Pub Date : 2026-03-01Epub Date: 2026-01-13DOI: 10.1016/j.clinre.2026.102763
Qunxiang Cao , Siyang Chen , Yutian Zhang , Juping Yang , Zhaohui Wang
<div><h3>Objective</h3><div>This study investigates the incidence, clinical characteristics, and risk factors of drug-induced liver injury (DILI) in cancer patients undergoing multiple courses of common chemotherapy drugs, providing evidence for developing DILI prevention and control strategies in clinical practice.</div></div><div><h3>Methods</h3><div>A retrospective cohort study included 165 cancer patients who received multiple courses of common chemotherapy drugs between January 2023 and January 2025. Participants were divided into a study group (<em>n</em> = 45, DILI occurrence) and a control group (<em>n</em> = 120, no DILI occurrence) based on DILI development. Baseline patient data, chemotherapy regimens, and liver function indicators were collected. Univariate analysis screened potential risk factors, while multivariate logistic regression validated independent risk factors. Spearman's rank correlation analyzed associations between risk factors and DILI severity.</div></div><div><h3>Results</h3><div>The overall DILI incidence among 165 patients was 27.27% (45/165), predominantly moderate in severity. Distribution by grade was: Grade 1 (mild) 14 cases (31.11%), Grade 2 (moderate) 24 cases (53.33%), Grade 3 (severe) 7 cases (15.56%), with no Grade 4 injury. Comparison of baseline characteristics between groups revealed higher DILI incidence among patients aged ≥60 years, with alcohol consumption history, viral hepatitis history, underlying liver disease, ≥3 chemotherapy drugs, and without prophylactic hepatoprotective/cholagogue use (all <em>p</em> < 0.05). Post-chemotherapy, the study group exhibited significantly higher levels of ALT, AST, ALP, GGT, and TBIL compared to the control group (all <em>p</em> < 0.001). Multivariate analysis confirmed that age ≥60 years (OR=2.964, 95% CI: 1.247–7.043, <em>p</em> = 0.014), history of alcohol consumption (OR=3.684, 95% CI: 1.523–8.912, <em>p</em> = 0.004), history of viral hepatitis (OR=3.116, 95% CI: 1.116–8.696, <em>p</em> = 0.030), underlying liver disease (OR=3.293, 95% CI: 1.312–8.266, <em>p</em> = 0.011), use of ≥3 chemotherapy drugs (OR=1.666, 95% CI: 1.031–2.690, <em>p</em> = 0.037), and lack of prophylactic hepatoprotective and cholagogue medication use (OR=0.326, 95% CI: 0.137–0.772, <em>p</em> = 0.011) were identified as independent risk factors for DILI occurrence. Spearman analysis revealed positive correlations between age, alcohol consumption history, viral hepatitis history, underlying liver disease, and number of chemotherapy drugs with DILI severity, while a negative correlation was observed between hepatoprotective and cholagogue drug use and DILI severity.</div></div><div><h3>Conclusion</h3><div>Tumor patients undergoing multiple courses of common chemotherapy drugs exhibit a high incidence of DILI, predominantly moderate in severity. Age ≥60 years, history of alcohol consumption, history of viral hepatitis, underlying liver disease, use of ≥3 chemotherapy drugs, and lac
{"title":"Clinical characteristics and risk factors of drug-induced hepatotoxicity in cancer patients following repeated chemotherapy cycles","authors":"Qunxiang Cao , Siyang Chen , Yutian Zhang , Juping Yang , Zhaohui Wang","doi":"10.1016/j.clinre.2026.102763","DOIUrl":"10.1016/j.clinre.2026.102763","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the incidence, clinical characteristics, and risk factors of drug-induced liver injury (DILI) in cancer patients undergoing multiple courses of common chemotherapy drugs, providing evidence for developing DILI prevention and control strategies in clinical practice.</div></div><div><h3>Methods</h3><div>A retrospective cohort study included 165 cancer patients who received multiple courses of common chemotherapy drugs between January 2023 and January 2025. Participants were divided into a study group (<em>n</em> = 45, DILI occurrence) and a control group (<em>n</em> = 120, no DILI occurrence) based on DILI development. Baseline patient data, chemotherapy regimens, and liver function indicators were collected. Univariate analysis screened potential risk factors, while multivariate logistic regression validated independent risk factors. Spearman's rank correlation analyzed associations between risk factors and DILI severity.</div></div><div><h3>Results</h3><div>The overall DILI incidence among 165 patients was 27.27% (45/165), predominantly moderate in severity. Distribution by grade was: Grade 1 (mild) 14 cases (31.11%), Grade 2 (moderate) 24 cases (53.33%), Grade 3 (severe) 7 cases (15.56%), with no Grade 4 injury. Comparison of baseline characteristics between groups revealed higher DILI incidence among patients aged ≥60 years, with alcohol consumption history, viral hepatitis history, underlying liver disease, ≥3 chemotherapy drugs, and without prophylactic hepatoprotective/cholagogue use (all <em>p</em> < 0.05). Post-chemotherapy, the study group exhibited significantly higher levels of ALT, AST, ALP, GGT, and TBIL compared to the control group (all <em>p</em> < 0.001). Multivariate analysis confirmed that age ≥60 years (OR=2.964, 95% CI: 1.247–7.043, <em>p</em> = 0.014), history of alcohol consumption (OR=3.684, 95% CI: 1.523–8.912, <em>p</em> = 0.004), history of viral hepatitis (OR=3.116, 95% CI: 1.116–8.696, <em>p</em> = 0.030), underlying liver disease (OR=3.293, 95% CI: 1.312–8.266, <em>p</em> = 0.011), use of ≥3 chemotherapy drugs (OR=1.666, 95% CI: 1.031–2.690, <em>p</em> = 0.037), and lack of prophylactic hepatoprotective and cholagogue medication use (OR=0.326, 95% CI: 0.137–0.772, <em>p</em> = 0.011) were identified as independent risk factors for DILI occurrence. Spearman analysis revealed positive correlations between age, alcohol consumption history, viral hepatitis history, underlying liver disease, and number of chemotherapy drugs with DILI severity, while a negative correlation was observed between hepatoprotective and cholagogue drug use and DILI severity.</div></div><div><h3>Conclusion</h3><div>Tumor patients undergoing multiple courses of common chemotherapy drugs exhibit a high incidence of DILI, predominantly moderate in severity. Age ≥60 years, history of alcohol consumption, history of viral hepatitis, underlying liver disease, use of ≥3 chemotherapy drugs, and lac","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102763"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988018","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 : 2026-03-01Epub Date: 2026-02-10DOI: 10.1016/j.clinre.2026.102783
Liang Wang , Yuliang Zhang , Xin Wan , Shipeng Ma , Qian Liu , Yulun Tang , Xiaoping Wu , Xiaopeng Li , Lajpat Rai Malhi , Shanfei Ge
<div><h3>Background and aims</h3><div>Hepatitis B e antigen (HBeAg) seroclearance and HBeAg seroconversion are critical milestones indicating reduced viral replication and a lower risk of disease progression to cirrhosis and hepatocellular carcinoma (HCC). Despite entecavir (ETV) and tenofovir alafenamide (TAF) being two first-line agents used for the treatment of patients with chronic hepatitis B (CHB), their comparative efficacy in attaining HBeAg seroclearance or HBeAg seroconversion is still unclear. Consequently, we aimed to directly compare the incidence of HBeAg seroclearance and HBeAg seroconversion in CHB patients treated with ETV or TAF.</div></div><div><h3>Methods</h3><div>This retrospective study included 244 patients who initiated therapy with ETV (<em>n</em>=145) or TAF (<em>n</em>=99) from 2017 to 2025. Multivariate Cox proportional hazards analysis was conducted to identify the factors independently associated with HBeAg seroclearance and seroconversion. Kaplan-Meier survival analysis was performed to compare the incidence of HBeAg seroclearance and seroconversion between the ETV and TAF groups.</div></div><div><h3>Results</h3><div>A 1:1 propensity score matching yielded 99 patients in each treatment group. The median HBeAg levels were 2.37 log<sub>10</sub> IU/ml and 2.44 log<sub>10</sub> IU/ml in the ETV and TAF groups respectively. After a follow-up period of 288 weeks, a total of 47 patients attained HBeAg seroclearance, comprising 20 patients from the ETV group and 27 patients from the TAF group, respectively. Additionally, 37 patients achieved HBeAg seroconversion, with 17 and 20 patients from the ETV and TAF treatment, respectively. The incidence of HBeAg seroclearance was significantly higher in TAF-treated patients than in ETV-treated patients (27.3% vs. 20.2%; <em>p</em> = 0.016), whereas the incidence of HBeAg seroconversion was comparable between the two groups (20.2% vs. 17.2%; <em>p</em>=0.075). Notably, compared with ETV, patients treated with TAF (HR=2.04; 95% CI: 1.84-6.47; <em>p</em><0.001) showed a significantly higher rate of HBeAg seroclearance. Higher baseline HBsAg levels (HR=0.50; 95% CI: 0.41-0.73; <em>p</em><0.001), and higher baseline HBeAg levels (HR=0.48; 95% CI: 0.43-0.75; <em>p</em><0.001) were associated with lower rates of HBeAg seroclearance, whereas elevated serum ALT levels (HR=1.001; 95% CI: 1.001-1.002; <em>p</em><0.001) were associated with higher rates of HBeAg seroclearance. In addition, factors significantly associated with HBeAg seroconversion included higher baseline HBsAg levels (HR=0.50; 95% CI: 0.45-0.78; <em>p</em><0.001) and higher baseline HBeAg levels (HR=0.51; 95% CI: 0.39-0.75; <em>p</em><0.001), which were linked to lower rates of HBeAg seroconversion, whereas elevated serum ALT levels (HR=1.001; 95% CI: 1.001-1.002; <em>p</em><0.001) were associated with higher rates of HBeAg seroconversion.</div></div><div><h3>Conclusion</h3><div>Higher incidence of HBeAg
背景和目的：乙型肝炎e抗原（HBeAg）血清清除率和HBeAg血清转化是表明病毒复制减少和疾病进展为肝硬化和肝细胞癌（HCC）风险降低的关键里程碑。尽管恩替卡韦（ETV）和替诺福韦（TAF）是两种用于治疗慢性乙型肝炎（CHB）患者的一线药物，但它们在实现HBeAg血清清除或HBeAg血清转化方面的比较疗效尚不清楚。因此，我们的目的是直接比较接受ETV或TAF治疗的CHB患者的HBeAg血清清除率和HBeAg血清转化的发生率。方法：本回顾性研究纳入2017年至2025年244例开始接受ETV （n=145）或TAF （n=99）治疗的患者。进行多因素Cox比例风险分析，以确定与HBeAg血清清除率和血清转化独立相关的因素。采用Kaplan-Meier生存分析比较ETV组和TAF组之间HBeAg血清清除率和血清转化率的发生率。结果：每个治疗组有99例患者，倾向评分匹配为1:1。ETV组和TAF组的中位HBeAg水平分别为2.37 log10 IU/ml和2.44 log10 IU/ml。经过288周的随访，共有47例患者达到HBeAg血清清除率，其中ETV组20例，TAF组27例。此外，37例患者实现了HBeAg血清转化，分别有17例和20例患者接受了ETV和TAF治疗。taf治疗患者的HBeAg血清清除率明显高于etv治疗患者（27.3% vs. 20.2%; p = 0.016），而两组之间的HBeAg血清转换发生率相当（20.2% vs. 17.2%; p=0.075）。值得注意的是，与ETV相比，TAF治疗的患者（HR=2.04; 95% CI: 1.84-6.47; p）结论：在HBeAg阳性的CHB患者中，TAF治疗的HBeAg血清清除率高于ETV。基线HBsAg、HBeAg和ALT水平被确定为HBeAg血清清除率和HBeAg血清转换的重要预测因子。
{"title":"Higher incidence of HBeAg seroclearance with tenofovir alafenamide fumarate than entecavir in HBeAg-positive patients with chronic hepatitis B","authors":"Liang Wang , Yuliang Zhang , Xin Wan , Shipeng Ma , Qian Liu , Yulun Tang , Xiaoping Wu , Xiaopeng Li , Lajpat Rai Malhi , Shanfei Ge","doi":"10.1016/j.clinre.2026.102783","DOIUrl":"10.1016/j.clinre.2026.102783","url":null,"abstract":"<div><h3>Background and aims</h3><div>Hepatitis B e antigen (HBeAg) seroclearance and HBeAg seroconversion are critical milestones indicating reduced viral replication and a lower risk of disease progression to cirrhosis and hepatocellular carcinoma (HCC). Despite entecavir (ETV) and tenofovir alafenamide (TAF) being two first-line agents used for the treatment of patients with chronic hepatitis B (CHB), their comparative efficacy in attaining HBeAg seroclearance or HBeAg seroconversion is still unclear. Consequently, we aimed to directly compare the incidence of HBeAg seroclearance and HBeAg seroconversion in CHB patients treated with ETV or TAF.</div></div><div><h3>Methods</h3><div>This retrospective study included 244 patients who initiated therapy with ETV (<em>n</em>=145) or TAF (<em>n</em>=99) from 2017 to 2025. Multivariate Cox proportional hazards analysis was conducted to identify the factors independently associated with HBeAg seroclearance and seroconversion. Kaplan-Meier survival analysis was performed to compare the incidence of HBeAg seroclearance and seroconversion between the ETV and TAF groups.</div></div><div><h3>Results</h3><div>A 1:1 propensity score matching yielded 99 patients in each treatment group. The median HBeAg levels were 2.37 log<sub>10</sub> IU/ml and 2.44 log<sub>10</sub> IU/ml in the ETV and TAF groups respectively. After a follow-up period of 288 weeks, a total of 47 patients attained HBeAg seroclearance, comprising 20 patients from the ETV group and 27 patients from the TAF group, respectively. Additionally, 37 patients achieved HBeAg seroconversion, with 17 and 20 patients from the ETV and TAF treatment, respectively. The incidence of HBeAg seroclearance was significantly higher in TAF-treated patients than in ETV-treated patients (27.3% vs. 20.2%; <em>p</em> = 0.016), whereas the incidence of HBeAg seroconversion was comparable between the two groups (20.2% vs. 17.2%; <em>p</em>=0.075). Notably, compared with ETV, patients treated with TAF (HR=2.04; 95% CI: 1.84-6.47; <em>p</em><0.001) showed a significantly higher rate of HBeAg seroclearance. Higher baseline HBsAg levels (HR=0.50; 95% CI: 0.41-0.73; <em>p</em><0.001), and higher baseline HBeAg levels (HR=0.48; 95% CI: 0.43-0.75; <em>p</em><0.001) were associated with lower rates of HBeAg seroclearance, whereas elevated serum ALT levels (HR=1.001; 95% CI: 1.001-1.002; <em>p</em><0.001) were associated with higher rates of HBeAg seroclearance. In addition, factors significantly associated with HBeAg seroconversion included higher baseline HBsAg levels (HR=0.50; 95% CI: 0.45-0.78; <em>p</em><0.001) and higher baseline HBeAg levels (HR=0.51; 95% CI: 0.39-0.75; <em>p</em><0.001), which were linked to lower rates of HBeAg seroconversion, whereas elevated serum ALT levels (HR=1.001; 95% CI: 1.001-1.002; <em>p</em><0.001) were associated with higher rates of HBeAg seroconversion.</div></div><div><h3>Conclusion</h3><div>Higher incidence of HBeAg ","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102783"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177423","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 : 2026-03-01Epub Date: 2026-02-10DOI: 10.1016/j.clinre.2026.102784
Kathryn Thompson , William Breaux , Lesley S. Miller , John Nemeth , Sarah Koumtouzoua , Natasha Travis
Background
With the global rise of metabolic dysfunction-associated steatotic liver disease (MASLD) that can lead to metabolic dysfunction-associated steatohepatitis (MASH), there are concerns about the public health and financial repercussions of a growing population developing end-stage liver disease. While numerous studies are being conducted to identify treatments for MASLD and MASH, it is still important to assess how existing diabetes medications affect MASLD, since these medications are readily available and have proven effective in other facets of metabolic syndrome. This systematic review evaluates the effects of five classes of diabetes medications, specifically sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1), dipeptidyl peptidase-4 inhibitors (DPP-4i), metformin, and statins, on MASLD.
Methods
We used the Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) by vibration-controlled transient elastography as non-invasive methods for quantifying hepatic fibrosis and steatosis. The literature search was completed on May 1, 2024 using four databases, and 38 studies were included in this review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Among the studies, SGLT2i and GLP-1 led to statistically significant reductions in the LSM and CAP, liver enzymes, body mass index, and hemoglobin A1c. There was less literature available for DPP-4i, metformin, and statins, making it difficult to draw conclusions about their effects on MASLD.
Conclusion
This review highlights the need for more trials for each of these five classes of medications, especially trials that incorporate non-invasive testing, to evaluate their effects on MASLD and MASH.
{"title":"Effect of common diabetes medications on metabolic dysfunction-associated steatotic liver disease as measured by transient elastography and other metabolic parameters: A systematic review","authors":"Kathryn Thompson , William Breaux , Lesley S. Miller , John Nemeth , Sarah Koumtouzoua , Natasha Travis","doi":"10.1016/j.clinre.2026.102784","DOIUrl":"10.1016/j.clinre.2026.102784","url":null,"abstract":"<div><h3>Background</h3><div>With the global rise of metabolic dysfunction-associated steatotic liver disease (MASLD) that can lead to metabolic dysfunction-associated steatohepatitis (MASH), there are concerns about the public health and financial repercussions of a growing population developing end-stage liver disease. While numerous studies are being conducted to identify treatments for MASLD and MASH, it is still important to assess how existing diabetes medications affect MASLD, since these medications are readily available and have proven effective in other facets of metabolic syndrome. This systematic review evaluates the effects of five classes of diabetes medications, specifically sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1), dipeptidyl peptidase-4 inhibitors (DPP-4i), metformin, and statins, on MASLD.</div></div><div><h3>Methods</h3><div>We used the Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) by vibration-controlled transient elastography as non-invasive methods for quantifying hepatic fibrosis and steatosis. The literature search was completed on May 1, 2024 using four databases, and 38 studies were included in this review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.</div></div><div><h3>Results</h3><div>Among the studies, SGLT2i and GLP-1 led to statistically significant reductions in the LSM and CAP, liver enzymes, body mass index, and hemoglobin A1c. There was less literature available for DPP-4i, metformin, and statins, making it difficult to draw conclusions about their effects on MASLD.</div></div><div><h3>Conclusion</h3><div>This review highlights the need for more trials for each of these five classes of medications, especially trials that incorporate non-invasive testing, to evaluate their effects on MASLD and MASH.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102784"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177253","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 : 2026-03-01Epub Date: 2026-02-01DOI: 10.1016/j.clinre.2026.102778
Siri A. Urquhart, Luis E. Ospina Velasquez, John B. Kisiel, Nayantara Coelho-Prabhu
Background and Aims
A direct causal association between inflammatory bowel disease (IBD) and appendiceal neoplasm (AN) is unclear.
Methods
Patients with IBD and AN were identified from 1992 to 2023 using bioinformatics and natural language processing tools.
Results
Thirty-one patients were identified. The most common type of AN was appendiceal mucinous neoplasm (83.9 %). Three patients with ulcerative colitis (9.7 %) had recurrence after surgical resection due to peritoneal seeding.
Conclusions
Incidence and recurrence of AN in patients with IBD is low. Further studies to compare AN in patients with and without IBD are needed to determine if IBD predisposes to development of this complication.
{"title":"Clinical characteristics and outcomes of appendiceal neoplasms in inflammatory bowel disease: A tertiary care center experience","authors":"Siri A. Urquhart, Luis E. Ospina Velasquez, John B. Kisiel, Nayantara Coelho-Prabhu","doi":"10.1016/j.clinre.2026.102778","DOIUrl":"10.1016/j.clinre.2026.102778","url":null,"abstract":"<div><h3>Background and Aims</h3><div>A direct causal association between inflammatory bowel disease (IBD) and appendiceal neoplasm (AN) is unclear.</div></div><div><h3>Methods</h3><div>Patients with IBD and AN were identified from 1992 to 2023 using bioinformatics and natural language processing tools.</div></div><div><h3>Results</h3><div>Thirty-one patients were identified. The most common type of AN was appendiceal mucinous neoplasm (83.9 %). Three patients with ulcerative colitis (9.7 %) had recurrence after surgical resection due to peritoneal seeding.</div></div><div><h3>Conclusions</h3><div>Incidence and recurrence of AN in patients with IBD is low. Further studies to compare AN in patients with and without IBD are needed to determine if IBD predisposes to development of this complication.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102778"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112499","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}
Transarterial chemoembolization (TACE) is the main treatment for intermediate-stage hepatocellular carcinoma (HCC), but its suitability varies due to tumor burden and liver function heterogeneity. TACE may worsen liver function in large tumors. This study aims to develop a model to predict one-year mortality in intermediate-stage HCC patients undergoing TACE as first-line therapy.
Methods
A retrospective cohort study analyzed data from the Indonesian National Hepatocellular Carcinoma Registry (RINKAS) at Cipto Mangunkusumo and Dharmais Cancer Hospitals (2006–2022). Prognostic factors for one-year mortality were identified using bivariate and multivariate Cox regression. The resulting model was evaluated for discrimination, calibration, and internal validation using AUROC, Hosmer-Lemeshow test, calibration curve, and bootstrapping.
Results
Among 538 intermediate-stage HCC patients, 191 received TACE, with a one-year survival rate of 49.8% and a median survival of 362 days. Significant predictors of mortality included ALBI grade 2–3 (HR 1.97; p = 0.003), nodule size ≥11 cm (HR 1.57; p = 0.04), and AFP ≥1000 ng/mL (HR 2.41; p < 0.001). The MANTAP model, based on these variables, stratifies patients into low-risk (score 0–1, mortality 29.6%), moderate-risk (score 2, mortality 52.9%), and high-risk (score 3–4, mortality 75.1%) groups. The model showed acceptable predictive performance (AUROC 0.72), good calibration (Hosmer-Lemeshow p = 0.343), and robust validation.
Conclusions
The MANTAP score proposes a simple risk stratification tool for estimating one-year mortality in intermediate-stage HCC patients undergoing TACE as first-line therapy.
{"title":"Development of the MANTAP score for predicting one-year mortality in intermediate-stage hepatocellular carcinoma patients undergoing transarterial chemoembolization","authors":"Imelda Maria Loho , Irsan Hasan , Rino Alvani Gani , Kuntjoro Harimurti , Noorwati Sutandyo , Evy Yunihastuti , Hamzah Shatri , Cosmas Rinaldi Lesmana","doi":"10.1016/j.clinre.2026.102781","DOIUrl":"10.1016/j.clinre.2026.102781","url":null,"abstract":"<div><h3>Background and Aim(s)</h3><div>Transarterial chemoembolization (TACE) is the main treatment for intermediate-stage hepatocellular carcinoma (HCC), but its suitability varies due to tumor burden and liver function heterogeneity. TACE may worsen liver function in large tumors. This study aims to develop a model to predict one-year mortality in intermediate-stage HCC patients undergoing TACE as first-line therapy.</div></div><div><h3>Methods</h3><div>A retrospective cohort study analyzed data from the Indonesian National Hepatocellular Carcinoma Registry (RINKAS) at Cipto Mangunkusumo and Dharmais Cancer Hospitals (2006–2022). Prognostic factors for one-year mortality were identified using bivariate and multivariate Cox regression. The resulting model was evaluated for discrimination, calibration, and internal validation using AUROC, Hosmer-Lemeshow test, calibration curve, and bootstrapping.</div></div><div><h3>Results</h3><div>Among 538 intermediate-stage HCC patients, 191 received TACE, with a one-year survival rate of 49.8% and a median survival of 362 days. Significant predictors of mortality included ALBI grade 2–3 (HR 1.97; <em>p</em> = 0.003), nodule size ≥11 cm (HR 1.57; <em>p</em> = 0.04), and AFP ≥1000 ng/mL (HR 2.41; <em>p</em> < 0.001). The MANTAP model, based on these variables, stratifies patients into low-risk (score 0–1, mortality 29.6%), moderate-risk (score 2, mortality 52.9%), and high-risk (score 3–4, mortality 75.1%) groups. The model showed acceptable predictive performance (AUROC 0.72), good calibration (Hosmer-Lemeshow <em>p</em> = 0.343), and robust validation.</div></div><div><h3>Conclusions</h3><div>The MANTAP score proposes a simple risk stratification tool for estimating one-year mortality in intermediate-stage HCC patients undergoing TACE as first-line therapy.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102781"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123922","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 : 2026-03-01Epub Date: 2026-01-19DOI: 10.1016/j.clinre.2026.102768
Paulina Chodnicka, Elżbieta Jurkiewicz, Kamil Janowski, Maria Janowska, Agnieszka Pytlewska, Małgorzata Gołuch, Małgorzata Markiewicz-Kijewska, Maciej Pronicki, Wiesława Grajkowska, Piotr Socha
Objectives
Liver fibrosis staging in pediatric patients traditionally relies on invasive methods, such as liver biopsy, which pose risks and limitations. Magnetic Resonance Elastography (MRE) has emerged as a promising noninvasive alternative. This study aimed to validate the use of MRE in pediatric liver diseases and assess its diagnostic accuracy.
Methods
A total of 110 participants (61 with autoimmune hepatitis (AIH), 33 post-liver transplantation (LTx), and 16 healthy controls) underwent MRE examinations. Liver biopsies were performed based on ESPGHAN indications in patients with AIH and according to institutional post-transplant protocols in LTx patients. Biochemical data were collected including ALT (alanine aminotransferase), AST (aspartate transaminase), INR (international normalized ratio), bilirubin, and platelet counts. The APRI (aspartate aminotransferase to platelet ratio index) and FIB 4 (Fibrosis Index Based on 4 Factors) were calculated.
Results
In AIH patients MRE showed a sensitivity of 76.2% and specificity of 84.6% for moderete to severe fibrosis, incomplete cirrhosis and cirrhosis (Ishak 4–6, AUC 0.828, cutoff 3.28 kPa) and a sensitivity of 80% and specificity of 88.9% for incomplete cirrhosis and cirrhosis (Ishak 5–6, AUC 0.896, cutoff 3.68 kPa). In LTx patients, MRE demonstrated a sensitivity of 80% and specificity of 91.3% for moderete to severe fibrosis and cirrhosis (Ishak 4–6, AUC 0.865, cutoff 3.1 kPa). Inter-observer agreement for MRE was excellent (ICC(3,1) of 0.988)
Conclusions
MRE is a valuable noninvasive tool offering an accurate assessment of fibrosis. Further research is warranted to expand MRE's utility across diverse pediatric liver conditions. This validation of the MRE highlights its potential to enhance clinical decision-making and patient care in pediatric hepatology.
{"title":"Sensitivity and specificity of magnetic resonance elastography in liver diseases in the pediatric age group","authors":"Paulina Chodnicka, Elżbieta Jurkiewicz, Kamil Janowski, Maria Janowska, Agnieszka Pytlewska, Małgorzata Gołuch, Małgorzata Markiewicz-Kijewska, Maciej Pronicki, Wiesława Grajkowska, Piotr Socha","doi":"10.1016/j.clinre.2026.102768","DOIUrl":"10.1016/j.clinre.2026.102768","url":null,"abstract":"<div><h3>Objectives</h3><div>Liver fibrosis staging in pediatric patients traditionally relies on invasive methods, such as liver biopsy, which pose risks and limitations. Magnetic Resonance Elastography (MRE) has emerged as a promising noninvasive alternative. This study aimed to validate the use of MRE in pediatric liver diseases and assess its diagnostic accuracy.</div></div><div><h3>Methods</h3><div>A total of 110 participants (61 with autoimmune hepatitis (AIH), 33 post-liver transplantation (LTx), and 16 healthy controls) underwent MRE examinations. Liver biopsies were performed based on ESPGHAN indications in patients with AIH and according to institutional post-transplant protocols in LTx patients. Biochemical data were collected including ALT (alanine aminotransferase), AST (aspartate transaminase), INR (international normalized ratio), bilirubin, and platelet counts. The APRI (aspartate aminotransferase to platelet ratio index) and FIB 4 (Fibrosis Index Based on 4 Factors) were calculated.</div></div><div><h3>Results</h3><div>In AIH patients MRE showed a sensitivity of 76.2% and specificity of 84.6% for moderete to severe fibrosis, incomplete cirrhosis and cirrhosis (Ishak 4–6, AUC 0.828, cutoff 3.28 kPa) and a sensitivity of 80% and specificity of 88.9% for incomplete cirrhosis and cirrhosis (Ishak 5–6, AUC 0.896, cutoff 3.68 kPa). In LTx patients, MRE demonstrated a sensitivity of 80% and specificity of 91.3% for moderete to severe fibrosis and cirrhosis (Ishak 4–6, AUC 0.865, cutoff 3.1 kPa). Inter-observer agreement for MRE was excellent (ICC(3,1) of 0.988)</div></div><div><h3>Conclusions</h3><div>MRE is a valuable noninvasive tool offering an accurate assessment of fibrosis. Further research is warranted to expand MRE's utility across diverse pediatric liver conditions. This validation of the MRE highlights its potential to enhance clinical decision-making and patient care in pediatric hepatology.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102768"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017486","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}
{"title":"Disparities in hepatocellular carcinoma surveillance and antiviral therapy among Somali patients with chronic hepatitis B","authors":"Naima Hashi, Hannah Chi, Melica Nikahd, Vivek Mendiratta, Erin Bouquet, Lindsay A Sobotka","doi":"10.1016/j.clinre.2026.102780","DOIUrl":"10.1016/j.clinre.2026.102780","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102780"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131369","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 : 2026-03-01Epub Date: 2026-01-26DOI: 10.1016/j.clinre.2026.102776
Alice Dongier , Edouard Louis , Jean-Philippe Loly , Pierre Dandoy , Odile Warling , Anne Vijverman , Jean Delwaide
Background
Prognosis in decompensated cirrhosis is heterogeneous and may be influenced by cirrhosis-associated immune dysfunction.
Aims
To assess whether QuantiFERON-Monitor, a whole blood interferon-γ release assay, predicts short-term outcomes in patients with acute decompensated cirrhosis.
Methods
We conducted a prospective cohort study in two hospitals (March 2022-March 2023), enrolling 44 patients hospitalized for acute decompensated cirrhosis. QuantiFERON-Monitor testing measured interferon-γ release after immune stimulation during hospitalization. Patients were followed for 90 days for mortality, bacterial infection, and acute-on-chronic liver failure. Associations between interferon-gamma levels and outcomes were evaluated using Cox proportional hazards and logistic regression models.
Results
The median interferon-γ release was 56 IU/mL (1-366). Each 10 IU/mL increase was associated with a 12% relative reduction in 90-day risk of death or ACLF (HR 0.88, 95% CI 0.79-0.99; p=0.03). No deaths occurred in patients with Interferon-γ ≥ 100 IU/mL versus 39% mortality in those below (p=0.01). Interferon-γ levels were not significantly associated with infection or acute-on-chronic liver failure. Adding QuantiFERON-Monitor to the MELD-Na improved discrimination for early mortality or acute-on-chronic liver failure.
Conclusions
Baseline interferon-γ release measured by the QuantiFERON-Monitor is a prognostic marker of short-term poor outcome in acute decompensated cirrhosis, reflecting cellular immune dysfunction. This assay may complement existing prognostic tools. Further validation with a larger cohort is required.
{"title":"QuantiFERON-Monitor as prognostic marker of mortality in patients with decompensated cirrhosis: A prospective cohort study","authors":"Alice Dongier , Edouard Louis , Jean-Philippe Loly , Pierre Dandoy , Odile Warling , Anne Vijverman , Jean Delwaide","doi":"10.1016/j.clinre.2026.102776","DOIUrl":"10.1016/j.clinre.2026.102776","url":null,"abstract":"<div><h3>Background</h3><div>Prognosis in decompensated cirrhosis is heterogeneous and may be influenced by cirrhosis-associated immune dysfunction.</div></div><div><h3>Aims</h3><div>To assess whether QuantiFERON-Monitor, a whole blood interferon-γ release assay, predicts short-term outcomes in patients with acute decompensated cirrhosis.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study in two hospitals (March 2022-March 2023), enrolling 44 patients hospitalized for acute decompensated cirrhosis. QuantiFERON-Monitor testing measured interferon-γ release after immune stimulation during hospitalization. Patients were followed for 90 days for mortality, bacterial infection, and acute-on-chronic liver failure. Associations between interferon-gamma levels and outcomes were evaluated using Cox proportional hazards and logistic regression models.</div></div><div><h3>Results</h3><div>The median interferon-γ release was 56 IU/mL (1-366). Each 10 IU/mL increase was associated with a 12% relative reduction in 90-day risk of death or ACLF (HR 0.88, 95% CI 0.79-0.99; p=0.03). No deaths occurred in patients with Interferon-γ ≥ 100 IU/mL versus 39% mortality in those below (p=0.01). Interferon-γ levels were not significantly associated with infection or acute-on-chronic liver failure. Adding QuantiFERON-Monitor to the MELD-Na improved discrimination for early mortality or acute-on-chronic liver failure.</div></div><div><h3>Conclusions</h3><div>Baseline interferon-γ release measured by the QuantiFERON-Monitor is a prognostic marker of short-term poor outcome in acute decompensated cirrhosis, reflecting cellular immune dysfunction. This assay may complement existing prognostic tools. Further validation with a larger cohort is required.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102776"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099936","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 : 2026-03-01Epub Date: 2026-02-06DOI: 10.1016/j.clinre.2026.102782
Arthur Jourdain , Romain Leenhardt , Ingrid Popa , Xavier Dray
A 47-year-old woman with Turner’s syndrome was admitted to the emergency room with anemic syndrome and melena. She has a history of hypothyroidism, premature ovarian insufficiency and chronic iron deficiency. She reported previous overt gastrointestinal (GI) bleeding attributed to duodenal vascular lesions. Endoscopic treatment and blood transfusion were performed. She received estroprogestative therapy, thyroid hormone substitution and oral iron replacement therapy on the long run. Hemoglobin rate was 6.1 g/dL. Upper GI endoscopy was normal, colonoscopy showed blood clots in the ileum and in the right colon. Small bowel capsule endoscopy identified active jejunal bleeding. Both capsule endoscopy and deep enteroscopy identified multiple, tiny, looped telangiectasias in the duodenum and jejunum (Fig 1 and Fig 2) which were ablated using argon plasma coagulation. GI bleeding and iron deficiency recurred several times during the three years follow-up. Long-acting release octreotide treatment was initiated and progressively increased due to recurrent GI bleeding. Parenteral iron supplementation were performed. Further endoscopic investigations identified once again non hemorrhagic typical looped small bowel telangiectasias. Eradication treatment consisted in argon plasma coagulation. Case reports have described hemorrhagic GI vascular abnormalities responsible for longstanding iron deficiency anemia and overt GI bleeding in women with Turner’s syndrome.(1) These vascular lesions were predominantly (72%) located in the small bowel where they can be diagnosed with capsule or enteroscopy. Authors usually use the terms telangiectasia, prominent submucosal vascular network, and/or phlebectasia to describe these lesions. Reports describing abnormalities observed during laparoscopic evaluation mentioned segmentally distended veins on the serosal surface of the small and large bowel (1,2,3). Exceptional reports of perendoscopic biopsies mentioned superficial telangiectasia of the mucosa, and an enterectomy pathological analysis showed medium-sized ectasic, congestive vessels in the mucosa and serosa.(3) The small bowel microvasculature lesions reported in association with Turner’s syndrome thus differ from angiodysplasias. Angiodysplasias are typically described as flat lesions, consisting of tortuous and clustered capillary dilatations, within the mucosal layer (4) either seen in a sporadic manner or as observed in Osler-Weber-Rendu syndrome (4,6). Still, because loop telangiectasias in Turner’s syndrome are tiny, superficial vascular lesions, we attempted a similar treatment to that of angiodysplasia (5), with first-line (argon plasma coagulation) and second-line (long-acting release octreotide), resulting in significant biological improvement in our patient. At 6 months of follow-up after octreotide optimization, no recurrence occurred, hemoglobin rate was 14.1 g/dL with ferritinemia at 16 ng/mL.
{"title":"Hemorrhagic jejunal vascular malformations with loop telangiectasia in Turner’s syndrome","authors":"Arthur Jourdain , Romain Leenhardt , Ingrid Popa , Xavier Dray","doi":"10.1016/j.clinre.2026.102782","DOIUrl":"10.1016/j.clinre.2026.102782","url":null,"abstract":"<div><div>A 47-year-old woman with Turner’s syndrome was admitted to the emergency room with anemic syndrome and melena. She has a history of hypothyroidism, premature ovarian insufficiency and chronic iron deficiency. She reported previous overt gastrointestinal (GI) bleeding attributed to duodenal vascular lesions. Endoscopic treatment and blood transfusion were performed. She received estroprogestative therapy, thyroid hormone substitution and oral iron replacement therapy on the long run. Hemoglobin rate was 6.1 g/dL. Upper GI endoscopy was normal, colonoscopy showed blood clots in the ileum and in the right colon. Small bowel capsule endoscopy identified active jejunal bleeding. Both capsule endoscopy and deep enteroscopy identified multiple, tiny, looped telangiectasias in the duodenum and jejunum (Fig 1 and Fig 2) which were ablated using argon plasma coagulation. GI bleeding and iron deficiency recurred several times during the three years follow-up. Long-acting release octreotide treatment was initiated and progressively increased due to recurrent GI bleeding. Parenteral iron supplementation were performed. Further endoscopic investigations identified once again non hemorrhagic typical looped small bowel telangiectasias. Eradication treatment consisted in argon plasma coagulation. Case reports have described hemorrhagic GI vascular abnormalities responsible for longstanding iron deficiency anemia and overt GI bleeding in women with Turner’s syndrome.(1) These vascular lesions were predominantly (72%) located in the small bowel where they can be diagnosed with capsule or enteroscopy. Authors usually use the terms telangiectasia, prominent submucosal vascular network, and/or phlebectasia to describe these lesions. Reports describing abnormalities observed during laparoscopic evaluation mentioned segmentally distended veins on the serosal surface of the small and large bowel (1,2,3). Exceptional reports of perendoscopic biopsies mentioned superficial telangiectasia of the mucosa, and an enterectomy pathological analysis showed medium-sized ectasic, congestive vessels in the mucosa and serosa.(3) The small bowel microvasculature lesions reported in association with Turner’s syndrome thus differ from angiodysplasias. Angiodysplasias are typically described as flat lesions, consisting of tortuous and clustered capillary dilatations, within the mucosal layer (4) either seen in a sporadic manner or as observed in Osler-Weber-Rendu syndrome (4,6). Still, because loop telangiectasias in Turner’s syndrome are tiny, superficial vascular lesions, we attempted a similar treatment to that of angiodysplasia (5), with first-line (argon plasma coagulation) and second-line (long-acting release octreotide), resulting in significant biological improvement in our patient. At 6 months of follow-up after octreotide optimization, no recurrence occurred, hemoglobin rate was 14.1 g/dL with ferritinemia at 16 ng/mL.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102782"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140603","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 : 2026-03-01Epub Date: 2026-02-10DOI: 10.1016/j.clinre.2026.102785
Koji Takahashi
{"title":"Generalizability and confounding in chemotherapy-induced hepatotoxicity: A call for robust risk stratification","authors":"Koji Takahashi","doi":"10.1016/j.clinre.2026.102785","DOIUrl":"10.1016/j.clinre.2026.102785","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 3","pages":"Article 102785"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177325","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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