Publications by authors named "Torzilli Guido"

Background: The global burden of metabolic diseases is increasing, but estimates of their impact on primary liver cancer are uncertain. We aimed to assess the global burden of primary liver cancer attributable to metabolic risk factors, including high body mass index (BMI) and high fasting plasma glucose (FPG) levels, between 1990 and 2021.

Methods: The total number and age-standardized rates of deaths and disability-adjusted life years (DALYs) from primary liver cancer attributable to each metabolic risk factor were extracted from the Global Burden of Disease Study 1990-2021.

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Introduction: The standard treatment of colorectal liver metastases (CRLM) is surgery with perioperative chemotherapy. A tumor response to systemic therapy confirmed at pathology examination is the strongest predictor of survival, but it cannot be adequately predicted in the preoperative setting. This bi-institutional retrospective study investigates whether CT-based radiomics of CRLM and peritumoral tissue provides a reliable non-invasive estimation of the pathological tumor response to chemotherapy.

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Introduction: No instruments are available to predict preoperatively the risk of posthepatectomy liver failure (PHLF) in HCC patients. The aim was to predict the occurrence of PHLF preoperatively by radiomics and clinical data through machine-learning algorithms.

Materials And Methods: Clinical data and 3-phases CT scans were retrospectively collected among 13 Italian centres between 2008 and 2022.

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We, herein, describe a case of complex parenchyma-sparing hepatectomy for multiple bilobar colorectal liver metastases (CRLMs). A 61-year-old woman, previously operated for an occlusive adenocarcinoma of the transverse colon and undergoing adjuvant chemotherapy, developed metachronous bilobar CRLMs. After administration of a II line chemotherapy with partial response, she was referred to our hospital.

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Article Synopsis
  • Recent advancements in understanding liver cancer (hepatocarcinogenesis) have led to increased interest in rare primary liver cancers (PLCs) like combined hepatocellular-cholangiocarcinoma, fibrolamellar carcinoma, and hepatic epithelioid hemangioendothelioma.
  • An international panel of experts has compiled information on the causes, diagnosis, and treatment of these rare PLCs.
  • While clinical trials for some of these cancers are in progress, there's a clear need for more research and collaboration across nations to improve outcomes.
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Background Histotripsy is a nonthermal, nonionizing, noninvasive, focused US technique that relies on cavitation for mechanical tissue breakdown at the focal point. Preclinical data have shown its safety and technical success in the ablation of liver tumors. Purpose To evaluate the safety and technical success of histotripsy in destroying primary or metastatic liver tumors.

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Purpose: Single large hepatocellular carcinoma >5cm (SLHCC) traditionally requires a major liver resection. Minor resections are often performed with the goal to reduce morbidity and mortality. Aim of the study was to establish if a major resection should be considered the best treatment for SLHCC or a more limited resection should be preferred.

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  • Value-based healthcare (VBHC) focuses on maximizing patient value and outcomes while minimizing costs, shifting the emphasis from the volume of services to the quality of care delivered.
  • This study evaluated the impact of a VBHC-principled preoperative evaluation at Humanitas Research Hospital by comparing results from 2019 (preintervention) to 2021 (postintervention).
  • The findings showed a significant reduction in preoperative tests and evaluation time, leading to lower healthcare costs without negatively affecting patient outcomes.
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  • Systemic inflammation plays a crucial role in intrahepatic cholangiocarcinoma (iCCA), and this study investigates the prognostic importance of inflammatory indexes like the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR).
  • A total of 101 iCCA patients were analyzed, revealing that higher NLR and lower LMR correlate with worse survival outcomes; those with high-risk profiles had significantly lower 5-year overall survival rates compared to low-risk patients.
  • Flow cytometry results showed distinct immune cell profiles, with high-risk patients having more CD4+ T-cells and fewer CD8+ T-cells, suggesting inflammatory indexes can serve as indicators for tumor microenvironment and prognosis
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  • Metabolic syndrome (MS) is linked to hepatocellular carcinoma (HCC), prompting a study on the long-term outcomes of liver resections in MS patients.
  • Data from 813 patients over 20 years showed a median overall survival of 81.4 months, with a recurrence rate of 48.3%, often peaking at 6 and 24 months post-surgery.
  • The study concluded that while patients have favorable long-term outcomes, the timing and nature of recurrences—linked to tumor features and cirrhosis—play a crucial role in survival, highlighting the need for careful post-operative monitoring.
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Background And Aim: VETC (vessel that encapsulate tumor cluster) is a peculiar vascular phenotype observed in hepatocellular carcinoma (HCC), associated with distant metastases and poor outcome. VETC has been linked to the Tie2/Ang2 axis and is characterized by lymphocytes poor (cold) tumor microenvironment (TME). In this setting the role of Tumor Associated Macrophages (TAMs) has never been explored.

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  • The study aimed to establish a common language regarding extreme liver surgery to facilitate better comparison of surgical outcomes across different centers.
  • A Delphi methodology was used, gathering opinions from 38 expert surgeons, who largely agreed on key definitions related to total vascular occlusion and surgical approaches, achieving consensus on various topics.
  • Ultimately, 75% agreed on a definition for extreme liver surgery, highlighting the importance of a unified approach in managing patients with complex liver diseases.
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Background: For many tumors, radiomics provided a relevant prognostic contribution. This study tested whether the computed tomography (CT)-based textural features of intrahepatic cholangiocarcinoma (ICC) and peritumoral tissue improve the prediction of survival after resection compared with the standard clinical indices.

Methods: All consecutive patients affected by ICC who underwent hepatectomy at six high-volume centers (2009-2019) were considered for the study.

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  • The 2022 Barcelona Clinic Liver Cancer algorithm advises against liver resection for patients with multiple small tumors (2 or 3 nodules, each ≤3 cm) in hepatocellular carcinoma.
  • This study retrospectively analyzed data from over 12,000 patients to compare survival outcomes among those undergoing liver resection (LR), percutaneous radiofrequency ablation (PRFA), and transarterial chemoembolization (TACE).
  • Results showed that LR had the highest survival rates at 1, 3, and 5 years (89.11%, 70.98%, 56.44% respectively) compared to PRFA and TACE, indicating that LR may offer better long-term outcomes in treating early multin
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  • Hepatocellular carcinoma (HCC) has a poor prognosis, and this study examines the effectiveness of neoadjuvant transarterial chemoembolization (TACE) for large, resectable HCC tumors over 5 cm.
  • In a retrospective analysis of 384 patients, TACE showed no significant impact on disease-free survival or overall survival when compared to surgery alone, even after adjusting for other variables.
  • However, TACE may benefit specific patients, particularly those with very large tumors (≥10 cm), single tumors, or those needing portal vein embolization.
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Introduction: Microvascular invasion (MVI) is the main risk factor for overall mortality and recurrence after surgery for hepatocellular carcinoma (HCC).The aim was to train machine-learning models to predict MVI on preoperative CT scan.

Methods: 3-phases CT scans were retrospectively collected among 4 Italian centers.

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Background: Preoperative nutritional status and body structure affect short-term prognosis in patients undergoing major oncologic surgery. Bioimpedance vectorial analysis (BIVA) is a reliable tool to assess body composition. Low BIVA-derived phase angle (PA) indicates a decline of cell membrane integrity and function.

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Background: Minimally invasive anatomical resection (AR) for posterosuperior lesions is technically challenging. The Glissonean approach or puncture technique is generally selected. The tumor-feeding portal pedicle compression AR (C-AR) is an established procedure in open surgery.

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  • - Tumor-associated macrophages (TAMs) play a crucial role in the tumor microenvironment, with smaller TAMs (S-TAMs) linked to better prognosis in colorectal liver metastasis compared to larger TAMs (L-TAMs).
  • - Research using multiparametric flow cytometry and metabolomics identified that L-TAMs show a strong association with riboflavin, which affects the enzyme lysine-specific demethylase 1A (LSD1) and plays a role in TAM morphology.
  • - The study suggests that targeting the riboflavin-LSD1 relationship could reprogram TAM subtypes, offering new strategies for anti-tumor therapies.
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Background & Aims: Cholangiocarcinoma (CCA) is a primary liver tumour characterised by a poor prognosis and limited therapeutic options. Available 3D human CCA models fail to faithfully recapitulate the tumour niche. We aimed to develop an innovative patient-specific CCA-on-chip platform.

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Background & Aims: Intrahepatic cholangiocarcinoma (iCCA) is a primary liver tumour, characterized by poor prognosis and lack of effective therapy. The cytoskeleton protein Filamin A (FLNA) is involved in cancer progression and metastasis, including primary liver cancer. FLNA is cleaved by calpain, producing a 90 kDa fragment (FLNA ) that can translocate to the nucleus and inhibit gene transcription.

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