Subin Heo

Background and Aims: Porto‐sinusoidal vascular disorder (PSVD) is a rare liver condition characterized by specific histological features primarily affecting the hepatic sinusoidal and periportal vasculature, in the absence of cirrhosis. This study aimed to identify prognostic factors and regulatory pathways associated with PSVD by integrating transcriptomic and clinical data. Methods: A total of 114 PSVD patients were included, with 74 followed longitudinally for liver‐related events. RNA sequencing was performed on 21 liver samples and compared to six histologically normal livers. Associations between clinical parameters, such as liver‐to‐spleen volume ratio (LSVR) and fibrosis stage, with liver‐related events were assessed. Transcriptomic analyses, including co‐expression and cell deconvolution, were conducted based on these parameters. Results: Among the 114 patients, 32 (28.1%) underwent liver transplantation at diagnosis. LSVR strongly correlated with fibrosis stage, which was significantly associated with liver transplantation (per 1‐stage increase: adjusted OR, 14.88; 95% CI: 3.72–59.58). Over a mean follow‐up of 6.7 years in the longitudinal cohort, 12 patients (16.2%) experienced liver‐related events. LSVR was identified as a significant prognostic marker, with an optimal cut‐off value of 1.33 for predicting liver‐related events. Transcriptomic analysis based on LSVR and fibrosis stage revealed distinct gene expression patterns and cellular changes in PSVD, including shifts in liver sinusoidal endothelial cell (LSEC) distribution, an increased hepatic stellate cell population, and upregulation of IL‐6 signalling, without changes in immune cell composition as the disease progresses. Conclusions: This study identified LSVR as a novel prognostic marker in PSVD and suggests that IL‐6 trans‐signalling‐induced endotheliopathy in LSECs may play a role in the proinflammatory and fibrotic changes associated with disease progression.

Stereotactic body radiation therapy (SBRT) is a noninvasive, high-precision radiation technique that delivers a high dose to the tumor in a limited number of fractions, typically five or fewer, and is increasingly used as a curative-intent option for hepatocellular carcinoma (HCC), particularly when surgical resection, liver transplantation, or local ablative therapies are not feasible. Although domestic and international guidelines have incorporated SBRT into the treatment algorithm for HCC, the lack of comprehensive evidence and expert opinion regarding patient selection, pretreatment evaluation, treatment planning and delivery, complication management, and post-treatment follow-up has resulted in substantial variation in clinical practice. Accordingly, expert consensus-based practical recommendations for SBRT were developed by a group of radiation oncologists, hepatologists, and radiologists from the Research Committee of the Korean Liver Cancer Association, based on expert surveys, a comprehensive review of evidence-based literature, and a modified Delphi process. Encompassing the entire clinical workflow of liver SBRT, these recommendations are intended to provide practical guidance for the safe and effective implementation of SBRT in patients with HCC.

Background: Combined hepatocellular–cholangiocarcinoma (cHCC-CCA) is an uncommon primary liver cancer with distinct histology but overlapping clinical features with hepatocellular carcinoma (HCC). This study compared postoperative outcomes between cHCC-CCA and HCC in patients with very-early or early-stage tumors. Methods: We retrospectively analyzed 137 patients with cHCC-CCA and 3637 with HCC, all of which were pathologically confirmed at Barcelona Clinic Liver Cancer stage 0–A and treated with curative-intent resection at a high-volume tertiary center between 2010 and 2018. Tumors were reclassified according to the 2019 World Health Organization criteria. To minimize baseline imbalances, 1:4 propensity score matching was performed, yielding 137 patients with cHCC-CCA and 532 matched patients with HCC. Overall survival (OS) and recurrence-free survival (RFS) were compared using Cox regression and subgroup analyses. Results: In the matched cohort, baseline characteristics – including tumor stage – were well balanced; nevertheless, 5-year RFS and OS were significantly lower in cHCC-CCA [RFS, 46.8% vs. 56.8%; hazard ratio (HR), 1.41; 95% confidence interval (CI), 1.10–1.81; P = 0.007; and OS, 70.8% vs. 86.1%; HR, 2.02; 95% CI, 1.47–2.78; P < 0.001]. Subgroup analyses consistently demonstrated inferior outcomes for cHCC-CCA across clinical strata. Notably, OS was comparable between groups among patients without recurrence; however, in those with recurrence, cHCC-CCA was associated with significantly worse OS and a higher incidence of extrahepatic relapse (24.1% vs. 7.7%; P < 0.001), most frequently in the lungs and lymph nodes. Conclusion: cHCC-CCA is associated with significantly poorer postoperative outcomes than HCC, particularly in the setting of recurrence. Intensified surveillance and strategies to reduce extrahepatic recurrence may be warranted in this population.

Artificial intelligence (AI)-driven deep learning has fundamentally transformed hepatosplenic volumetry, elevating it from a labor-intensive research procedure to a scalable, clinically deployable biomarker. This narrative review synthesizes the current evidence on automated liver and spleen volumetry derived from abdominal CT and MRI. The discussion encompasses technical developments, normative reference intervals, and clinical applications—including hepatic fibrosis staging, portal hypertension assessment, prediction of liver-related outcomes, and preoperative risk stratification for post-hepatectomy liver failure. We have further examined the critical limitations, particularly the restricted inter-vendor and cross-institutional generalizability and absence of prospective validation, and delineate possible future directions in segmentation refinement, multimodal data integration, and opportunistic screening pipelines.

Extracellular contrast agent MRI demonstrated higher sensitivity than hepatobiliary contrast agent MRI for detecting viable hepatocellular carcinoma in patients who underwent locoregional treatment when ancillary features were not applied, whereas using ancillary features resulted in comparable sensitivities between groups.

Background/Aims: Various expanded criteria (EC) for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) have been proposed to avoid the narrow nature of the Milan criteria (MC). To investigate which EC predicts more favorable outcomes in terms of overall survival (OS) and recurrence-free survival (RFS), we conducted a network meta-analysis (NMA).Methods: A database search was conducted on PubMed, Embase, and the Cochrane Library, to identify studies comparing OS and RFS between patients within the MC and those exceeding the MC but within the EC. Hazard ratios (HRs) were pooled using a random-effects NMA and validated in an in-house cohort of 1,008 LT recipients.Results: Among 22,466 articles identified, 35 studies with 45 pairwise comparisons were included in the NMA along with 8 different EC. The University of California San Francisco (HR, 1.43; 95% CI, 1.19–1.71), Up-to-Seven (HR, 1.50; 95% CI, 1.15–1.97), and Hangzhou criteria (HR, 1.69; 95% CI, 1.11–2.57) showed inferior OS to the MC. The MC ranked highest for both OS and RFS, followed by Metroticket 2.0 for OS and the Asan criteria for RFS. In the validation cohort, both Metroticket 2.0 and AFP model yielded more favorable HCC-specific mortality than other EC.Conclusions: Several EC, of which those of Metroticket 2.0 were the best, yielded comparable outcomes to the MC. AFP-based EC such as Metroticket 2.0 and AFP model appeared to be useful in both the NMA and the validation cohort, suggesting a potential role in identifying selected low-risk patients beyond the MC.

Extending nonperipheral washout to the transitional phase (TP) at gadoxetate-enhanced MRI while considering TP liver parenchymal signal intensity improved the diagnostic performance of the Liver Imaging Reporting and Data System for hepatocellular carcinoma.

Intraindividual concordance and discordance of CT and MRI Liver Imaging Reporting and Data System (LI-RADS) categorizations were associated with 2-year recurrence-free survival, with the lowest survival observed when hepatocellular carcinoma lesions were categorized as LI-RADS category M with both modalities.