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Introduction: We aim to assess the long‐term outcomes of percutaneous multi‐bipolar radiofrequency (mbpRFA) as the first treatment for hepatocellular carcinoma (HCC) in transplant‐eligible cirrhotic patients, followed by salvage transplantation for intrahepatic distant tumour recurrence or liver failure. Materials and Methods: We included transplant‐eligible patients with cirrhosis and a first diagnosis of HCC within Milan criteria treated by upfront mbp RFA. Transplantability was defined by age <70 years, social support, absence of significant comorbidities, no active alcohol use and no recent extrahepatic cancer. Baseline variables were correlated with outcomes using the Kaplan‐Meier and Cox models. Results: Among 435 patients with HCC, 172 were considered as transplantable with HCCs >2 cm (53%), uninodular (87%) and AFP >100 ng/mL (13%). Median overall survival was 87 months, with 75% of patients alive at 3 years, 61% at 5 years and 43% at 10 years. Age (p =.003) and MELD>10 (p =.01) were associated with the risk of death. Recurrence occurred in 118 patients within Milan criteria in 81% of cases. Local recurrence was observed in 24.5% of cases at 10 years and distant recurrence rates were observed in 69% at 10 years. After local recurrence, 69% of patients were still alive at 10 years. At the first tumour recurrence, 75 patients (65%) were considered transplantable. Forty‐one patients underwent transplantation, mainly for distant intrahepatic tumour recurrence. The overall 5‐year survival post‐transplantation was 72%, with a tumour recurrence of 2.4%. Conclusion: Upfront multi‐bipolar RFA for a first diagnosis of early HCC on cirrhosis coupled with salvage liver transplantation had a favourable intention‐to‐treat long‐term prognosis, allowing for spare grafts. [ABSTRACT FROM AUTHOR]

Introduction: The effectiveness of percutaneous radiofrequency ablation (RFA) in intrahepatic cholangiocarcinomas (iCCA) remains insufficiently studied. Methods: We conducted a retrospective study including patients with histologically proven iCCA within Milan criteria treated by percutaneous RFA from 2000 to 2022. The primary outcome was overall survival in treatment‐naive patients and secondary outcomes included ablation completeness, adverse events, local and distant recurrence. A total of 494 patients with hepatocellular carcinoma (HCC) on cirrhosis treated by RFA were included as a comparison group. Oncological events were analysed using Kaplan–Meier, log‐rank and univariate/multivariate Cox models. Results: The main population included 71 patients, mostly cirrhotic (80%) with solitary tumours (66%) of a median size of 24 mm. Local recurrence was 45% at 5 years, lower in multibipolar versus monopolar RFA (22% vs. 55%, p =.007). In treatment‐naive patients (n = 45), median overall and recurrence‐free survivals were 26 and 11 months, respectively. Tumour size (p =.01) and Child‐Pugh B (p =.001) were associated with death. The rate of distant recurrence was 59% at 5 years significantly lower for single tumours of less than 2 (p =.002) or 3 cm (p =.02). In cirrhotic patients naïve of previous treatment (n = 40), overall survival was shorter than in HCC (26 vs 68 months, p <.0001), with more local recurrences (p <.0001). Among distant recurrences, 50% were extrahepatic metastases compared to 12% in HCC (p <.001). Conclusion: Multibipolar RFA provides better results in terms of tumour recurrence than monopolar RFA and could be used to treat small iCCA (<3 cm). Adjuvant chemotherapy should be discussed due to the frequent extra‐hepatic metastasis at recurrence. [ABSTRACT FROM AUTHOR]

A recent study published in Liver International explores the need for imaging biomarkers to predict the prognosis of early-stage hepatocellular carcinoma (HCC). The study developed a deep learning model to predict the presence of microvascular invasion (MVI) using pre-treatment magnetic resonance imaging (MRI). The model achieved high performance in predicting MVI in a cohort of surgically resected HCC and showed clinical relevance as a companion biomarker for adjuvant therapies. The study highlights the importance of exploiting the full potential of MRI and calls for further research and clinical trials to refine and test these imaging-based biomarkers. [Extracted from the article]

Background: The combination of atezolizumab and bevacizumab (AtezoBev) is the current first‐line treatment for patients with hepatocellular carcinoma (HCC). Our aim was to evaluate the prognostic role of alpha‐foetoprotein (AFP) early response and its combination with albumin–bilirubin (ALBI) in these patients. Methods: Patients with HCC under AtezoBev with AFP > 20 ng/ml were included in three centres. The optimal threshold of AFP variation after 3 weeks of treatment was identified for overall survival (OS) and radiological response (RR) using RECIST 1.1 and mRECIST and its ability to predict progression‐free survival (PFS) and OS was tested using univariate and multivariate analysis in derivation and validation cohorts. Results: Seventy‐five patients with AFP values >20 ng/ml were included. Fifty‐eight patients were male with a median age of 63.5 years; 73% had cirrhosis and HCC stage was classified as BCLC B (18.7%) or C (81.3%). In the derivation cohort (n = 38), a decline in AFP ≥ 20% at 3 weeks (AFP early response) was associated with RR using mRECIST criteria (OR: 13.09 95% CI: 1.44–19.34 p =.02), PFS (HR: 0.42; 95% CI: 0.19–0.93, p =.03) and OS (HR: 0.35; 95% CI: 0.15–0.83, p =.01). AFP early response was confirmed as predictor of RR (p =.02 for mRECIST) and OS (p =.03) in the validation cohort (n= 37). In the whole cohort, the combination of ALBI and AFP early response was significantly associated with OS (p =.046) and PFS (p =.012) with a poor prognosis in patients belonging to the ALBI2‐AFP non‐responders class. Conclusion: AFP early response at 3 weeks predicts oncological outcomes in HCC patients treated with AtezoBev and combination with ALBI grade refines prognostic discrimination. [ABSTRACT FROM AUTHOR]

Background & Aims: Long‐term outcomes after percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in patients with non‐alcoholic fatty liver disease (NAFLD) have been poorly studied. We aim to determine the outcomes after multibipolar RFA in these patients compared to other aetiologies as well as the prognostic impact of metabolic syndrome (MS). Methods: Patients who underwent multibipolar RFA as the first treatment for HCC within Milan criteria (2008‐2018) were enrolled in this multicentre retrospective cohort from four tertiary centres in France. The association of MS and NAFLD with adverse events and outcomes after percutaneous RFA were assessed using Kaplan Meier method, log‐rank test and uni/multivariate analysis with the Cox models. Results: Among 520 patients, 390 patients (75%) had at least one component of MS including obesity (30%) and 95% had cirrhosis. Sixty‐two patients (12.6%) had NAFLD‐HCC, 225 (45.5%) had alcohol‐related‐HCC, 36 (7.3%) had HBV‐HCC and 171 (34.6%) had HCV‐HCC. Patients with NAFLD‐HCC were significantly older (median age 72.6 years, P <.001), more obese (median BMI 30.3 kg/m2, P <.001) and had more components of MS. Patients with NAFLD‐HCC achieved a median overall survival (OS) of 79 months (1‐year, 3‐year and 5‐year OS of 90%, 71% and 59%). There were no differences in morbidity, tumour recurrence and OS among patients with NAFLD‐HCC vs other aetiologies as well as no prognostic impact of metabolic components. Conclusions: Percutaneous multibipolar RFA is an efficient treatment in HCC patients with NAFLD or metabolic syndrome and achieved similar long‐term oncological outcomes compared to other aetiologies. [ABSTRACT FROM AUTHOR]

Purpose: To describe and evaluate an image fusion technique for the portal vein puncture guidance during TIPS procedure: a three-dimensional (3D) virtual target fluoroscopic display obtained with an automated 3D carbon dioxide wedged hepatic vein portography (3D CO2-WHVP).Materials and Methods: All the 37 TIPS creations performed in our institution between 3/2017 and 12/2018 were retrospectively reviewed. Seventeen procedures were guided using the 3D CO2-WHVP technique (group 1) and were compared with the other 20 procedures performed under conventional 2D fluoroscopic guidance (group 2). Image acquisition for the 3D CO2-WHVP consisted of combining a CBCT acquisition and an automatic CO2 injection. Once located on the multiplanar reformatted images of the CBCT acquisition, the portal bifurcation was manually segmented to create a virtual target that was overlaid onto live fluoroscopy allowing a real-time 3D guidance during portal vein puncture.Results: Primary success was 100% in group1 and 95% in group2. Median intervention length, fluoroscopy time and dose area product (DAP) were, respectively, 124 min [IQR 94-137], 40 min [IQR 26-52] and 12140 cGy.cm2 [IQR 10147-18495] in group 1 and 146 min [IQR 118-199], 40 min [IQR 36-60] and 13290 cGy.cm2 [IQR 10138-19538] in group 2. No technical parameter was significantly different between the two groups. Intraprocedural complication rate was 0% in group 1 and 20% in group 2 (p = 0.05).Conclusion: Three-dimensional virtual target fluoroscopic display using a CBCT-acquired CO2 wedged portography is an effective and safe technique to ease intrahepatic puncture of the portal vein during TIPS procedures. [ABSTRACT FROM AUTHOR]

Résumé: La sarcopénie au cours des maladies du foie est définie comme une réduction généralisée de la masse musculaire et de la fonction musculaire due à une hépatopathie aiguë ou chronique. Les recommandations actuelles préconisent d'inclure une évaluation de la sarcopénie dans l'évaluation nutritionnelle chez tout patient ayant une hépatopathie chronique. Les mécanismes physiopathologiques impliqués sont l'autophagie, l'hyperactivation du système ubiquitine/protéasome et l'activation de la voie mTOR. L'installation de la sarcopénie est multifactorielle, liée à la présence d'une hyperammoniémie, la diminution du taux sanguin de testostérone et de facteurs de croissance ou d'acides aminés ramifiés. La mesure de la sarcopénie peut être effectuée de façon fonctionnelle ou morphologique ; la technique la plus répandue d'évaluation de la sarcopénie et source de plusieurs publications est le calcul de la surface musculaire squelettique au scanner (skeletal muscle area) au niveau de la troisième vertèbre lombaire avec des seuils fixés à < 50 cm2/m2 chez l'homme et < 39 cm2/m2 chez la femme. La mesure du diamètre ou de la surface du muscle psoas par tomodensitométrie a été considérée par plusieurs groupes d'auteurs comme une alternative simple et fiable. L'impact pronostique négatif de la sarcopénie chez les patients en attente de transplantation hépatique ou en post-transplantation hépatique est bien établi. De plus, la sarcopénie est également un facteur pronostique péjoratif décrit au cours du carcinome hépatocellulaire développé sur cirrhose. Un certain nombre d'études ont suggéré le rôle bénéfique de l'exercice physique avec une amélioration de la sarcopénie chez le patient cirrhotique. L'aspect nutritionnel est majeur au cours de la prise en charge de la sarcopénie, puisque la dénutrition en est un facteur déclenchant et d'entretien important de la sarcopénie. Un patient cirrhotique devrait avoir un apport énergétique d'au moins 35 kcal/kg/j et un apport protéique entre 1,2 et 1,5 g/kg/j auxquels s'ajoutent une collation nocturne et éventuellement une supplémentation en acides aminés ramifiés. Sarcopenia in liver diseases is defined by a global reduction in muscle mass and muscle function due to acute or chronic liver disease. Current recommendations advice to include an assessment of sarcopenia in the nutritional evaluation in all patients with chronic liver disease. The main pathophysiological mechanisms involved in the process of sarcopenia are autophagy, hyper activation of the ubiquitin/proteasome system and activation of the mTOR pathway. The occurence of sarcopenia is multifactorial; the presence of hyperammonemia, decreased blood levels of testosterone and growth factors or branched chain amino acids play an important role. Assessment of sarcopenia can be performed functionally or morphologically ; the most widespread method used for the evaluation of sarcopenia is the measurement of the skeletal muscle area by tomography scanner (skeletal muscle area, SMA) at the level of the third lumbar vertebra with thresholds for sarcopenia set at <50 cm2/m2 in men and <39 cm2/m2 in women. Several groups have considered the diameter or area of the psoas muscle by computed tomography as a simple and reliable alternative. The negative prognostic impact of sarcopenia in patients awaiting liver transplantation or after liver transplantation is well established. Moreover, sarcopenia is also a poor prognostic factor in patients with hepatocellular carcinoma (HCC) developed on cirrhosis. Several studies have suggested the positive role of physical exercise with an improvement in sarcopenia in the cirrhotic patient. The nutritional aspect is a key point for the management of sarcopenia. A cirrhotic patient should have an energy intake of at least 35 kcal/kg/d and a protein intake between 1.2 and 1.5 g/kg/d to which is added a night snack and possibly a supplementation of branched amino acids in some cases. [ABSTRACT FROM AUTHOR]

Background and aim: The prognostic value of transient elastography (TE) in cirrhotic patients with hepatocellular carcinoma (HCC) treated by percutaneous radiofrequency ablation (RFA) is currently unknown. Method(s): We included patients with histologically proven cirrhosis and with a first diagnosis of HCC inside Milan criteria treated by percutaneous RFA, and with TE available the year before treatment with 10 shots and interquartile range/median < 30%. Association between variables and clinical events was assessed by the Kaplan–Meier method with the log–rank test and using Cox univariate and multivariate analyses. Results: One hundred fifty‐nine patients were included, with a median age of 65 years; 77.4% were men. Causes of cirrhosis were alcohol consumption (48.1%), hepatitis C (43.7%), hepatitis B (12.7%), and non‐alcoholic steatohepatitis (32.3%). Median value of TE was 26 kPa (4–75 kPa). Overall survival at 1, 2, and 5 years was, respectively, 93%, 81%, and 44%; overall recurrence was 28%, 49%, and 80%. The TE value was not associated with tumor recurrence (0.13). In contrast, in univariate analysis, TE value, age, Child–Pugh B, and alkaline phosphatase were predictive factors in overall survival. In multivariate analysis, TE value (hazards ratio [HR] = 1.02, 95% confidence interval (IC): 1.01–1.04, 0.001), age (HR = 1.05, 95% IC: 1.03–1.08, P = 0.00006), and Child–Pugh B score (HR = 2.78, 95% IC: 1.27–6.08, P = 0.01) were independently associated with higher risk of death. A TE value ≥ 40 kPa was associated with shorter median overall survival (34 months) compared to a TE value < 40 kPa (59 months, P = 0.0008). Conclusion(s): Transient elastography (TE) predicts overall survival but not tumor recurrence in cirrhotic patients with HCC treated by RFA. [ABSTRACT FROM AUTHOR]