Journal of Hepatocellular Carcinoma

Bridge and Downstage Hepatocellular Carcinoma to Surgery

Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related mortality worldwide and frequently develops in the setting of chronic liver disease and cirrhosis. Surgical resection and liver transplantation offer the greatest potential for long-term survival and cure, yet many patients present with tumor burden or liver dysfunction that initially precludes these curative treatments. Over the past two decades, advances in locoregional therapies, systemic therapies, and multidisciplinary treatment strategies have transformed the management of HCC by enabling bridging to transplantation, reducing waitlist dropout, and downstaging selected patients to meet transplant or resection criteria. The rapid evolution of transarterial therapies, ablative techniques, radiotherapy, immunotherapy, and combination treatment strategies has generated new opportunities while also raising important questions regarding patient selection, treatment sequencing, response assessment, and long-term outcomes. This Collection aims to provide a comprehensive overview of current evidence and emerging strategies for bridging and downstaging HCC to potentially curative surgical interventions.

The ability to successfully bridge or downstage HCC has profound implications for patient outcomes, organ allocation, and healthcare resource utilization. Effective bridging therapy minimizes tumor progression during waiting times for liver transplantation, thereby reducing waitlist mortality and preserving transplant eligibility. Similarly, successful downstaging expands access to curative treatment for carefully selected patients who would otherwise be considered ineligible for resection or transplantation. As new systemic agents and immunotherapy-based combinations demonstrate unprecedented response rates, traditional treatment paradigms are rapidly evolving. However, many unresolved issues remain, including the optimal integration of locoregional and systemic therapies, appropriate selection criteria, biomarkers predicting treatment response, imaging assessment after therapy, and the impact of preoperative treatment on surgical complexity, recurrence, and survival. Addressing these questions requires collaboration across hepatology, medical oncology, transplant surgery, interventional radiology, radiation oncology, pathology, and diagnostic radiology. A dedicated Collection will provide an up-to-date forum for synthesizing current evidence and highlighting future directions that can improve patient selection and multidisciplinary decision-making.

This Collection welcomes submissions that address the full spectrum of bridging and downstaging strategies for HCC before surgical resection or liver transplantation. Topics of interest include patient selection criteria, transplant eligibility and downstaging protocols, locoregional therapies such as transarterial chemoembolization, radioembolization, thermal ablation, and stereotactic body radiation therapy, systemic therapy and immunotherapy, combination and sequential treatment strategies, imaging and biomarker assessment of treatment response, surgical technique, perioperative outcomes, post-transplant outcomes, organ allocation considerations, and multidisciplinary treatment algorithms. We welcome a broad range of article types accepted by the journal, including original research articles, reviews, clinical trial reports, expert opinions and commentaries.

Qian Yu (Clark), MD is a vascular and interventional radiologist at the Department of Radiology, University of Chicago. He specializes in interventional oncology, endovascular venous reconstruction, vascular malformations, portal hypertension, and embolization. His oncologic research concentrates on personalized dosimetry of transarterial radioembolization (TARE), hybrid imaging guidance during percutaneous thermoablation, and combining locoregional therapy and immunotherapy.

Kumaran Shanmugarajah, MD, PhD, is an abdominal transplant and hepatobiliary surgeon who cares for patients with complex liver conditions. He specializes in liver transplantation, including living donor transplants, as well as treating patients with liver cancer and benign liver tumors. Along with his clinical practice, Dr. Shanmigarajah is also interested in research that focuses on using machine perfusion to optimize organs for transplants, reducing immunosuppression after transplant (transplant tolerance) and organ failure associated with liver disease.

­­All manuscripts submitted to this Article Collection will undergo a full peer-review; the Guest Advisor for this Collection will not be handling the manuscripts (unless they are an Editorial Board member).

Please review the journal scope and author submission instructions prior to submitting a manuscript.

The deadline for submitting manuscripts is 1st May 2027.

Please contact Rebecca Turner at [email protected] with any questions or requests for discount codes relating to this Article Collection.

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