| The treatment of HCC is diverse depending on tumor stage and complexity of liver reserve. Due to the advance in immunotherapy, the immunotherapy can be introduced from early to advanced stage HCC. However, in general, only around 30% of HCC patients can have objective response to the immunotherapy. How to optimize the treatment outcome by immunotherapy is in unmet clinical needs. For early-stage HCC, recurrence is the key issue after surgical resection for radiofrequency ablation. Although IMbrave 050 is in the success of recurrence free survival in the first year of observation, the selection criteria for high-risk patients who required adjuvant immunotherapy is diverse. AI-based algorithm can assist clinical decision and recently we develop an evolutionary learning-derived clinical-radiomic GARSL models that can predict the risk of recurrence after surgical resection both by before and after surgery models. This model can further discriminate the risk of recurrence either in high or low risk patients defined by IMbrave 050 study. TACE unsuitability is an emerging issue for intermediate stage HCC. Up-to-7 derived from the criteria for liver transplantation has been adopted as the rule of TACE-unsuitability. We have recently proposed a novel 7-11 criteria to divide BCLC B HCC into low-, intermediate-, and high tumor burden, which might be able to select the possibility of curative conversion by immunotherapy for intermediate stage HCC. Additionally, the outcomes of TACE can be predicted through radiologic patterns that can assist for decision making before the TACE. Dissimilarities in gut microbiome composition and dysbiosis are associated with immune status and susceptibility to immunotherapy for many cancers. Recently, we also identify the association of gut microbiota and metabolites with the outcome of HCC undergoing immune checkpoint inhibitors treatment, supporting the clinical application of gut microbiota in selection patients with HCC for immunotherapy in near future. |
