No abstract

PRO-C3 is an independent predictor of fibrosis stage in NAFLD. A PRO-C3 based score (ADAPT) accurately identifies patients with NAFLD and advanced fibrosis and is superior to APRI, FIB-4 and NFS. This article is protected by copyright. All rights reserved.

We investigated the clinical significance of a vascular growth pattern of hepatocellular carcinoma (HCC), the vessels that encapsulate tumor clusters (VETC), previously linked to HCC metastatic dissemination. VETC was assessed in a large multi‐institutional cohort of 541 resected HCCs from Italy, Korea and Japan, and matched against a full spectrum of clinical and pathological variables. The VETC phenotype (defined as ≥ 55% tumor area by CD34 immunostaining) was easily reproducible and reliably detectable in whole sections and small‐sized tissues of tissue microarray. VETC HCCs represented 18.9% of the whole series, the lowest proportion occurring in the cohort with smallest tumors (8.7%, Japanese series). VETC was significantly associated with several clinical and pathological features such as high alfa‐fetoprotein (AFP) level, tumor size greater than 5 cm, poor differentiation, macrotrabecular pattern, less compact pattern, less inflammatory infiltrates, and frequent microvascular invasion. VETC was associated with early recurrence (hazard ratio [HR]: 1.52 [1.06‐2.19], P = 0.023), disease‐free survival (HR: 1.66 [1.21‐2.27], P = 0.002), and overall survival (HR: 2.26 [1.37‐3.72], P = 0.001) at multivariable analysis. VETC affected the survival in HCC patients stratified for etiology (hepatitis C virus/hepatitis B virus), vascular invasion, and specific molecular phenotypes (β‐catenin/GS+). This distinct vascular pattern was enriched in the recently reported macrotrabecular massive HCC subtype, which was seen in 7.8% (42 of 541) of patients and associated with high AFP levels and poor differentiation. Conclusion: The VETC pattern was found to be easily detectable in a consistent fraction of HCC and a powerful pathological finding affecting survival. This study suggests that the heterogeneous pattern of angiogenesis is involved in HCC behavior.

Interferon alfa (IFN-␣) has been shown to possess antiviral activity, antiproliferative activity, and various immunoregulatory activities including: 1) stimulation of cytotoxic activities of lymphocytes and macrophages, and of natural killer cell activity; and 2) induction of class I major histocompatibility complex antigens. 1 The effects of IFN-␣ are mediated through interaction with the specific cell-surface receptor, type I IFN receptor. This receptor consists of two chains, Hu-IFN-␣R1 and Hu-IFN-␣R2, which can be present in different forms. [2][3][4][5][6] The Hu-IFN-␣R1 chain is present as either the full chain (Hu-IFN-␣R1) or a splice-variant (Hu-IFN-␣R1s) lacking exons 4 and 5. Hu-IFN-␣R2 chain exists in soluble, short, and long forms (Hu-IFN-␣R2a, Hu-IFN-␣R2b, and Hu-IFN␣R2c, respectively). [2][3][4] Most likely, the Hu-IFN-␣R1 and Hu-IFN-␣R2c chains represent the predominantly active form. 2 Binding of the receptor and IFN-␣ induce transcription of IFN-inducible genes through the activation of the Jak/signal transducer and activator of transcription (STAT) signaling pathway. 7-9 Interferon regulatory factor (IRF)-1, a transcriptional activator, and its antagonistic repressor, IRF-2, have been identified as regulators of type I IFN (mainly IFN-␣ and IFN-␤) and IFN-inducible genes. 10-12 IRF-1 has recently been shown to inhibit cell proliferation, induce apoptosis, and manifest antioncogenic activities, 10,13-17 while IRF-2 has the oncogenic potential. 10 The IRF-1 gene itself is IFN-inducible and may thus be one of the critical target genes mediating IFN action. 11 Antivirus activity of IFN-␣ has attracted a great deal of attention, and IFN-␣ has been applied in treatment for hepatitis B virus (HBV)-and hepatitis C virus (HCV)-related chronic hepatitis in several countries (reviewed in Gutterman 18 ). In the liver of HCV-infected patients, expressions of Hu-IFN-␣R1 and Hu-IFN-␣R2 chains were investigated in terms of mRNA level, and the relationship between their expression levels and response to IFN-␣ therapy was reported. 19,20 Although IFN-␣ has been proven to have a curative potential in treatment of HBV-and HCV-associated chronic liver diseases, its effect on hepatocellular carcinoma (HCC), which is a common and often fatal complication of HBV-and HCV-related chronic liver diseases, 21 is not well known. Clinical trials of IFN-␣ in treatment of HCC did not achieve consistent results: one study showed beneficial effects, 22 and the other studies did not show significant antitumor effects. 23,24 In contrast, IFN-␣ has been shown to be useful for the treatment of several malignant diseases, including hairy-cell leukemia and chronic myelogenous leukemia (reviewed in Gutterman 18 ).Experimental studies showed that IFN-␣ can inhibit the growth of various normal and malignant cells in vitro by inducing cell-cycle changes (e.g., induction of G 0 /G 1 arrest and prolongation of the S phase) 25-34 and/or apoptoAbbreviations: IFN-␣, interferon alfa; STAT, signal transducer and activator of transcription; IRF, ...

Combined hepatocellular-cholangiocarcinoma comprises <1% of all liver carcinomas. The histogenesis of combined hepatocellular-cholangiocarcinoma has remained unclear for many years. However, recent advances in hepatic progenitor cell (HPC) investigations have provided new insights. The concept that combined hepatocellular-cholangiocarcinoma originates from HPCs is adopted in the chapter "combined hepatocellular-cholangiocarcinoma" of the latest World Health Organization (WHO) classification. In this study, we conducted clinicopathologic analysis of combined hepatocellular-cholangiocarcinoma according to the latest WHO classification. Fifty-four cases were included in this study. Pathologic diagnosis was made according to the WHO classification. When a tumor contained plural histologic patterns, predominant histologic pattern (≥50%) was defined. Minor histologic patterns were also appended. Immunohistochemical staining with biliary markers (CK7, CK19, and EMA), hepatocyte paraffin (HepPar)-1, HPC markers (CD56, c-kit, CD133, and EpCAM), and vimentin was performed. Forty-five and 50 patients were analyzed for progression-free survival and overall survival, respectively. Ten, 1, 32, and 11 cases were diagnosed as: combined hepatocellular-cholangiocarcinoma, classical type; combined hepatocellular-cholangiocarcinoma, stem cell features, typical subtype; combined hepatocellular-cholangiocarcinoma, stem cell features, intermediate cell subtype; and combined hepatocellular-cholangiocarcinoma, stem cell features, cholangiolocellular type, respectively. Combined hepatocellular-cholangiocarcinomas usually have high expression of biliary markers. CD56, c-kit, and EpCAM were expressed to various degrees in all combined hepatocellular-cholangiocarcinomas apart from the hepatocellular carcinoma component of combined hepatocellular-cholangiocarcinoma, classical type. The expression of CD133 and vimentin was observed only in combined hepatocellular-cholangiocarcinoma, stem cell features of intermediate cell subtype and cholangiolocellular subtype. The expression of CD133, EpCAM, and vimentin was significantly high in combined hepatocellular-cholangiocarcinoma, subtypes with stem cell features, especially cholangiolocellular subtype. Minor histologic patterns were significantly frequent in combined hepatocellular-cholangiocarcinoma, subtypes with stem cell features, compared with combined hepatocellular-cholangiocarcinoma, classical type. There was no significant difference in clinical outcome between each subtype. Combined hepatocellular-cholangiocarcinoma has wide histologic diversity and shows immunophenotypic expression of not only biliary markers but also HPC markers to various degrees, suggesting that the histogenesis of combined hepatocellular-cholangiocarcinoma could be strongly associated with HPCs. Our results pathologically validate the latest WHO classification of combined hepatocellular-cholangiocarcinoma. However, the complex mixture of histologic subtypes has presented a challenge to the classification of combined ...