Pub Date : 2026-01-12DOI: 10.1016/j.clinre.2026.102765
François Le Calvez , James King , Alexis Couret , Armand Abergel , David Thivel , Gaël Ennequin
Malnutrition is highly prevalent in end-stage liver disease (ESLD), while being strongly associated with sarcopenia and poor prognosis in this population. The physiological regulation of energy intake is influenced by tonic signals, reflecting body composition and metabolic demands, and episodic signals, arising from gastrointestinal peptides, that remain to be better explored in the context of ESLD. The present narrative review analyzed 94 studies that characterises circulating concentrations of ghrelin, CCK, PYY, GLP-1 and leptin in cirrhosis and hepatocellular carcinoma. Overall, in patients with ESLD, orexigenic signaling, particularly from ghrelin and Fat-Free Mass (FFM) appears blunted, while anorexigenic peptides (CCK, PYY, GLP-1) are frequently elevated, prolonging satiety. Leptin regulation is inconsistent, reflecting both inflammation-driven increases and fat mass-related decreases. These disturbances converge toward a mismatch between elevated metabolic requirements and insufficient energy intake. Understanding how ESLD disrupts appetite-regulating pathways may help design new strategies to restore nutritional balance and improve clinical outcomes.
{"title":"Associations of episodic and tonic appetite-related signals with malnutrition and appetite dysregulation in end-stage liver disease","authors":"François Le Calvez , James King , Alexis Couret , Armand Abergel , David Thivel , Gaël Ennequin","doi":"10.1016/j.clinre.2026.102765","DOIUrl":"10.1016/j.clinre.2026.102765","url":null,"abstract":"<div><div>Malnutrition is highly prevalent in end-stage liver disease (ESLD), while being strongly associated with sarcopenia and poor prognosis in this population. The physiological regulation of energy intake is influenced by tonic signals, reflecting body composition and metabolic demands, and episodic signals, arising from gastrointestinal peptides, that remain to be better explored in the context of ESLD. The present narrative review analyzed 94 studies that characterises circulating concentrations of ghrelin, CCK, PYY, GLP-1 and leptin in cirrhosis and hepatocellular carcinoma. Overall, in patients with ESLD, orexigenic signaling, particularly from ghrelin and Fat-Free Mass (FFM) appears blunted, while anorexigenic peptides (CCK, PYY, GLP-1) are frequently elevated, prolonging satiety. Leptin regulation is inconsistent, reflecting both inflammation-driven increases and fat mass-related decreases. These disturbances converge toward a mismatch between elevated metabolic requirements and insufficient energy intake. Understanding how ESLD disrupts appetite-regulating pathways may help design new strategies to restore nutritional balance and improve clinical outcomes.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 2","pages":"Article 102765"},"PeriodicalIF":2.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.clinre.2026.102759
Valbert Oliveira Costa Filho , Pedro Robson Costa Passos , Márcia Valéria Pitombeira Ferreira , Silvia Helena Barem Rabenhorst
{"title":"BEND3 is associated with poor prognosis and treatment response in Hepatocellular Carcinoma","authors":"Valbert Oliveira Costa Filho , Pedro Robson Costa Passos , Márcia Valéria Pitombeira Ferreira , Silvia Helena Barem Rabenhorst","doi":"10.1016/j.clinre.2026.102759","DOIUrl":"10.1016/j.clinre.2026.102759","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 2","pages":"Article 102759"},"PeriodicalIF":2.4,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.clinre.2026.102760
Elizabeth Beyene , Lakshmi Chirumamilla , Mekdem Bisrat , Allan Bowen , Yonas Fetle , Brandon Wilkerson , Addishiwot Wudeneh , Syed Fahad Gillani , Daniel Larbi , Miriam Michael
Background
Metabolic dysfunction associated steatohepatitis (MASH) is a progressive liver disease associated with metabolic syndrome. While both GLP-1 receptor agonists and SGLT2 inhibitors offer cardiometabolic benefits, their comparative impact on liver-related outcomes in MASH remains unclear.
Objective
To compare the incidence of cirrhosis, hepatocellular carcinoma (HCC), and changes in liver enzyme profiles in patients with MASH treated with GLP-1 receptor agonists versus SGLT2 inhibitors.
Methods
This retrospective cohort study used de-identified electronic health records from the TriNetX network. Adults with MASH were grouped into GLP-1 receptor agonist users (n=19,421) or SGLT2 inhibitor users (n=12,772). After 1:1 propensity score matching on demographics, BMI, diabetes, liver enzymes, and substance use, 10,803 patients remained in each cohort. Patients with overlapping use of both drug classes or with preexisting cirrhosis, fibrosis, HCC, viral hepatitis, or alcoholic liver disease were excluded. Outcomes included incidence of cirrhosis, HCC, and liver enzyme normalization (ALT <60 U/L, AST <60 U/L, GGT ≤140 U/L). Risk estimates and hazard ratios were calculated using TriNetX analytics; p<0.05 was considered significant.
Results
After matching, 10,803 patients were included in each cohort. Compared to SGLT2 inhibitors, the GLP-1 cohort showed significantly lower risks of cirrhosis (5.8 %¦vs. 17.3 %; HR: 0.31, 95 % CI: 0.29–0.34), HCC (0.4 %¦vs. 1.8 %; HR: 0.25, 95 % CI: 0.18–0.34), and elevated GGT (5.4 %¦vs. 6.8 %; HR: 0.80, 95 % CI: 0.72–0.89). Liver enzyme control (ALT and AST < 60 U/L) was also more favorable in the GLP-1 group (p < 0.001).
Conclusion
In this large real-world cohort of patients with MASH, GLP-1 receptor agonists were associated with significantly better liver-related outcomes compared to SGLT2 inhibitors. These findings support the potential hepatoprotective role of GLP-1 agents and highlight their promise in managing MASH beyond glycemic control.
背景：代谢功能障碍相关脂肪性肝炎（MASH）是一种与代谢综合征相关的进行性肝脏疾病。虽然GLP-1受体激动剂和SGLT2抑制剂都提供心脏代谢益处，但它们对MASH中肝脏相关结局的比较影响尚不清楚。目的：比较GLP-1受体激动剂与SGLT2抑制剂治疗的MASH患者肝硬化、肝细胞癌（HCC）的发生率和肝酶谱的变化。方法：本回顾性队列研究使用来自TriNetX网络的去识别电子健康记录。成人MASH患者被分为GLP-1受体激动剂使用者（n=19,421）和SGLT2抑制剂使用者（n=12,772）。在人口统计学、BMI、糖尿病、肝酶和药物使用方面进行1:1的倾向评分匹配后，每个队列中仍有10,803名患者。两种药物类别重叠使用或既往存在肝硬化、纤维化、HCC、病毒性肝炎或酒精性肝病的患者被排除在外。结果包括肝硬化、HCC和肝酶正常化（ALT）的发生率。结果：匹配后，每个队列纳入10,803例患者。与SGLT2抑制剂相比，GLP-1队列显示肝硬化（5.8% vs. 17.3%; HR: 0.31, 95% CI: 0.29-0.34）、HCC （0.4% vs. 1.8%; HR: 0.25, 95% CI: 0.18-0.34）和GGT升高（5.4% vs. 6.8%; HR: 0.80, 95% CI: 0.72-0.89）的风险显著降低。肝酶控制（ALT和AST < 60 U/L）在GLP-1组也更有利（p < 0.001）。结论：在这个现实世界的大型MASH患者队列中，与SGLT2抑制剂相比，GLP-1受体激动剂与肝脏相关的预后明显更好。这些发现支持GLP-1药物潜在的肝脏保护作用，并强调了它们在控制血糖以外的MASH管理方面的前景。
{"title":"Liver gains beyond glycemic control: GLP-1 vs. SGLT2 in metabolic dysfunction–associated steatohepatitis (MASH): A real-world data analysis","authors":"Elizabeth Beyene , Lakshmi Chirumamilla , Mekdem Bisrat , Allan Bowen , Yonas Fetle , Brandon Wilkerson , Addishiwot Wudeneh , Syed Fahad Gillani , Daniel Larbi , Miriam Michael","doi":"10.1016/j.clinre.2026.102760","DOIUrl":"10.1016/j.clinre.2026.102760","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic dysfunction associated steatohepatitis (MASH) is a progressive liver disease associated with metabolic syndrome. While both GLP-1 receptor agonists and SGLT2 inhibitors offer cardiometabolic benefits, their comparative impact on liver-related outcomes in MASH remains unclear.</div></div><div><h3>Objective</h3><div>To compare the incidence of cirrhosis, hepatocellular carcinoma (HCC), and changes in liver enzyme profiles in patients with MASH treated with GLP-1 receptor agonists versus SGLT2 inhibitors.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used de-identified electronic health records from the TriNetX network. Adults with MASH were grouped into GLP-1 receptor agonist users (n=19,421) or SGLT2 inhibitor users (n=12,772). After 1:1 propensity score matching on demographics, BMI, diabetes, liver enzymes, and substance use, 10,803 patients remained in each cohort. Patients with overlapping use of both drug classes or with preexisting cirrhosis, fibrosis, HCC, viral hepatitis, or alcoholic liver disease were excluded. Outcomes included incidence of cirrhosis, HCC, and liver enzyme normalization (ALT <60 U/L, AST <60 U/L, GGT ≤140 U/L). Risk estimates and hazard ratios were calculated using TriNetX analytics; p<0.05 was considered significant.</div></div><div><h3>Results</h3><div>After matching, 10,803 patients were included in each cohort. Compared to SGLT2 inhibitors, the GLP-1 cohort showed significantly lower risks of cirrhosis (5.8 %¦vs. 17.3 %; HR: 0.31, 95 % CI: 0.29–0.34), HCC (0.4 %¦vs. 1.8 %; HR: 0.25, 95 % CI: 0.18–0.34), and elevated GGT (5.4 %¦vs. 6.8 %; HR: 0.80, 95 % CI: 0.72–0.89). Liver enzyme control (ALT and AST < 60 U/L) was also more favorable in the GLP-1 group (p < 0.001).</div></div><div><h3>Conclusion</h3><div>In this large real-world cohort of patients with MASH, GLP-1 receptor agonists were associated with significantly better liver-related outcomes compared to SGLT2 inhibitors. These findings support the potential hepatoprotective role of GLP-1 agents and highlight their promise in managing MASH beyond glycemic control.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 2","pages":"Article 102760"},"PeriodicalIF":2.4,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-28DOI: 10.1016/j.clinre.2025.102753
Jennifer Candi , Emma Zuppi , Camille Besch , Thibault Wolf , Pietro Addeo
{"title":"Refractory ascites following pancreatoduodenectomy after preoperative oxaliplatin based chemotherapy: be aware of nodular regenerative hyperplasia!","authors":"Jennifer Candi , Emma Zuppi , Camille Besch , Thibault Wolf , Pietro Addeo","doi":"10.1016/j.clinre.2025.102753","DOIUrl":"10.1016/j.clinre.2025.102753","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 2","pages":"Article 102753"},"PeriodicalIF":2.4,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-26DOI: 10.1016/j.clinre.2025.102752
Amany Mahmoud Genidy , Abdelaziz Awad , Omar Khaled Abdelsalam , Belal Mohamed Hamed , Nesma Mahmoud Ibrahim , Ahmed K.M. Khaled , Omar Saeed , May Mahmoud Elgamal , Manar A Balouz , Ahmed Abdelgayed M Hussein , Fatma S Mohamed , Ahmed L. Youseif , Jawad Mahmood
Introduction
Endoscopic submucosal dissection (ESD) is an increasingly effective endoscopic technique worldwide. Robot-assisted ESD is a novel technique that enables complex movements by providing an extended range of motions to improve the visualization of the surgical field and provide better cosmetic surgical outcomes. We aim to systematically review and meta-analyze the efficacy and safety of robot-assisted ESD.
Methods
We followed the PRISMA guidelines for meta-analysis. We included studies reporting on patients with GI tumors or masses who underwent robot-assisted ESD. Our primary outcomes were en bloc resection rates, recurrence rates, and complications like bleeding and perforation. Secondary outcomes encompassed the length of the procedure, lesion size, complete resection rates, and duration of hospital stay. We used Joanna Briggs Institute's (JBI) Critical Appraisal Tool and the ROBINS-I tool for quality assessment. Continuous data were pooled as means, while dichotomous data were pooled as proportions with a 95 % confidence interval (95 % CI).
Results
Eight studies consisting of two clinical trials, three cohort studies, and three case reports with 115 participants were included. The en bloc resection rate was 97.400 %, 95 % CI (0.901, 0.993). According to the complete resection outcome, the rate was 82.900 %, 95 % CI (0.722, 0.900). Procedure time and Hospital Stay were 82.030 min 95 % CI: 48.130, 115.940), 1.640 days 95 % CI (-0.180, 3.740), respectively. The intraoperative bleeding rate was 1.800 %, 95 % CI (0.004, 0.068).
Conclusion
Our systematic review and meta-analysis demonstrated robot-assisted endoscopic submucosal dissection's potential efficacy and safety. However, future high-quality studies with larger sample sizes and extended follow-up periods are needed to support our initial findings further. Robot-assisted ESD may be promising in dealing with larger lesions, which are often challenging with conventional ESD.
{"title":"Robot-assisted endoscopic submucosal dissection in gastrointestinal lesions: A systematic review and meta-analysis","authors":"Amany Mahmoud Genidy , Abdelaziz Awad , Omar Khaled Abdelsalam , Belal Mohamed Hamed , Nesma Mahmoud Ibrahim , Ahmed K.M. Khaled , Omar Saeed , May Mahmoud Elgamal , Manar A Balouz , Ahmed Abdelgayed M Hussein , Fatma S Mohamed , Ahmed L. Youseif , Jawad Mahmood","doi":"10.1016/j.clinre.2025.102752","DOIUrl":"10.1016/j.clinre.2025.102752","url":null,"abstract":"<div><h3>Introduction</h3><div>Endoscopic submucosal dissection (ESD) is an increasingly effective endoscopic technique worldwide. Robot-assisted ESD is a novel technique that enables complex movements by providing an extended range of motions to improve the visualization of the surgical field and provide better cosmetic surgical outcomes. We aim to systematically review and meta-analyze the efficacy and safety of robot-assisted ESD.</div></div><div><h3>Methods</h3><div>We followed the PRISMA guidelines for meta-analysis. We included studies reporting on patients with GI tumors or masses who underwent robot-assisted ESD. Our primary outcomes were en bloc resection rates, recurrence rates, and complications like bleeding and perforation. Secondary outcomes encompassed the length of the procedure, lesion size, complete resection rates, and duration of hospital stay. We used Joanna Briggs Institute's (JBI) Critical Appraisal Tool and the ROBINS-I tool for quality assessment. Continuous data were pooled as means, while dichotomous data were pooled as proportions with a 95 % confidence interval (95 % CI).</div></div><div><h3>Results</h3><div>Eight studies consisting of two clinical trials, three cohort studies, and three case reports with 115 participants were included. The en bloc resection rate was 97.400 %, 95 % CI (0.901, 0.993). According to the complete resection outcome, the rate was 82.900 %, 95 % CI (0.722, 0.900). Procedure time and Hospital Stay were 82.030 min 95 % CI: 48.130, 115.940), 1.640 days 95 % CI (-0.180, 3.740), respectively. The intraoperative bleeding rate was 1.800 %, 95 % CI (0.004, 0.068).</div></div><div><h3>Conclusion</h3><div>Our systematic review and meta-analysis demonstrated robot-assisted endoscopic submucosal dissection's potential efficacy and safety. However, future high-quality studies with larger sample sizes and extended follow-up periods are needed to support our initial findings further. Robot-assisted ESD may be promising in dealing with larger lesions, which are often challenging with conventional ESD.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 2","pages":"Article 102752"},"PeriodicalIF":2.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-24DOI: 10.1016/j.clinre.2025.102751
Chuanfu Ding , Youwei Xing , Siwei Liang , Chunxiang Wang , Wei Zhang , Huan Chen , Xueqian Li , Yuyun Jia , Zihao Cai , Wei Li , Yang Cheng , Song Zhang , Jiangqiang Xiao , Lei Wang , Qin Yin , Yuzheng Zhuge , Feng Zhang
Background & Aims
Transjugular intrahepatic portosystemic shunt (TIPS) is linked to an elevated risk of overt hepatic encephalopathy (OHE), yet evidence supporting primary prophylaxis for post-TIPS OHE remains limited. This study aimed to evaluate whether rifaximin reduces the incidence of post-TIPS OHE in cirrhotic patients.
Methods
A retrospective analysis was conducted on 72 patients who received rifaximin (400 mg twice daily) for 6 months after TIPS (rifaximin group). A matched control group (n = 72) was recruited from a randomized clinical trial (ChiCTR-INR-17,012,479). The primary endpoint was the occurrence of OHE within 6 months. Secondary endpoints included 1-year mortality, rebleeding episodes, stent dysfunction, and improvements in liver function.
Results
The 6-month incidence of OHE was significantly lower in the rifaximin group (21%, 15/72) than in the control group (40%, 29/72; P = 0.011). The risk difference was -19.5% (95% confidence interval [CI]: -34.2% to -4.7%), with an odds ratio (OR) of 0.39 (95% CI: 0.19–0.82). Kaplan-Meier analysis demonstrated a significantly reduced cumulative risk of OHE in the rifaximin group (log-rank P = 0.009). No significant differences were observed between groups in terms of mortality, rebleeding, or stent dysfunction (all P > 0.05).
Conclusions
Six-month rifaximin prophylaxis following TIPS significantly reduced the incidence of early OHE in patients with cirrhosis.
{"title":"Rifaximin for Primary prophylaxis of overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: A cohort analysis","authors":"Chuanfu Ding , Youwei Xing , Siwei Liang , Chunxiang Wang , Wei Zhang , Huan Chen , Xueqian Li , Yuyun Jia , Zihao Cai , Wei Li , Yang Cheng , Song Zhang , Jiangqiang Xiao , Lei Wang , Qin Yin , Yuzheng Zhuge , Feng Zhang","doi":"10.1016/j.clinre.2025.102751","DOIUrl":"10.1016/j.clinre.2025.102751","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Transjugular intrahepatic portosystemic shunt (TIPS) is linked to an elevated risk of overt hepatic encephalopathy (OHE), yet evidence supporting primary prophylaxis for post-TIPS OHE remains limited. This study aimed to evaluate whether rifaximin reduces the incidence of post-TIPS OHE in cirrhotic patients.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 72 patients who received rifaximin (400 mg twice daily) for 6 months after TIPS (rifaximin group). A matched control group (<em>n</em> = 72) was recruited from a randomized clinical trial (ChiCTR-INR-17,012,479). The primary endpoint was the occurrence of OHE within 6 months. Secondary endpoints included 1-year mortality, rebleeding episodes, stent dysfunction, and improvements in liver function.</div></div><div><h3>Results</h3><div>The 6-month incidence of OHE was significantly lower in the rifaximin group (21%, 15/72) than in the control group (40%, 29/72; <em>P</em> = 0.011). The risk difference was -19.5% (95% confidence interval [CI]: -34.2% to -4.7%), with an odds ratio (OR) of 0.39 (95% CI: 0.19–0.82). Kaplan-Meier analysis demonstrated a significantly reduced cumulative risk of OHE in the rifaximin group (log-rank <em>P</em> = 0.009). No significant differences were observed between groups in terms of mortality, rebleeding, or stent dysfunction (all <em>P</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>Six-month rifaximin prophylaxis following TIPS significantly reduced the incidence of early OHE in patients with cirrhosis.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 2","pages":"Article 102751"},"PeriodicalIF":2.4,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-20DOI: 10.1016/j.clinre.2025.102750
Jialu Fu , Jiafeng Chen , Lei Jin , Junfeng Huang , Shengwei Mao , Xuhui Zhao , Weifeng Qu , Rui Yang , Yi Wang , Yichao Bu , Zhiqi Guan , Jun Gao , Xiaoling Wu , Qianfu Zhao , Tianhao Chu , Guiqi Zhu , Yuan Fang , Yinghong Shi , Weiren Liu
Purpose
To compare survival outcomes between repeat hepatectomy (RHT) and radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) patients with solitary intrahepatic recurrence after initial hepatic resection, and to identify associated prognostic factors.
Patients and Methods
This study included 377 HCC patients with solitary intrahepatic recurrence after initial hepatectomy (RHT=280, RFA=97). Propensity score matching (PSM) was used to balance intergroup characteristics. Survival outcomes (OS and rRFS) were analyzed using Kaplan-Meier method and compared by log-rank test. Variables that were significant in univariate analysis were further included in multivariate analysis.
Results
No significant differences were observed in either OS or rRFS between RFA and RHT groups before (P = 0.37 for OS; P = 0.30 for rRFS) or after PSM (P = 0.58 for OS; P = 0.76 for rRFS). Era-stratified analysis (earlier cohort [1996–2005]: P = 0.40 for OS, P = 0.62 for rRFS; later cohort [2006–2010]: P = 0.18 for OS, P = 0.08 for rRFS) confirmed this finding. Subgroup analyses confirmed the equivalent survival outcomes between RFA and RHT in patients with tumors ≤ 3 cm or > 3 cm but ≤ 5 cm. Multivariate analysis identified HBsAg positivity and tumor diameter > 2 cm as independent risk factors for OS, while recurrence time ≤ 24 months was an independent risk factor for both OS and rRFS.
Conclusion
RFA provides comparable OS and rRFS to RHT for HCC patients with solitary intrahepatic recurrence ≤ 5 cm after hepatic resection.
{"title":"Comparison of repeat hepatectomy with radiofrequency ablation for the survival of hepatocellular carcinoma with solitary intrahepatic recurrence after hepatectomy","authors":"Jialu Fu , Jiafeng Chen , Lei Jin , Junfeng Huang , Shengwei Mao , Xuhui Zhao , Weifeng Qu , Rui Yang , Yi Wang , Yichao Bu , Zhiqi Guan , Jun Gao , Xiaoling Wu , Qianfu Zhao , Tianhao Chu , Guiqi Zhu , Yuan Fang , Yinghong Shi , Weiren Liu","doi":"10.1016/j.clinre.2025.102750","DOIUrl":"10.1016/j.clinre.2025.102750","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare survival outcomes between repeat hepatectomy (RHT) and radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) patients with solitary intrahepatic recurrence after initial hepatic resection, and to identify associated prognostic factors.</div></div><div><h3>Patients and Methods</h3><div>This study included 377 HCC patients with solitary intrahepatic recurrence after initial hepatectomy (RHT=280, RFA=97). Propensity score matching (PSM) was used to balance intergroup characteristics. Survival outcomes (OS and rRFS) were analyzed using Kaplan-Meier method and compared by log-rank test. Variables that were significant in univariate analysis were further included in multivariate analysis.</div></div><div><h3>Results</h3><div>No significant differences were observed in either OS or rRFS between RFA and RHT groups before (<em>P</em> = 0.37 for OS; <em>P</em> = 0.30 for rRFS) or after PSM (<em>P</em> = 0.58 for OS; <em>P</em> = 0.76 for rRFS). Era-stratified analysis (earlier cohort [1996–2005]: <em>P</em> = 0.40 for OS, <em>P</em> = 0.62 for rRFS; later cohort [2006–2010]: <em>P</em> = 0.18 for OS, <em>P</em> = 0.08 for rRFS) confirmed this finding. Subgroup analyses confirmed the equivalent survival outcomes between RFA and RHT in patients with tumors ≤ 3 cm or > 3 cm but ≤ 5 cm. Multivariate analysis identified HBsAg positivity and tumor diameter > 2 cm as independent risk factors for OS, while recurrence time ≤ 24 months was an independent risk factor for both OS and rRFS.</div></div><div><h3>Conclusion</h3><div>RFA provides comparable OS and rRFS to RHT for HCC patients with solitary intrahepatic recurrence ≤ 5 cm after hepatic resection.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 2","pages":"Article 102750"},"PeriodicalIF":2.4,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Portopulmonary hypertension (PoPH) increases perioperative mortality in liver transplantation, underscoring the need for early detection. To better quantify its burden and improve detection, we performed a systematic review and meta-analysis of studies reporting PoPH prevalence and risk factors among adults with chronic liver disease (CLD).
Methods
We searched multiple databases through March 2025 for studies reporting the prevalence and risk factors of PoPH in CLD. The primary outcome of interest was the pooled prevalence, while the secondary outcome was risk factors. Standard meta-analysis methods were followed using the random-effects model, generating pooled effect estimates with 95% confidence intervals (CI). Heterogeneity was assessed using the I2% statistic.
Results
A total of 48 studies were included, comprising 16,351 CLD patients (mean age 55.5; 60% males). The pooled prevalence of PoPH on RHC was 2.4 % (95% CI: 1.4, 4.1; I2 = 93.3%), whereas the pooled prevalence on TTE was 8.7% (95% CI: 5.9, 12.7). Significant risk factors for PoPH on TTE were female sex (OR 1.83), autoimmune hepatitis (AIH) (OR 1.92), older age (MD 2.19), and higher INR (MD 0.11). AIH was a significant risk factor for PoPH on RHC (OR 2.28). Meta-regression revealed significant decrease of RHC-based prevalence with time (-0.07% per year; p=0.007). Egger’s tests showed no publication bias.
Conclusion
PoPH confirmed by RHC is uncommon but appears overestimated by TTE. Females, patients with AIH, older age, and coagulopathy may benefit from earlier screening. Standardized echocardiographic thresholds and prospective multicenter studies are needed to refine prevalence and risk prediction.
{"title":"Prevalence and risk factors of portopulmonary hypertension in chronic liver disease: systematic review and meta-analysis","authors":"Tareq Alsaleh , Amir Harb , Parikshit Chapagain , Bassel Dakkak , Prachi Mann , Nouman Shafique , Nihal Khan , Mohamad Khaled Almujarkesh , Ayman Koteish","doi":"10.1016/j.clinre.2025.102748","DOIUrl":"10.1016/j.clinre.2025.102748","url":null,"abstract":"<div><h3>Background</h3><div>Portopulmonary hypertension (PoPH) increases perioperative mortality in liver transplantation, underscoring the need for early detection. To better quantify its burden and improve detection, we performed a systematic review and meta-analysis of studies reporting PoPH prevalence and risk factors among adults with chronic liver disease (CLD).</div></div><div><h3>Methods</h3><div>We searched multiple databases through March 2025 for studies reporting the prevalence and risk factors of PoPH in CLD. The primary outcome of interest was the pooled prevalence, while the secondary outcome was risk factors. Standard meta-analysis methods were followed using the random-effects model, generating pooled effect estimates with 95% confidence intervals (CI). Heterogeneity was assessed using the I<sup>2</sup>% statistic.</div></div><div><h3>Results</h3><div>A total of 48 studies were included, comprising 16,351 CLD patients (mean age 55.5; 60% males). The pooled prevalence of PoPH on RHC was 2.4 % (95% CI: 1.4, 4.1; I<sup>2</sup> = 93.3%), whereas the pooled prevalence on TTE was 8.7% (95% CI: 5.9, 12.7). Significant risk factors for PoPH on TTE were female sex (OR 1.83), autoimmune hepatitis (AIH) (OR 1.92), older age (MD 2.19), and higher INR (MD 0.11). AIH was a significant risk factor for PoPH on RHC (OR 2.28). Meta-regression revealed significant decrease of RHC-based prevalence with time (-0.07% per year; p=0.007). Egger’s tests showed no publication bias.</div></div><div><h3>Conclusion</h3><div>PoPH confirmed by RHC is uncommon but appears overestimated by TTE. Females, patients with AIH, older age, and coagulopathy may benefit from earlier screening. Standardized echocardiographic thresholds and prospective multicenter studies are needed to refine prevalence and risk prediction.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 1","pages":"Article 102748"},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.clinre.2025.102747
Zhikun Wang , Linqian Wu , Ke Bai , Mengru Qiu , Qing Li , Liangtao Zeng , Yipeng Wan , Hui Zhu , Lifang Chen , Zhili Wen , Lingling Yang
Backgrounds and Aims
Liver biopsy is a valuable tool for diagnosing liver diseases with unknown etiology, but it sometimes fails to provide a clear diagnosis. This study aimed to identify the cause of unexplained liver injury and evaluate the accuracy of histological diagnosis.
Methods
A retrospective analysis was conducted on the clinical and histological data of patients with chronic liver disease of unknown etiology at the Second Affiliated Hospital of Nanchang University, China, who underwent liver biopsy between September 2019 and June 2024. Diagnoses were divided into admission diagnosis, histological diagnosis, and final clinical diagnosis groups.
Results
A total of 104 patients were included, with 64 women (61.5 %) and 40 men (38.5 %), 96 (92.3 %) of whom received a definitive diagnosis through liver biopsy. The main diseases were autoimmune liver disease (AILD, 49 cases, 47.1 %), non-alcoholic fatty liver disease (NAFLD, 26 cases, 25.0 %), drug-induced liver injury (DILI, 22 cases, 21.2 %), others (11 cases, 10.6 %) and unknown etiology (8 cases, 6.9 %). AILD was most common in women (40 cases, 55.6 %), while NAFLD was most common in men (19 cases, 40.4 %). Histological diagnosis showed higher sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) compared to admission diagnosis. Venn diagram analysis revealed that 57.7 % of cases matched between admission and histological diagnosis, 60.6 % matched between admission and final clinical diagnosis, and 92.3 % matched between the histological and final clinical diagnosis.
Conclusions
Histological diagnosis is effective in determining the cause of unexplained liver injury, and liver biopsy remains a crucial tool.
{"title":"Evaluating the accuracy of the histological diagnosis in unexplained liver injury: A retrospective study","authors":"Zhikun Wang , Linqian Wu , Ke Bai , Mengru Qiu , Qing Li , Liangtao Zeng , Yipeng Wan , Hui Zhu , Lifang Chen , Zhili Wen , Lingling Yang","doi":"10.1016/j.clinre.2025.102747","DOIUrl":"10.1016/j.clinre.2025.102747","url":null,"abstract":"<div><h3>Backgrounds and Aims</h3><div>Liver biopsy is a valuable tool for diagnosing liver diseases with unknown etiology, but it sometimes fails to provide a clear diagnosis. This study aimed to identify the cause of unexplained liver injury and evaluate the accuracy of histological diagnosis.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the clinical and histological data of patients with chronic liver disease of unknown etiology at the Second Affiliated Hospital of Nanchang University, China, who underwent liver biopsy between September 2019 and June 2024. Diagnoses were divided into admission diagnosis, histological diagnosis, and final clinical diagnosis groups.</div></div><div><h3>Results</h3><div>A total of 104 patients were included, with 64 women (61.5 %) and 40 men (38.5 %), 96 (92.3 %) of whom received a definitive diagnosis through liver biopsy. The main diseases were autoimmune liver disease (AILD, 49 cases, 47.1 %), non-alcoholic fatty liver disease (NAFLD, 26 cases, 25.0 %), drug-induced liver injury (DILI, 22 cases, 21.2 %), others (11 cases, 10.6 %) and unknown etiology (8 cases, 6.9 %). AILD was most common in women (40 cases, 55.6 %), while NAFLD was most common in men (19 cases, 40.4 %). Histological diagnosis showed higher sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) compared to admission diagnosis. Venn diagram analysis revealed that 57.7 % of cases matched between admission and histological diagnosis, 60.6 % matched between admission and final clinical diagnosis, and 92.3 % matched between the histological and final clinical diagnosis.</div></div><div><h3>Conclusions</h3><div>Histological diagnosis is effective in determining the cause of unexplained liver injury, and liver biopsy remains a crucial tool.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 1","pages":"Article 102747"},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.clinre.2025.102746
Annalice Gandini , Victoria Probst , Matteo Landi , Maria Caterina De Grandis , Chiara Cremolini , Sara Lonardi , Paul Girot , Marie Decraecker , Alessandro Passardi , Lisa Salvatore , Alessandro Pastorino , Jeremy C Jones , Lucien Grados , Lina Sayah , Isabelle Trouilloud , David Tougeron , Julien Taieb
BRAF V600E mutation (BRAFm) is present in around 8 % of metastatic colorectal cancers (mCRC) and is associated with a poor prognosis. The encorafenib-cetuximab combination (ENCOCET) is currently the standard second-line treatment of BRAFm mCRC. However, 2–5 % of patients treated with cetuximab experience grade 3–4 infusion-related reactions (IRRs), leading to treatment discontinuation. In addition, BRAF inhibitors must be combined with an anti-EGFR to have any efficacy in BRAFm mCRC. As panitumumab (PANI) is associated with a lower risk of IRRs, this study aimed to assess the safety and efficacy of ENCO-PANI as an alternative strategy in patients experiencing an IRR to CET.
We retrospectively collected BRAFm mCRC patients that switched ENCOCET for ENCO-PANI following an IRR to CET. Twenty pts were identified across 12 centers from 4 countries. Most were male (12/20), 11/20 had right-sided primary tumor and 5/20 pts were dMMR/MSI. Median age was 66, treatment line was 2nd line in 85 % and 3rd line in 15 % of patients; 19 patients started ENCOCET and switched to ENCO-PANI (cycle 2 or 3) and 1 received ENCO-PANI upfront due to patient’s choice. Response rate was 25 % and disease control rate 85 %. Median progression-free survival was 6.2 and median overall survival 11 months. Adverse events (AEs) during ENCO-PANI occurred in 15/20, mostly G1-G2. No new IRRs nor toxic deaths were reported.
ENCO-PANI appears to be as safe and effective in pts treated for a BRAFm mCRC unable to continue CET and may represent a valid alternative therapeutic option in this setting.
{"title":"Switch from cetuximab to panitumumab during encorafenib-based therapy in BRAF V600E mutated metastatic colorectal cancer: An international multicenter analysis from the AGEO group","authors":"Annalice Gandini , Victoria Probst , Matteo Landi , Maria Caterina De Grandis , Chiara Cremolini , Sara Lonardi , Paul Girot , Marie Decraecker , Alessandro Passardi , Lisa Salvatore , Alessandro Pastorino , Jeremy C Jones , Lucien Grados , Lina Sayah , Isabelle Trouilloud , David Tougeron , Julien Taieb","doi":"10.1016/j.clinre.2025.102746","DOIUrl":"10.1016/j.clinre.2025.102746","url":null,"abstract":"<div><div><em>BRAF</em> V600E mutation (<em>BRAF</em>m) is present in around 8 % of metastatic colorectal cancers (mCRC) and is associated with a poor prognosis. The encorafenib-cetuximab combination (ENCO<img>CET) is currently the standard second-line treatment of <em>BRAF</em>m mCRC. However, 2–5 % of patients treated with cetuximab experience grade 3–4 infusion-related reactions (IRRs), leading to treatment discontinuation. In addition, BRAF inhibitors must be combined with an anti-EGFR to have any efficacy in <em>BRAFm</em> mCRC. As panitumumab (PANI) is associated with a lower risk of IRRs, this study aimed to assess the safety and efficacy of ENCO-PANI as an alternative strategy in patients experiencing an IRR to CET.</div><div>We retrospectively collected <em>BRAFm</em> mCRC patients that switched ENCO<img>CET for ENCO-PANI following an IRR to CET. Twenty pts were identified across 12 centers from 4 countries. Most were male (12/20), 11/20 had right-sided primary tumor and 5/20 pts were dMMR/MSI. Median age was 66, treatment line was 2nd line in 85 % and 3rd line in 15 % of patients; 19 patients started ENCO<img>CET and switched to ENCO-PANI (cycle 2 or 3) and 1 received ENCO-PANI upfront due to patient’s choice. Response rate was 25 % and disease control rate 85 %. Median progression-free survival was 6.2 and median overall survival 11 months. Adverse events (AEs) during ENCO-PANI occurred in 15/20, mostly G1-G2. No new IRRs nor toxic deaths were reported.</div><div>ENCO-PANI appears to be as safe and effective in pts treated for a <em>BRAFm</em> mCRC unable to continue CET and may represent a valid alternative therapeutic option in this setting.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 1","pages":"Article 102746"},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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