Background: Lenvatinib and transarterial chemoembolization (TACE) are first-line treatments for unresectable hepatocellular carcinoma (HCC), but the objective response rate (ORR) is not satisfactory. We aimed to predict the response to lenvatinib combined with TACE before treatment for unresectable HCC using machine learning (ML) algorithms based on clinical data. Methods: Patients with unresectable HCC receiving the combination therapy of lenvatinib combined with TACE from two medical centers were retrospectively collected from January 2020 to December 2021. The response to the combination therapy was evaluated over the following 4–12 weeks. Five types of ML algorithms were applied to develop the predictive models, including classification and regression tree (CART), adaptive boosting (AdaBoost), extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM). The performance of the models was assessed by the receiver operating characteristic (ROC) curve and area under the receiver operating characteristic curve (AUC). The Shapley Additive exPlanation (SHAP) method was applied to explain the model. Results: A total of 125 unresectable HCC patients were included in the analysis after the inclusion and exclusion criteria, among which 42 (33.6%) patients showed progression disease (PD), 49 (39.2%) showed stable disease (SD), and 34 (27.2%) achieved partial response (PR). The nonresponse group (PD + SD) included 91 patients, while the response group (PR) included 34 patients. The top 40 most important features from all 64 clinical features were selected using the recursive feature elimination (RFE) algorithm to develop the predictive models. The predictive power was satisfactory, with AUCs of 0.74 to 0.91. The SVM model and RF model showed the highest accuracy (86.5%), and the RF model showed the largest AUC (0.91, 95% confidence interval (CI): 0.61–0.95). The SHAP summary plot and decision plot illustrated the impact of the top 40 features on the efficacy of the combination therapy, and the SHAP force plot successfully predicted the efficacy at the individualized level. Conclusions: A new predictive model based on clinical data was developed using ML algorithms, which showed favorable performance in predicting the response to lenvatinib combined with TACE for unresectable HCC. Combining ML with SHAP could provide an explicit explanation of the efficacy prediction. Full article
(This article belongs to the Special Issue Predictors, Presentation, and Treatment Outcomes in Hepatocellular Carcinoma and Cirrhosis)
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11 pages, 1377 KiB  
Article
Three-Dimensional Quantitative Tumor Response and Survival Analysis of Hepatocellular Carcinoma Patients Who Failed Initial Transarterial Chemoembolization: Repeat or Switch Treatment?
by Yan Zhao, Reham R. Haroun, Sonia Sahu, Ruediger E. Schernthaner, Susanne Smolka, Ming-De Lin, Kelvin K. Hong, Christos Georgiades and Rafael Duran
Cancers 2022, 14(15), 3615; https://doi.org/10.3390/cancers14153615 - 25 Jul 2022
Cited by 1 | Viewed by 1671
Abstract
Objectives: The purpose of this study was to assess treatment responses and evaluate survival outcomes between responders and non-responders after each transarterial chemoembolization (TACE) session using the 3D quantitative criteria of the European Association for the Study of the Liver (qEASL) in hepatocellular [...] Read more.
Objectives: The purpose of this study was to assess treatment responses and evaluate survival outcomes between responders and non-responders after each transarterial chemoembolization (TACE) session using the 3D quantitative criteria of the European Association for the Study of the Liver (qEASL) in hepatocellular carcinoma (HCC) patients. Methods: A total of 94 consecutive patients who underwent MR imaging before and after TACE were retrospectively included. Volumetric tumor enhancement (qEASL) was expressed in cubic centimeters (cm3). The Kaplan–Meier method with the log-rank test was used to calculate the overall survival (OS) for the non-/responders. Results: In total, 28 (29.8%) patients showed a response after the first TACE. These responders demonstrated a clear trend toward longer OS compared with the non-responders (36.7 vs. 21.5 months, p = 0.071). Of the 43 initial non-responders who underwent a second TACE within 3 months and had complete follow-up imaging, 15/43 (34.9%) achieved a response, and their median OS was significantly longer than that of the 28 non-responders to the second TACE (47.8 vs. 13.6 months, p = 0.01). Furthermore, there was no significant difference in OS between the 28 patients who achieved a response after the first TACE and the 15 initial non-responders who achieved a response after the second TACE (36.7 vs. 47.8 months, p = 0.701). The difference in OS between the responders and non-responders after the third TACE was not significant (11.4 months vs. 13.5 months, p = 0.986). Conclusion: Our study quantitatively demonstrated that a second TACE can be beneficial in terms of tumor response and survival for HCC patients who do not initially respond to TACE. Full article
(This article belongs to the Special Issue Predictors, Presentation, and Treatment Outcomes in Hepatocellular Carcinoma and Cirrhosis)
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12 pages, 1022 KiB  
Article
Real-World Data on Ramucirumab Therapy including Patients Who Experienced Two or More Systemic Treatments: A Multicenter Study
by Yutaka Yasui, Masayuki Kurosaki, Kaoru Tsuchiya, Yuka Hayakawa, Chitomi Hasebe, Masami Abe, Chikara Ogawa, Kouji Joko, Hironori Ochi, Toshifumi Tada, Shinichiro Nakamura, Koichiro Furuta, Hiroyuki Kimura, Keiji Tsuji, Yuji Kojima, Takehiro Akahane, Takashi Tamada, Yasushi Uchida, Masahiko Kondo, Akeri Mitsuda and Namiki Izumiadd Show full author list remove Hide full author list
Cancers 2022, 14(12), 2975; https://doi.org/10.3390/cancers14122975 - 16 Jun 2022
Cited by 8 | Viewed by 2328
Abstract
Background: The present study aimed to clarify the efficacy and safety of ramucirumab in a real-world setting, including patients who experienced two or more systemic treatments or whose hepatic reserve was deteriorated. Methods: In total, 79 patients with hepatocellular carcinoma (HCC) from 14 [...] Read more.
Background: The present study aimed to clarify the efficacy and safety of ramucirumab in a real-world setting, including patients who experienced two or more systemic treatments or whose hepatic reserve was deteriorated. Methods: In total, 79 patients with hepatocellular carcinoma (HCC) from 14 institutes throughout Japan were retrospectively analyzed. The response was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and AEs were recorded according to the Common Terminology Criteria for AEs (CTCAE) version 5.0. Results: Median overall survival (OS) in the total cohort was 7.5 months (m). Median OS was 8.8 m in patients who were administered ramucirumab as a second-line treatment, while it was 7.3 m in third- or later-line treatment. Progression-free survival rates in the second- and third- or later-line therapies were 3.2 m and 3.2 m, respectively. The disease control rate (DCR) in the study was 43%. There were no statistically significant differences in DCR between the treatment courses. Regarding adverse events (AEs), the development of ascites was observed significantly more frequently in modified albumin–bilirubin (mALBI) 2b/3 patients than in mALBI 1/2a patients (54.5% vs. 25.0%, p = 0.03). Conclusions: Ramucirumab is useful as a second-line therapy and feasible as a third- or later-line treatment for HCC. Full article
(This article belongs to the Special Issue Predictors, Presentation, and Treatment Outcomes in Hepatocellular Carcinoma and Cirrhosis)
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Review

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11 pages, 1606 KiB  
Review
Early-Stage HCC Percutaneous Locoregional Management: East versus West Perspectives
by Roberto Iezzi, Alessandro Posa, Andrea Contegiacomo, In Joon Lee, Reto Bale, Alessandro Tanzilli, Lorenzo Tenore, Felice Giuliante, Antonio Gasbarrini, Shraga Nahum Goldberg, Tobias Jakobs, Maurizio Pompili, Irene Bargellini, Evis Sala and Hyo-Cheol Kim
Cancers 2023, 15(15), 3988; https://doi.org/10.3390/cancers15153988 - 6 Aug 2023
Viewed by 1556
Abstract
Hepatocellular carcinoma represents an important cause of death worldwide. Early-stage hepatocellular carcinoma patients not suitable for surgery can be treated with a variety of minimally invasive locoregional interventional oncology techniques. Various guidelines in different countries address the treatment of hepatocellular carcinoma, but the [...] Read more.
Hepatocellular carcinoma represents an important cause of death worldwide. Early-stage hepatocellular carcinoma patients not suitable for surgery can be treated with a variety of minimally invasive locoregional interventional oncology techniques. Various guidelines in different countries address the treatment of hepatocellular carcinoma, but the actual treatment is usually discussed by a multidisciplinary tumor board in a personalized manner, leading to potential treatment differences based on Western and Eastern perspectives. The aim of this paper is to integrate literature evidence with the eminent experiences collected during a focused session at the Mediterranean Interventional Oncology (MIO) Live Congress 2023. Full article
(This article belongs to the Special Issue Predictors, Presentation, and Treatment Outcomes in Hepatocellular Carcinoma and Cirrhosis)
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14 pages, 2838 KiB  
Review
Liquid Biopsy-Guided Interventional Oncology: A Proof of Concept with a Special Focus on Radiotherapy and Radiology
by Natalia Malara, György Kovacs, Francesco Bussu, Teresa Ferrazzo, Virginia Garo, Cinzia Raso, Patrizia Cornacchione, Roberto Iezzi and Luca Tagliaferri
Cancers 2022, 14(19), 4676; https://doi.org/10.3390/cancers14194676 - 26 Sep 2022
Cited by 2 | Viewed by 1861
Abstract
Although the role of liquid biopsy (LB) to measure minimal residual disease (MRD) in the treatment of epithelial cancer is well known, the biology of the change in the availability of circulating biomarkers arising throughout treatments such as radiotherapy and interventional radio-oncology is [...] Read more.
Although the role of liquid biopsy (LB) to measure minimal residual disease (MRD) in the treatment of epithelial cancer is well known, the biology of the change in the availability of circulating biomarkers arising throughout treatments such as radiotherapy and interventional radio-oncology is less explained. Deep knowledge of how therapeutic effects can influence the biology of the release mechanism at the base of the biomarkers available in the bloodstream is needed for selecting the appropriate treatment-induced tumor circulating biomarker. Combining existing progress in the LB and interventional oncology (IO) fields, a proof of concept is provided, discussing the advantages of the traditional risk assessment of relapsing lesions, limitations, and the timing of detection of the circulating biomarker. The current review aims to help both interventional radiologists and interventional radiation oncologists evaluate the possibility of drawing a tailor-made board of blood-based surveillance markers to reveal subclinical diseases and avoid overtreatment. Full article
(This article belongs to the Special Issue Predictors, Presentation, and Treatment Outcomes in Hepatocellular Carcinoma and Cirrhosis)
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