International Hepatology

Recently, Professor Shichun Lu's team from the Chinese PLA General Hospital published an article titled "Application of Proportion of Viable Tumor Cells in Prognosis Evaluation of Initial Unresectable Hepatocellular Carcinoma Patients Undergoing Sequential Surgical Treatment After Conversion Therapy" in the professional journal Chinese Journal of Hepatobiliary Surgery. The study retrospectively analyzed clinical data and pathological evaluations of 80 initially unresectable HCC patients who received PD-1 antibody combined with tyrosine kinase inhibitors (TKIs) as conversion therapy followed by sequential surgical treatment. The research team confirmed the value of the proportion of viable tumor cells (RVTCs) in surgical pathology specimens as a prognostic marker for patients undergoing conversion surgery and identified the optimal threshold for RVTCs (15%) and factors influencing achieving RVTCs ≤ 15% postoperatively.

Primary liver cancer (PLC) is one of the most common cancers worldwide and a leading cause of cancer-related deaths, with hepatocellular carcinoma (HCC) accounting for about 85% of all PLC cases. Despite continuous advancements in medical technology, radical surgical resection of the primary tumor remains a key component of HCC treatment. Robotic liver resection (RLR) is a relatively new technique that combines the advantages of traditional surgery with the precision and flexibility of robotic surgical systems. However, it remains unclear whether RLR is superior to traditional surgery in clinical practice.

The "Hepatology Digest - Liver Vascular Diseases" column is a scholarly column co-initiated by Dr. Xingshun Qi from the Department of Gastroenterology at the General Hospital of Northern Theater Command, at the invitation of the editorial board of Hepatology Digest. This column regularly collects and summarizes research progress in the field of liver vascular diseases, selecting and discussing one significant paper every two weeks (Wednesday). The aim is to help readers understand the reasoning behind the findings, inspire clinical research thinking, and apply what they have learned in practice.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common liver disease worldwide, with recent data showing prevalence rates of up to 39% in adults and 20% in children. MAFLD is characterized by overweight or obesity, type 2 diabetes, and/or metabolically dysregulated hepatic steatosis and can coexist with various hepatic and cardiovascular metabolic diseases.

Complications related to portal hypertension are the main cause of death in patients with advanced chronic liver disease (ACLD). Even after the underlying cause is controlled, clinical events during the progression of portal hypertension, such as esophageal variceal bleeding, ascites, overt hepatic encephalopathy, and acute-on-chronic liver failure, are the most critical factors leading to high mortality in chronic liver disease. The hepatic venous pressure gradient is the "gold standard" for assessing portal hypertension, and upper gastrointestinal endoscopy is an essential tool for screening and evaluating esophagogastric varices and their severity. However, both are invasive procedures, making them unsuitable for screening and monitoring portal hypertension. Non-invasive diagnostic methods based on spleen stiffness measurement (SSM) using vibration-controlled transient elastography can be used for screening, stratifying diagnosis, and monitoring portal hypertension and esophageal varices. At the recent 2024 Jinling Liver Disease Conference, Professor Jinjun Chen from Nanfang Hospital, shared advances in the non-invasive diagnosis of portal hypertension and esophagogastric varices in ACLD patients using spleen stiffness. The content is summarized as follows for the readers.

To help clinicians and researchers in the field of hepatology stay updated with academic knowledge and research trends, Hepatology Digest and the Journal of Clinical and Translational Hepatology (JCTH) jointly launched the "Journal Club" column. Every two weeks (Tuesday), one selected article is highlighted, focusing on key points or insights to improve clinical practice, inspire research thinking, and enhance writing skills.

Since the advent of immune checkpoint inhibitors (ICI) for the treatment of malignant tumors, the exploration of their use in hepatocellular carcinoma (HCC) has been relentless. In 2017 and 2018, nivolumab and pembrolizumab were respectively granted accelerated approval by the FDA for second-line treatment of HCC following progression on sorafenib. However, both agents failed to meet primary endpoints in phase III clinical trials (CheckMate-459 for nivolumab and Keynote-240 for pembrolizumab) as first-line and second-line treatments respectively, which prevented them from securing a standalone role in HCC treatment. Conversely, a phase III trial in an Asian population (Keynote-394), which tested pembrolizumab as a second-line treatment compared to a placebo, reported positive results, and pembrolizumab continues to be conditionally used post-sorafenib progression. Subsequent extensive clinical research has continued to explore the role of ICIs across the entire spectrum of HCC treatment, including neoadjuvant and adjuvant therapies around curative resection, first-line therapy combining with TACE for intermediate-stage HCC, and first and second-line treatments for advanced-stage HCC. Professor Ming Zhao from the Sun Yat-sen University Cancer Center provides a comprehensive review of the recent applications of immunotherapy in HCC.

Since the advent of immune checkpoint inhibitors (ICI) for the treatment of malignant tumors, the exploration of their use in hepatocellular carcinoma (HCC) has been relentless. In 2017 and 2018, nivolumab and pembrolizumab were respectively granted accelerated approval by the FDA for second-line treatment of HCC following progression on sorafenib. However, both agents failed to meet primary endpoints in phase III clinical trials (CheckMate-459 for nivolumab and Keynote-240 for pembrolizumab) as first-line and second-line treatments respectively, which prevented them from securing a standalone role in HCC treatment. Conversely, a phase III trial in an Asian population (Keynote-394), which tested pembrolizumab as a second-line treatment compared to a placebo, reported positive results, and pembrolizumab continues to be conditionally used post-sorafenib progression. Subsequent extensive clinical research has continued to explore the role of ICIs across the entire spectrum of HCC treatment, including neoadjuvant and adjuvant therapies around curative resection, first-line therapy combining with TACE for intermediate-stage HCC, and first and second-line treatments for advanced-stage HCC. Professor Ming Zhao from the Sun Yat-sen University Cancer Center provides a comprehensive review of the recent applications of immunotherapy in HCC.