Charing C. N. Chong

Integration of albumin–bilirubin (ALBI) score into Barcelona Clinic Liver Cancer (BCLC) system for hepatocellular carcinoma

The albumin–bilirubin (ALBI) grade is a recently reported, simpler, more objective, and evidence‐based alternative to the Child–Pugh (CP) score for hepatocellular carcinoma (HCC). We aimed to study whether ALBI grade could substitute for CP score in Barcelona Clinic Liver Cancer (BCLC) for HCC.

A Seven-microRNA Expression Signature Predicts Survival in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the fifth common cancer. The differential expression of microRNAs (miRNAs) has been associated with the prognosis of various cancers. However, limited information is available regarding genome-wide miRNA expression profiles in HCC to generate a tumor-specific miRNA signature of prognostic values. In this study, the miRNA profiles in 327 HCC patients, including 327 tumor and 43 adjacent non-tumor tissues, from The Cancer Genome Atlas (TCGA) Liver hepatocellular carcinoma (LIHC) were analyzed. The associations of the differentially expressed miRNAs with patient survival and other clinical characteristics were examined with t-test and Cox proportional regression model. Finally, a tumor-specific miRNA signature was generated and examined with Kaplan–Meier survival, univariate\multivariate Cox regression analyses and KEGG pathway analysis. Results showed that a total of 207 miRNAs were found differentially expressed between tumor and adjacent non-tumor HCC tissues. 78 of them were also discriminatively expressed with gender, race, tumor grade and AJCC tumor stage. Seven miRNAs were significantly associated with survival (P value <0.001). Among the seven significant miRNAs, six (hsa-mir-326, hsa-mir-3677, hsa-mir-511-1, hsa-mir-511-2, hsa-mir-9-1, and hsa-mir-9-2) were negatively associated with overall survival (OS), while the remaining one (hsa-mir-30d) was positively correlated. A tumor-specific 7-miRNAs signature was generated and validated as an independent prognostic predictor. Collectively, we have identified and validated an independent prognostic model based on the expression of seven miRNAs, which can be used to assess patients’ survival. Additional work is needed to translate our model into clinical practice.

Incorporating Albumin‐Bilirubin grade into the Cancer of the Liver Italian Program system for hepatocellular carcinoma

The albumin–bilirubin (ALBI) grade is a recently emerging alternative of the Child–Pugh (CP) grade. The Cancer of the Liver Italian Program (CLIP) was demonstrated to be a useful prognostic model for hepatocellular carcinoma (HCC) in large prospective cohorts. We aimed to investigate the feasibility of substituting the CP grade by the ALBI grade in the CLIP system and compare the prognostic performance with other existing staging systems.

Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016

Portal vein tumor thrombosis (PVTT) is a common phenomenon in hepatocellular carcinoma (HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a higher chance of complications related to portal hypertension and poorer tolerance to treatment. Conventionally, HCC with PVTT is grouped together with metastatic HCC during the planning of its management, and most patients are offered palliative treatment with sorafenib or other systemic agents. As a result, most data on the management of HCC with PVTT comes from subgroup analyses or retrospective series. In the past few years, there have been several updates on management of HCC with PVTT. First, it is evident that HCC with PVTT consists of heterogeneous subgroups with different prognoses. Different classifications have been proposed to stage the degree of portal vein invasion/thrombosis, suggesting that different treatment modalities may be individualized to patients with different risks. Second, more studies indicate that more aggressive treatment, including surgical resection or locoregional treatment, may benefit select HCC patients with PVTT. In this review, we aim to discuss the recent conceptual changes and summarize the data on the management of HCC with PVTT.

Applicability of Albumin-Bilirubin-based Japan Integrated Staging (ALBI-T) score in hepatitis B-associated hepatocellular carcinoma.

The Japan Integrated Staging (JIS) for hepatocellular carcinoma (HCC) has been extensively studied in hepatitis virus C‐endemic Japanese population but seldom evaluated outside Japan, while albumin‐bilirubin (ALBI)‐based JIS (ALBI‐T) has never been externally validated. We evaluate the prognostic significance of the ALBI‐T score among Chinese patients with hepatitis virus B (HBV)‐related HCC, and to explore its potential therapeutic application in selecting patients for appropriate treatments in addition to the Barcelona Clinic Liver Cancer (BCLC) recommendation.

Laparoscopic and robotic hepatectomy: experience from a single centre.

Both laparoscopic and robotic hepatectomy have been adopted in our centre for selected patients with benign or malignant liver diseases. This article reports the perioperative outcomes of these two approaches and tries to determine any difference between them.

Systematic evaluation of circulating inflammatory markers for hepatocellular carcinoma.

A number of circulating inflammatory factors are implicated in the pathogenesis and prognostication of hepatocellular carcinoma (HCC). We aim to evaluate the prognostication of multiple serum inflammatory factors simultaneously and develop an objective inflammatory score for HCC.

Alternative splicing of estrogen receptor alpha in hepatocellular carcinoma

BackgroundThe role of estrogen receptor alpha (ERa), estrogen receptor beta (ERb) and ERa36 signaling in hepatocellular carcinoma (HCC) is not fully addressed.MethodsIn this study, three cohorts were included: (i) primary HCC patients (N = 76, cohort P), (ii) colorectal liver metastasis (mCRC) (N = 32, cohort S), and (iii) HCC from The Cancer Genome Atlas (TCGA) (N = 121). The levels of ERa36 and wtER36 were measured and their correlation with clinicopathologic features was determined.ResultsWtERa was downregulated and that ERa36 was upregulated in tumor tissues in both cohort P and TCGA data set. ERa36 was downregulated in tumor tissues in cohort S. In cohort P, wtERa was differentially expressed in gender (P < 0.000), age (P = 0.004), tumor number (P = 0.043), tumor size (P = 0.002), intrahepatic recurrence (P = 0.054). ERa36 was unequally expressed in different non-tumor liver status (P = 0.040). WtERa was negatively associated with overall survival (OS) and disease free survival (DFS) in cohort P. Compared with non-tumor tissues, the expression of ERa36 was increased in primary HCC but decreased in secondary HCC, showing opposite expression patterns of ERa36 between primary HCC and secondary HCC.ConclusionsPrimary HCC is associated with the decreased WtERa but increased ERa36. The expression pattern of ERa36 is different between primary HCC and secondary HCC, as the former with the increased ERa36 but the latter with the decreased ERa36. Therefore, the expression of ERa36 may be used to differentiate the primary HCC and the secondary one.

Steatotic hepatocellular carcinoma: a variant associated with metabolic factors and late tumour relapse.

Steatosis in hepatocellular carcinoma (HCC) has been recognized for decades and found most commonly in small, well‐differentiated HCC. However, the clinicopathological features and pathogenesis of HCC with steatosis is not well characterized. There are few data concerning whether HCC with steatosis should be regarded a distinct histological variant, steatotic HCC.

Validating the ALBI grade: Its current and future use in HCC prognostication

To the Editor: We have read with interest the article from Pinato et al., who validated the prognostication of the albumin-bilirubin (ALBI) grade in an international cohort of 2426 patients with hepatocellular carcinoma (HCC) from Europe, the United States and Asia [1]. The authors confirmed that the ALBI grade was an independent prognostic factor among different treatment modalities, geographical location and time of study recruitment across each Barcelona Clinic Liver Cancer (BCLC) stage. In this letter, we would like to raise two interesting points for discussion. First, the authors observed that prognostication of the ALBI grade on survival was more apparent in the post-year 2000 dataset than the pre-year 2000 one, which raised a hypothesis that the adoption of the BCLC treatment allocation could help unify the patient selection and management. Our group have a similar observation in a previously published cohort of HCC (n = 1973) [2], which was recruited during a different time period (year 2001–2013) from the one by Pinato et al. (year 1985–2015). Our results showed that the prognostic performance of the ALBI grade on overall survival was better after 2008 (n = 906) than before January 2008 (n = 1067) (Table 1). However, we did not find any difference in the adherence to the BCLC treatment algorithm between the preand post-year 2008 subset, withweighted kappa 0.720 and 0.724 for preand post-2008 subset, respectively. This finding has led us to look for an alternative explanation for this phenomenon. As our cohort was characterized by a high proportion of chronic hepatitis B (CHB) infection and the use of antiviral