Diagnosis and treatment of hepatocellular carcinoma. Update of the consensus document of the AEEH, AEC, SEOM, SERAM, SERVEI, and SETH. / Diagnóstico y tratamiento del carcinoma hepatocelular. Actualización del documento de consenso de la AEEH, AEC, SEOM, SERAM, SERVEI y SETH.

Hepatocellular carcinoma (HCC) is the most common primary liver neoplasm and one of the most common causes of death in patients with cirrhosis of the liver. In parallel, with recognition of the clinical relevance of this cancer, major new developments have recently appeared in its diagnosis, prognostic assessment and in particular, in its treatment. Therefore, the Spanish Association for the Study of the Liver (AEEH) has driven the need to update the clinical practice guidelines, once again inviting all the societies involved in the diagnosis and treatment of this disease to participate in the drafting and approval of the document: Spanish Society for Liver Transplantation (SETH), Spanish Society of Diagnostic Radiology (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Association of Surgeons (AEC) and Spanish Society of Medical Oncology (SEOM). The clinical practice guidelines published in 2016 and accepted as National Health System Clinical Practice Guidelines were taken as the reference documents, incorporating the most important recent advances. The scientific evidence and the strength of the recommendation is based on the GRADE system.

CNApp, a tool for the quantification of copy number alterations and integrative analysis revealing clinical implications.

Somatic copy number alterations (CNAs) are a hallmark of cancer, but their role in tumorigenesis and clinical relevance remain largely unclear. Here, we developed CNApp, a web-based tool that allows a comprehensive exploration of CNAs by using purity-corrected segmented data from multiple genomic platforms. CNApp generates genome-wide profiles, computes CNA scores for broad, focal and global CNA burdens, and uses machine learning-based predictions to classify samples. We applied CNApp to the TCGA pan-cancer dataset of 10,635 genomes showing that CNAs classify cancer types according to their tissue-of-origin, and that each cancer type shows specific ranges of broad and focal CNA scores. Moreover, CNApp reproduces recurrent CNAs in hepatocellular carcinoma and predicts colon cancer molecular subtypes and microsatellite instability based on broad CNA scores and discrete genomic imbalances. In summary, CNApp facilitates CNA-driven research by providing a unique framework to identify relevant clinical implications. CNApp is hosted at https://tools.idibaps.org/CNApp/.

In most cases, human cells contain two copies of each of their genes, yet sometimes this can change, an effect called copy number alteration (CNA). Cancer is a genetic disease and thus, studying the DNA from tumor samples is crucial to improving diagnosis and choosing the right treatment. Most tumors contain cells with CNAs; however, the impact of CNAs in cancer progression is poorly understood. CNAs can be studied by examining the genome of tumor cells and finding which regions display an unusual number of copies. It may also be possible to gather information about different cancer types by analyzing the CNAs in a tumor, but this approach requires the analysis of large amounts of data. To aid the analysis of CNAs in cancer cells, Franch-Expósito, Bassaganyas et al. have created an online tool called CNApp, which is able to identify and count CNAs in genomic data and link them to features associated with different cancers. The hope is that a better understanding of the effect of CNAs in cancer could help better diagnose cancers, and improve outcomes for patients. Potentially, this could also predict what type of treatment would work better for a specific tumor. Besides, by using a machine-learning approach, the tool can also make predictions about specific cancer subtypes in order to facilitate clinical decisions. Franch-Expósito, Bassaganyas et al. tested CNApp using previously existing cancer data from 33 different cancer types to show how CNApp can help the interpretation of CNAs in cancer. Moreover, CNApp can also use CNAs to identify different types of bowel (colorectal) cancer in a way that could help doctors to make decisions about treatment. Together these findings show that CNApp provides an adaptable and accessible research tool for the study of cancer genomics, which could provide opportunities to inform medical procedures.

Diagnóstico y tratamiento del carcinoma hepatocelular. Actualización del documento de consenso de la AEEH, SEOM, SERAM, SERVEI y SETH / Diagnosis and treatment of hepatocellular carcinoma. Update consensus document from the AEEH, SEOM, SERAM, SERVEI and SETH

El carcinoma hepatocelular es la neoplasia primaria de hígado más común y una de las causas de muerte más frecuentes en los pacientes afectos de cirrosis hepática. Simultáneamente al reconocimiento de la relevancia clínica de esta neoplasia, en los últimos años han aparecido novedades importantes en el diagnóstico, estadificación y tratamiento del carcinoma hepatocelular. Por tal motivo, desde la Asociación Española para el Estudio del Hígado se ha impulsado la necesidad de actualizar las guías de práctica clínica, invitando de nuevo a todas las sociedades involucradas en el diagnóstico y tratamiento de esta enfermedad a participar en la redacción y aprobación del documento (la Sociedad Española de Trasplante Hepático, la Sociedad Española de Radiología Médica, la Sociedad Española de Radiología Vascular e Intervencionista y la Sociedad Española de Oncología Médica). Se ha tomado como documento de referencia las guías de práctica clínica publicadas en 2009 aceptadas como Guía de Práctica Clínica del Sistema Nacional de Salud, incorporando los avances más importantes que se han obtenido en los últimos años. La evidencia científica en el tratamiento del carcinoma hepatocelular se ha evaluado de acuerdo con las recomendaciones del National Cancer Institute (www.cancer.gov) y la fuerza de la recomendación se basa en el sistema GRADE (AU)

Hepatocellular carcinoma is the most common primary malignancy of the liver and one of the most frequent causes of death in patients with liver cirrhosis. Simultaneously with the recognition of the clinical relevance of this neoplasm, in recent years there have been important developments in the diagnosis, staging and treatment of HCC. Consequently, the Asociación Española para el Estudio del Hígado has driven the need to update clinical practice guidelines, continuing to invite all the societies involved in the diagnosis and treatment of this disease to participate in the drafting and approval of the document (Sociedad Española de Trasplante Hepático, Sociedad Española de Radiología Médica, Sociedad Española de Radiología Vascular e Intervencionista y Sociedad Española de Oncología Médica). The clinical practice guidelines published in 2009 accepted as Clinical Practice Guidelines of the National Health System has been taken as reference document, incorporating the most important advances that have been made in recent years. The scientific evidence for the treatment of HCC has been evaluated according to the recommendations of the National Cancer Institute (www.cancer.gov) and the strength of recommendation is based on the GRADE system (AU)

[Diagnosis and treatment of hepatocellular carcinoma. Update consensus document from the AEEH, SEOM, SERAM, SERVEI and SETH]. / Diagnóstico y tratamiento del carcinoma hepatocelular. Actualización del documento de consenso de la AEEH, SEOM, SERAM, SERVEI y SETH.

Hepatocellular carcinoma is the most common primary malignancy of the liver and one of the most frequent causes of death in patients with liver cirrhosis. Simultaneously with the recognition of the clinical relevance of this neoplasm, in recent years there have been important developments in the diagnosis, staging and treatment of HCC. Consequently, the Asociación Española para el Estudio del Hígado has driven the need to update clinical practice guidelines, continuing to invite all the societies involved in the diagnosis and treatment of this disease to participate in the drafting and approval of the document (Sociedad Española de Trasplante Hepático, Sociedad Española de Radiología Médica, Sociedad Española de Radiología Vascular e Intervencionista y Sociedad Española de Oncología Médica). The clinical practice guidelines published in 2009 accepted as Clinical Practice Guidelines of the National Health System has been taken as reference document, incorporating the most important advances that have been made in recent years. The scientific evidence for the treatment of HCC has been evaluated according to the recommendations of the National Cancer Institute (www.cancer.gov) and the strength of recommendation is based on the GRADE system.

Guía de Práctica Clínica sobre Diagnóstico y Tratamiento del Carcinoma Hepatocelular (actualización del documento de consenso de la AEEH, SEOM, SERAM, SERVEI, SETH) / Diagnosis and treatment of hepatocellular carcinoma. Update consensus document from the AEEH, SEOM, SERAM, SERVEI and SETH

El carcinoma hepatocelular es la neoplasia primaria de hígado más común y una de las causas de muerte más frecuentes en los pacientes afectos de cirrosis hepática. Simultáneamente al reconocimiento de la relevancia clínica de esta neoplasia, en los últimos anos ˜ han aparecido novedades importantes en el diagnóstico, estadificación y tratamiento del carcinoma hepatocelular. Por tal motivo, desde la Asociación Espanola ˜ para el Estudio del Hígado se ha impulsado la necesidad de actualizar las guías de práctica clínica, invitando de nuevo a todas las sociedades involucradas en el diagnóstico y tratamiento de esta enfermedad a participar en la redacción y aprobación del documento (la Sociedad Espanola ˜ de Trasplante Hepático, la Sociedad Espanola ˜ de Radiología Médica, la Sociedad Espanola ˜ de Radiología Vascular e Intervencionista y la Sociedad Espanola ˜ de Oncología Médica). Se ha tomado como documento de referencia las guías de práctica clínica publicadas en 2009 aceptadas como Guía de Práctica Clínica del Sistema Nacional de Salud, incorporando los avances más importantes que se han obtenido en los últimos anos. ˜ La evidencia científica en el tratamiento del carcinoma hepatocelular se ha evaluado de acuerdo con las recomendaciones del National Cancer Institute (www.cancer.gov) y la fuerza de la recomendación se basa en el sistema GRADE.

Ecografía con contraste de segunda generación (SonoVue) en la valoración del tratamiento percutáneo del carcinoma hepatocelular. Comparación con la TC multifásica / Second-generation ultrasound contrast agents (SonoVue) in the evaluation of percutaneous treatment of hepatocellular carcinoma: comparison with multiphase CT

Objetivo: Determinar la eficacia de la ecografía con contraste (EC) de segunda generación en la valoración del tratamiento percutáneo del carcinoma hepatocelular (CHC), tanto de una forma precoz (< 24 h), como al mes después del tratamiento. Asimismo, se analiza la utilidad de la tomografía computarizada (TC) en la valoración inmediata después del tratamiento, hecho cuestionado hasta el momento. Material y métodos: Se han incluido en el estudio 30 pacientes afectados de CHC de pequeño tamaño, no tributarios de resección quirúrgica, tratados mediante alcoholización o radiofrecuencia. Antes del tratamiento, pasadas menos de 24 h de tratamiento, y 1 mes postratamiento efectuaron una EC (con software especial de contrastes y bajo índice mecánico) y una TC multifásica. Se compararon los hallazgos de las exploraciones a las 24 h (EC y TC) y los de la EC 1 mes postratamiento con los de la TC al mes (gold standar).Resultados: Valorado con TC al mes, el tratamiento percutáneo obtuvo una respuesta completa en 22 de los 30 pacientes. La EC y la TC realizadas antes de las 24 h postratamiento obtuvieron, respectivamente, los siguientes resultados: sensibilidad (S), 12,5 (28,5%); especificidad (E), 95,4 (95,4%); rentabilidad diagnóstica (RD), 73,3 (79,3%); valor predictivo positivo (VPP), 50 (66%); valor predictivo negativo (VPN), 75 (80,6%). Los resultados de la EC realizada al mes postratamiento fueron: S, 87,5%; E, 95,4%; RD, 93,3%; VPP, 87,5%, y VPN, 95,4%.Conclusión: La EC y la TC realizadas antes de las 24 h postratamiento tienen escasa utilidad para detectar la persistencia tumoral valorada de forma inmediata postratamiento. Dados los buenos resultados de la EC realizada al mes postratamiento, esta exploración podría sustituir a la TC para valorar la necesidad de nuevos tratamientos

Objective: to determine the efficacy of ultrasonography using second-generation contrast agents (CUS) in the evaluation of percutaneous treatment of hepatocellular carcinoma (HCC), both for early evaluation (< 24 hours) and for evaluation one month after treatment. Likewise, the usefulness of computerized tomography (CT) for evaluation immediately after treatment, to date controversial, is assessed. Material and methods: A total of 30 patients with small-sized HCC without indications for surgery treated by radiofrequency ablation or alcohol injection were included in the study. All patients underwent CUS (using special contrast software and low mechanical index) and multiphase CT prior to treatment, within 24 hours of treatment, and one month after treatment. CT findings one month after treatment were taken as the gold standard. Findings at CUS and CT examination within 24 hours of treatment and CUS findings at one month were compared with the gold standard. Results: CT performed one month after percutaneous treatment found a complete response in 22 of the 30 patients. Comparison of CUS and CT findings within 24 hours of treatment with the gold standard yielded the following results: (CUS/CT) Sensitivity (S) = 12.5/28.5%, specificity (SP) = 95.4/95.4%, diagnostic yield (DY) = 73.3/79.3%, positive predictive value (PPV) = 50/66%, negative predictive value (NPV) = 75/80.6%. The results of CUS performed one month after treatment were : S = 87.5%, SP = 95.4%, DY = 93.3%, PPV = 87.5% and NPV = 95.4%.Conclusion: CUS and CT performed within 24 hours of treatment are of little use in detecting tumor persistence immediately after treatment. Given the good results obtained using CUS one month after treatment, this technique could substitute CT to assess the need for retreatment