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Simple Summary: Many drugs has become available for the advanced hepatocellular carcinoma and sequential systemic therapies play an important role in the clinical settings. Because the key eligibility criteria for post-progression treatment included the performance status of ≦1 and Child-Pugh score of ≦6, to clarify the eligibility for post-progression treatment will provide meaningful information. The aim of this multicenter retrospective study was to investigate the predictive factors of progression to Child-Pugh class B, the formation of ascites and the candidates for post-progression treatment. Authors confirmed that male, ALBI grade 1, Child-Pugh score 5 (CP5A) and BCLC early or intermediate stage were favorable factors related to sustaining liver function and the patients with ALBI grade 1 and CP5A were eligible for the post-progression treatment. Careful screening for ascites was needed in patients with low platelet count and Child-Pugh score 6. The aim of this multicenter retrospective study was to assess the change in liver function in patients with hepatocellular carcinoma treated with lenvatinib. Among 139 consecutive patients receiving lenvatinib treatment between March 2018 and July 2019, 28 patients with Child-Pugh class B and one patient with inadequate patient information were excluded. Remaining 110 patients with Child-Pugh class A were analyzed. The median age of 110 patients was 73 years (IQR 66.7–80) and 88 patients (80.0%) were men. Child-Pugh score was 5 (CP5A) and 6 (CP6A) in 58 (52.7%) and 52 patients (47.3%), and ALBI grade was 1 and 2 in 38 (34.5%) and 72 patients (65.5%), respectively. The deterioration to Child-Pugh class B was found in 43 patients (39.1%) during the lenvatinib treatment. The favorable factors related to preserving liver function were significantly shown to be male, ALBI grade 1, CP5A and BCLC early or intermediate stage in the multivariate analysis. The formation of ascites was found in 32 patients (28.6%). The significant unfavorable factors associated with the formation of ascites were found to be low platelet count and CP6A. Among the 79 patients, there were 36 (45.6%) and 11 patients (13.9%) who fulfilled the criteria for candidate for the post-progression treatment and ramucirumab treatment, respectively. The predictive factors of the post-progression treatment were shown to be ALBI grade 1 and CP5A in multivariate analysis. In conclusion, male, ALBI grade 1, CP5A and BCLC early or intermediate stage were favorable factors related to sustaining liver function and the patients with ALBI grade 1 and CP5A were eligible for the post-progression treatment. Careful screening for ascites was needed in patients with low platelet count and CP6A. [ABSTRACT FROM AUTHOR]

Simple Summary: Atezolizumab plus bevacizumab (Atez/Bev) is the first-line treatment for unresectable advanced hepatocellular carcinoma (HCC). The tumor markers (TMs) for HCC include alpha-fetoprotein (AFP), fucosylated alpha-fetoprotein (AFP-L3), and des-gamma carboxyprothrombin (DCP). A TM score combining these markers has been reported to be useful in predicting HCC prognosis. This retrospective study aimed to evaluate the ability of this previously reported TM score involving AFP, AFP-L3, and DCP as TMs in predicting prognosis and therapeutic efficacy in HCC patients administered Atez/Bev as first-line treatment. The TM score was found to be effective in stratifying overall survival and progression-free survival in 371 patients with unresectable advanced HCC treated with Atez/Bev. The TM score proved to be a simple and useful prognostic marker and therapeutic efficacy indicator for advanced HCC patients administered Atez/Bev as first-line treatment. Aim: This study aimed to evaluate the ability of a previously reported tumor marker (TM) score involving alpha-fetoprotein (AFP), fucosylated AFP (AFP-L3), and des gamma-carboxy prothrombin (DCP) as TMs in predicting the prognosis and therapeutic efficacy in hepatocellular carcinoma (HCC) patients administered atezolizumab plus bevacizumab (Atez/Bev) as first-line treatment. Materials/Methods: The study period covered September 2020 to December 2022 and involved 371 HCC patients treated with Atez/Bev. The values of the TMs AFP, AFP-L3, and DCP were measured upon introducing Atez/Bev. Elevations in the values of AFP (≥100 ng/mL), AFP-L3 (≥10%), and DCP (≥100 mAU/mL) were considered to indicate a positive TM. The number of positive TMs was summed up and used as the TM score, as previously proposed. Hepatic reserve function was assessed using the modified albumin–bilirubin grade (mALBI). Predictive values for prognosis were evaluated retrospectively. Results: A TM score of 0 was shown in 81 HCC patients (21.8%), 1 in 110 (29.6%), 2 in 112 (29.9%), and 3 in 68 (18.3%). The median overall survival (OS) times for TM scores 0, 1, 2, and 3 were not applicable [NA] (95% CI NA-NA), 24.0 months (95% CI 17.8-NA), 16.7 months (95% CI 17.8-NA), and NA (95% CI 8.3-NA), respectively (p < 0.001). The median progression-free survival (PFS) times for TM scores 0, 1, 2, and 3 were 16.5 months (95% CI 8.0-not applicable [NA]), 13.8 months (95% CI 10.6–21.3), 7.7 months (95% CI 5.3–8.9), and 5.8 months (95% CI 3.0–7.6), respectively (p < 0.001). OS was well stratified in mALBI 1/2a and mALBI 2a/2b. PFS was well stratified in mALBI 2a/2b, but not in mALBI 1/2a. Conclusions: The TM score involving AFP, AFP-L3, and DCP as TMs was useful in predicting the prognosis and therapeutic efficacy in terms of OS and PFS in HCC patients administered Atez/Bev as first-line treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Systemic therapy for advanced-stage hepatocellular carcinoma (HCC) is undergoing major changes owing to the advancements made in molecular-targeted therapies and immune checkpoint inhibitors (ICIs). Although transarterial chemoembolization has been used as the standard treatment for intermediate-stage HCC, it has recently included molecular-targeted drugs and ICIs. As intermediate-stage HCC encompasses a wide variety of HCCs, the appropriate regimen to be used and the order of drug administration, including the use of anti-angiogenic inhibitors, remain controversial. This review discusses treatment strategies for intermediate-stage HCC considering the background of progress in the treatment of advanced-stage HCC. Transarterial chemoembolization (TACE) has been standard treatment for intermediate-stage hepatocellular carcinoma (HCC). However, all intermediate-stage HCC patients did not benefit from TACE treatment because intermediate-stage HCC encompasses a wide variety of HCCs. Owing to remarkable progress in systemic therapy, including molecular-targeted therapy for advanced-stage HCC, the standard treatment of HCC has recently shifted to systemic therapy. However, it remains controversial as to which treatment should be initially performed for intermediate-stage HCC. In addition, although curative treatment can be considered when the tumor shrinks, the timing of conversion therapy remains uncertain. This review summarizes the advances of HCC treatment and discusses treatment strategies for intermediate-stage HCC. [ABSTRACT FROM AUTHOR]

Simple Summary: In this retrospective study of 198 HCC patients receiving ablation therapy, participants were divided into two groups based on body mass index (BMI): overweight patients (BMI ≥ 25) and non-overweight patients (BMI < 25). The technical success rate (TSR) in the first session was significantly higher in non-overweight patients than in overweight patients (90.3% vs. 78.4%, p = 0.03). Fifteen (20.3%) overweight and eleven (8.9%) non-overweight patients required additional ablation therapy for residual tumors, resulting in almost similar TSRs at the final session (95.9% vs. 99.2%, p = 0.3). Local tumor progression and distant recurrence rates were not significantly different between the two groups, but overall survival was better in overweight patients than in non-overweight patients (p < 0.001). Despite the potential adverse impact of being overweight on public health problems, the present findings showed the relationship between being overweight and improved survival. The negative aspects of being overweight might remain as minor technical issues in HCC patients receiving ablation therapy. This study aimed to investigate the effect of being overweight on the outcome of ablation therapy for patients with early-stage hepatocellular carcinoma (HCC). This retrospective study included 198 patients with HCC who underwent radiofrequency ablation or microwave ablation at Gunma Saiseikai Maebashi Hospital between April 2017 and December 2021. We divided the patients into two groups based on their body mass index (BMI): overweight (BMI ≥ 25 kg/m2, n = 74 (37.4%)) and non-overweight (BMI < 25 kg/m2, n = 124 (62.6%)). The technical success rates (TSRs) in the first session were 78.4% and 90.3% in overweight and non-overweight patients, respectively, with a significant difference (p = 0.03). Additional ablation therapy for residual tumors was required in 15 (20.3%) overweight and 11 (8.9%) non-overweight patients (p = 0.03), resulting in 95.9% and 99.2% TSRs at the final session, respectively, without a significant difference (p = 0.3). While local tumor progression and distant recurrence rates were not significantly different between the two groups, overall survival was better in overweight patients than in non-overweight patients (p < 0.001). Despite the potential adverse impact of being overweight on public health problems, the present findings showed the relationship between being overweight and improved survival. The negative aspects of being overweight might remain as minor technical issues in HCC patients receiving ablation therapy. [ABSTRACT FROM AUTHOR]