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Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
Ji Yeon Lee1,2 , Pil Soo Sung1,2
Correspondence to: Pil Soo Sung
ORCID https://orcid.org/0000-0002-5780-9607
E-mail pssung@catholic.ac.kr
See “ Analysis of Factors Predicting the Real-World Efficacy of Atezolizumab and Bevacizumab in Patients with Advanced Hepatocellular Carcinoma” by Byeong Geun Song, et al. on page 709, Vol. 18, No. 4, 2024
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gut Liver 2024;18(4):558-559. https://doi.org/10.5009/gnl240274
Published online July 15, 2024, Published date July 15, 2024
Copyright © Gut and Liver.
More than half of patients are diagnosed with hepatocellular carcinoma (HCC) that is unresectable and requires chemoembolization or systemic treatment.1 The IMbrave150 trial established a combination treatment of atezolizumab and bevacizumab as the first-line treatment for advanced HCC, showing significantly improved overall survival and progression-free survival (PFS) compared with sorafenib in patients with unresectable HCC.2
Research to identify biomarkers for the screening, diagnosis, and prediction of unresectable HCC is ongoing. For example, alpha-fetoprotein (AFP) has been studied extensively in relation to prognosis, with increased AFP values associated with poor prognosis in advanced HCC; however, controversy exists regarding the optimal cutoff value for AFP to predict poor prognosis.3 The ability to make a definitive diagnosis of HCC through radiographic evaluation alone, without histological confirmation, limits the need to obtain tumor tissue, resulting in a smaller sample size for tissue-based biomarkers and potentially reducing their reliability.4 Circulating tumor DNA, microRNA, and circulating tumor cells, which are obtained through liquid biopsy, have demonstrated potential as prognostic and predictive biomarkers for HCC.5,6 However, much of the evidence is derived from observational studies, and further validation is needed through additional research. Radiomics, an emerging concept that proposes the discovery of new associations between clinical data and quantitative data extracted from medical images using artificial intelligence, aims to provide guidance in clinical decision-making by predicting the phenotype and genotype of the underlying tissue.7 However, the reproducibility and repeatability of radiomic models are often poor owing to insufficient reporting and a lack of effective means to interpret extensive datasets. In summary, biopsy- and radiomics-based biomarkers have not shown a clear and consistent performance in daily clinical practice.
In this issue of Gut and Liver, Song et al.8 evaluated the real-world efficacy and safety of atezolizumab plus bevacizumab in advanced HCC patients. Their analysis showed that the albumin-bilirubin grade, age, C-reactive protein (CRP) and AFP in immunotherapy CRAFITY score, macrovascular invasion, lung metastases, and combined radiotherapy were significant predictors of PFS. The CRAFITY score, which assigns points based on the AFP (≥100 ng/mL)and CRP (≥1 ng/mL) levels, is known to predict overall survival and the radiological response in HCC patients undergoing immunotherapy with immune checkpoint inhibitors.9 It was also shown in Song et al.’s study to be an independent prognostic factor in the multivariate analysis; patients with higher CRAFITY scores showed a significantly shorter PFS than those with HCC undergoing atezolizumab plus bevacizumab treatment. The researchers also found that AFP levels were higher in the progressive disease group, but protein induced by vitamin K absence-II and CRP levels showed no significant differences across the best-response categories. Patients with peritoneal seeding demonstrated a higher likelihood of complete remission, and those receiving combined radiotherapy showed significantly better objective responses.
Overall, the study of Song et al.8 confirmed the efficacy of atezolizumab and bevacizumab for the treatment of advanced HCC in domestic clinical settings. Through a logistic regression analysis, the CRAFITY score emerged as a valuable tool for predicting PFS and overall prognosis in immunotherapy without invasive measures. Clinical parameters such as the Glasgow Prognosis Score, reflecting systemic inflammatory response and nutritional status, have shown similar prognostic utility across various types of cancers. It is a scoring tool based on serum concentrations of CRP and albumin and has been identified as a prognostic factor for inoperable gastroesophageal, pancreatic, and colorectal cancer.10
Clinical parameters work well as predictive and prognostic factors in various types of cancers treated with immune-based therapy, including advanced HCC. Further research is needed to refine these clinical parameters and validate their role in guiding personalized treatment decisions according to individual patient conditions.
This research was supported by the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT (grant number RS-2024-00337298 to P.S.S.).
No potential conflict of interest relevant to this article was reported.
Gut and Liver 2024; 18(4): 558-559
Published online July 15, 2024 https://doi.org/10.5009/gnl240274
Copyright © Gut and Liver.
Ji Yeon Lee1,2 , Pil Soo Sung1,2
1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea; 2Department of Internal Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
Correspondence to:Pil Soo Sung
ORCID https://orcid.org/0000-0002-5780-9607
E-mail pssung@catholic.ac.kr
See “ Analysis of Factors Predicting the Real-World Efficacy of Atezolizumab and Bevacizumab in Patients with Advanced Hepatocellular Carcinoma” by Byeong Geun Song, et al. on page 709, Vol. 18, No. 4, 2024
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
More than half of patients are diagnosed with hepatocellular carcinoma (HCC) that is unresectable and requires chemoembolization or systemic treatment.1 The IMbrave150 trial established a combination treatment of atezolizumab and bevacizumab as the first-line treatment for advanced HCC, showing significantly improved overall survival and progression-free survival (PFS) compared with sorafenib in patients with unresectable HCC.2
Research to identify biomarkers for the screening, diagnosis, and prediction of unresectable HCC is ongoing. For example, alpha-fetoprotein (AFP) has been studied extensively in relation to prognosis, with increased AFP values associated with poor prognosis in advanced HCC; however, controversy exists regarding the optimal cutoff value for AFP to predict poor prognosis.3 The ability to make a definitive diagnosis of HCC through radiographic evaluation alone, without histological confirmation, limits the need to obtain tumor tissue, resulting in a smaller sample size for tissue-based biomarkers and potentially reducing their reliability.4 Circulating tumor DNA, microRNA, and circulating tumor cells, which are obtained through liquid biopsy, have demonstrated potential as prognostic and predictive biomarkers for HCC.5,6 However, much of the evidence is derived from observational studies, and further validation is needed through additional research. Radiomics, an emerging concept that proposes the discovery of new associations between clinical data and quantitative data extracted from medical images using artificial intelligence, aims to provide guidance in clinical decision-making by predicting the phenotype and genotype of the underlying tissue.7 However, the reproducibility and repeatability of radiomic models are often poor owing to insufficient reporting and a lack of effective means to interpret extensive datasets. In summary, biopsy- and radiomics-based biomarkers have not shown a clear and consistent performance in daily clinical practice.
In this issue of Gut and Liver, Song et al.8 evaluated the real-world efficacy and safety of atezolizumab plus bevacizumab in advanced HCC patients. Their analysis showed that the albumin-bilirubin grade, age, C-reactive protein (CRP) and AFP in immunotherapy CRAFITY score, macrovascular invasion, lung metastases, and combined radiotherapy were significant predictors of PFS. The CRAFITY score, which assigns points based on the AFP (≥100 ng/mL)and CRP (≥1 ng/mL) levels, is known to predict overall survival and the radiological response in HCC patients undergoing immunotherapy with immune checkpoint inhibitors.9 It was also shown in Song et al.’s study to be an independent prognostic factor in the multivariate analysis; patients with higher CRAFITY scores showed a significantly shorter PFS than those with HCC undergoing atezolizumab plus bevacizumab treatment. The researchers also found that AFP levels were higher in the progressive disease group, but protein induced by vitamin K absence-II and CRP levels showed no significant differences across the best-response categories. Patients with peritoneal seeding demonstrated a higher likelihood of complete remission, and those receiving combined radiotherapy showed significantly better objective responses.
Overall, the study of Song et al.8 confirmed the efficacy of atezolizumab and bevacizumab for the treatment of advanced HCC in domestic clinical settings. Through a logistic regression analysis, the CRAFITY score emerged as a valuable tool for predicting PFS and overall prognosis in immunotherapy without invasive measures. Clinical parameters such as the Glasgow Prognosis Score, reflecting systemic inflammatory response and nutritional status, have shown similar prognostic utility across various types of cancers. It is a scoring tool based on serum concentrations of CRP and albumin and has been identified as a prognostic factor for inoperable gastroesophageal, pancreatic, and colorectal cancer.10
Clinical parameters work well as predictive and prognostic factors in various types of cancers treated with immune-based therapy, including advanced HCC. Further research is needed to refine these clinical parameters and validate their role in guiding personalized treatment decisions according to individual patient conditions.
This research was supported by the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT (grant number RS-2024-00337298 to P.S.S.).
No potential conflict of interest relevant to this article was reported.