Hepatocellular Carcinoma Growth and Molecular Aggressiveness
Hepatocellular Carcinoma Growth and Molecular Aggressiveness
Our long-term objective is to develop a new tool based on a (molecular-biology) integrated
 imaging technology able to characterize and categorize hepatocellular carcinoma (HCC)
 patients in need of liver transplant (LT). To this end, our study aims at correlating
 specific imaging traits and fractional growth of individual tumors collected over a
 restricted time frame (T0 and at week 7 after first tumor detection), with a "molecular
 signature", obtained by custom microarray, histochemical and cytokine analysis. This should
 allow us to translate a series of purely morphologic information into a meaningful
 pathobiologic data sets. Validation of the integrated molecular-imaging tool will be
 performed prospectively by correlating the imaging-molecular data with HCC outcome in term of
 survival and disease-free survival after down staging procedures.
Organ allocation in our region is regulated according to MELD score. Patients with
 hepatocellular carcinoma (HCC) receive an additional score depending on size of the tumor and
 the time spent in transplant waiting list. However, the advantage given to these patients is
 uniform and does not take into account the profound biological heterogeneity of individual
 HCCs. To make the additional score righteous, the investigators need to identify patients
 with aggressively growing HCC who require salvage transplantation while those with
 slow-growing HCC do not deserve the additional score.

 All cirrhotics with suspect HCC identified at routine US screening will be therefore enrolled
 in the prospective imaging and bio-molecular study.

 They will be subjected to two computed tomography (CT) exams at 7 weeks interval to define
 fractional tumor growth and imaging traits, baseline US-guided liver biopsy for microarray
 and histochemical characterization, serum sampling for cytokine assay. Survival, disease-free
 survival after downstaging and transplant outcome will be recorded and analyzed in relation
 with imaging and molecular data. The investigators expect to set up an accurate imaging and
 molecular diagnostic tool able to identify patients with aggressive HCC requiring urgent
 access to transplant, reliable in predicting survival, standardisable and not too expensive.
Inclusion Criteria:

 -  Cirrhotic patients at first US identification of a focal lesion compatible with HCC

 -  Age > than 18 years

 -  No contraindications to performance of CT

 -  No contraindications to performance of US-guided liver biopsy

 Exclusion Criteria:

 Patients will be excluded if

 -  are unable to give informed consent to the study;

 -  liver tissue obtained at biopsy is insufficient to perform molecular/histochemical
 study