Tumour Biology Characteristics Score Based on AFP and PIVKA-II Predicts Recurrence and Survival After Curative Resection for Hepatocellular Carcinoma: A Multicentre Cohort StudyWang, Wang, Diao
et alJ Gastrointest Surg (2025)
Abstract: Current hepatocellular carcinoma (HCC) staging systems lack comprehensive assessment of tumour biological characteristics. This study aimed to develop and validate a tumour biology characteristics score (TBCS) based on alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) to predict long-term oncologic outcomes after HCC resection.In this multicentre retrospective cohort study, patients who underwent curative resection for HCC between June 2018 and December 2022 were included. TBCS (range 2-6 points) was calculated by combining preoperative AFP (<20, 20~199, ≥200ng/mL) and PIVKA-II (<40, 40~399, ≥400 mAU/mL) levels. Patients were stratified into low (2 points), medium (3~4 points), and high (5~6 points) TBCS groups. The primary outcomes were recurrence-free survival (RFS) and overall survival (OS).A total of 695 patients were analysed; the low, medium, and high TBCS groups comprised 132 (19.0%), 233 (33.5%), and 330 (47.5%) patients, respectively. 5-year RFS was 30.4%, 14.7%, and 9.7%, while 5-year OS was 42.1%, 35.5%, and 23.5% for low, medium, and high TBCS groups, respectively (both P<0.001). Multivariate analysis identified TBCS as an independent predictor of both RFS (medium TBCS: HR 1.583, 95% CI 1.219-2.057, P=0.001; high TBCS: HR 1.895, 95% CI 1.473-2.438, P<0.001) and OS (high TBCS: HR 1.781, 95% CI 1.353-2.343, P<0.001).The novel TBCS combining AFP and PIVKA-II effectively stratified HCC patients into distinct prognostic groups after curative-intent resection, independently predicting both RFS and OS. This score may help identify high-risk patients for more intense postoperative recurrence surveillance, as well as receipt of adjuvant therapies.Copyright © 2025 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.
Clinical and biochemical spectrum of APOB-related hypobetalipoproteinemia: Insights from a retrospective cohort studySürücü Kara, Köse, Mutlu
et alJ Clin Lipidol (2025)
Abstract: APOB-related familial hypobetalipoproteinemia (APOB-FHBL), the most common form of primary hypobetalipoproteinemia, often leaves heterozygous patients asymptomatic. This study aims to provide updated insights into the complications observed in heterozygous and homozygous APOB-FHBL patients.A retrospective analysis was conducted on 15 patients (53.3% female) from 7 families diagnosed with FHBL and followed in a metabolic clinic. Demographic, laboratory, clinical, and genetic data were reviewed.Patients were followed for an average of 4.5 ± 4.1 years. The median levels were as follows: low-density lipoprotein cholesterol (LDL-C; 25.7 ± 10.5 mg/dL), apolipoprotein B (ApoB; 0.3 ± 0.1 g/L), aspartate aminotransferase (AST; 40.1 ± 22.5 U/L), alanine aminotransferase (ALT; 43.0 ± 38.3 U/L), and alpha feto-protein (AFP; 1.3 ± 0.7 ng/mL). Elevated AST and ALT levels were observed in 20.0% and 26.7% of cases, respectively. Vitamin E deficiency was identified in 26.7%, vitamin A deficiency in 13.3%, and vitamin D insufficiency in 66.7% of cases. Liver ultrasonography revealed hepatosteatosis in 73.3% of patients. Additionally, the study identified 5 novel APOB gene variants. Among the families, 3 had members who died due to complications related to viral infections (COVID-19, hepatitis B virus) or hepatocellular carcinoma (HCC) resulting from chronic liver disease.Patients with elevated transaminase levels or hepatosteatosis should undergo a lipid profile assessment. LDL-C levels below 50 mg/dL require further evaluation, including ApoB and fat-soluble vitamin levels. Monoallelic APOB variants are linked to poor outcomes due to deficiencies in vitamins A, E, and D, as well as an increased risk of HCC. Early recognition and regular monitoring are essential for the effective management of APOB-FHBL patients.Copyright © 2025. Published by Elsevier Inc.
Nucleolin as a Potent Biomarker for Predicting Tumor Recurrence among Patients with Hepatocellular Carcinoma after TransplantationChen, Hu, Huang
et alJ Gastrointestin Liver Dis (2025) 34 (1), 81-89
Abstract: Tumor recurrence poses a significant challenge post-liver transplantation (LT) for hepatocellular carcinoma (HCC), necessitating the development of more precise predictive tools. In this study we aimed to investigate nucleolin as a biomarker for predicting HCC recurrence after LT.A cohort of 241 HCC patients undergoing LT was enrolled from three medical facilities spanning January 1, 2015, to December 31, 2017. Utilizing tissue microarrays, we assessed the predictive potential of nucleolin. Survival analyses, including Kaplan-Meier and log-rank tests, were employed to scrutinize overall survival and recurrence-free survival. Based on univariate and multivariate Cox regression analyses of preoperative parameters, nomogram and risk score were designed to predict HCC recurrence and determine the effectiveness of the model.The expression of nucleolin in HCC nucleus was increased. High nucleolin expression in tumor tissues correlated with poor overall survival and recurrence-free survival (5-year overall survival ratios: 34% vs. 64.8%, 5-year recurrence-free survival ratios: 36.1% vs.67.9%, all p<0.001). Multivariate Cox regression analysis identified nucleolin expression score, Hangzhou criteria, HBsAg, tumor differentiation and alpha-fetoprotein level as independent risk factors for tumor recurrence in HCC patients post- LT. A new nomogram is established based on the above risk factors with effective prediction efficiency (area under time-dependent receiver operating characteristic =0.742, concordance-index =0.7742).Nucleolin can be combined with a nomogram as an effective tool to predict recurrence in HCC patients following LT.
Differential Prognostic Impact of Tumor Burden Score on Hepatocellular Carcinoma Patients with Variable Physical Performance StatusTseng, Liu, Hsu
et alDig Dis Sci (2025)
Abstract: Performance status (PS) plays a crucial role in prognostic prediction for patients with hepatocellular carcinoma (HCC). The extent of tumor burden is also a major survival determinant. Recently, tumor burden score (TBS) was proposed to evaluate the extent of tumor involvement, but the interaction between TBS and PS has not been evaluated. We aimed to assess the prognostic role of TBS in HCC patients with variable PS.A large cohort of 4185 treatment-naïve HCC patients were retrospectively analyzed. The multivariate Cox proportional hazards model was used to determine the independent predictors associated with survival.Patients with poorer PS had significantly higher TBS at baseline. In the Cox model, older age, lower serum albumin level, higher serum bilirubin, creatinine and α-fetoprotein levels, presence of ascites, presence of vascular invasion, PS 1-2, PS 3-4, and medium TBS and high TBS were independently associated with increased mortality in the entire cohort (p < 0.001). In subgroup analysis stratified by PS, TBS was able to predict long-term survival in patients with PS 0 in the multivariate model. For patients with PS 1-2, the trend was significant only in those with high TBS (p < 0.001); in patients with PS 3-4, TBS was not significantly associated with survival (p > 0.05).TBS is a feasible prognostic surrogate for HCC and can well discriminate long-term survival in patients with good PS. Our findings demonstrate that TBS has a differential prognostic impact on HCC and may play a distinct role in outcome prediction for patients with variable PS.© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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