Clinics and research in hepatology and gastroenterology最新文献_第3页

Refractory ascites following pancreatoduodenectomy after preoperative oxaliplatin based chemotherapy: be aware of nodular regenerative hyperplasia! 术前奥沙利铂化疗后胰十二指肠切除术后难治性腹水：注意结节性再生增生！

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-28 DOI: 10.1016/j.clinre.2025.102753

Jennifer Candi , Emma Zuppi , Camille Besch , Thibault Wolf , Pietro Addeo

引用次数: 0

Robot-assisted endoscopic submucosal dissection in gastrointestinal lesions: A systematic review and meta-analysis 机器人辅助内镜下粘膜夹层在胃肠道病变中的应用：系统综述和荟萃分析。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-26 DOI: 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.

内镜下粘膜剥离术（ESD）是一种在世界范围内日益有效的内镜技术。机器人辅助ESD是一种新颖的技术，通过提供更大范围的运动来实现复杂的运动，从而提高手术视野的可视化，并提供更好的美容手术效果。我们的目的是系统地回顾和荟萃分析机器人辅助ESD的有效性和安全性。方法：我们遵循PRISMA指南进行meta分析。我们纳入了报告胃肠道肿瘤或肿块患者接受机器人辅助ESD的研究。我们的主要结果是整体切除率、复发率和并发症，如出血和穿孔。次要结果包括手术时间、病变大小、完全切除率和住院时间。我们使用乔安娜布里格斯研究所（JBI）的关键评估工具和ROBINS-I工具进行质量评估。连续数据合并为均值，二分类数据合并为具有95%置信区间（95% CI）的比例。结果：共纳入8项研究，包括2项临床试验、3项队列研究和3份病例报告，共115名受试者。整体切除率为97.400%,95% CI（0.901, 0.993）。完全切除率为82.900%,95% CI（0.722, 0.900）。手术时间和住院时间分别为82.030 min （95% CI: 48.130, 115.940）和1.640天（95% CI: -0.180, 3.740）。术中出血率为1.800%,95% CI（0.004, 0.068）。结论：我们的系统综述和荟萃分析证明了机器人辅助内镜下粘膜夹层的潜在有效性和安全性。然而，未来需要更大样本量的高质量研究和更长的随访期来进一步支持我们的初步发现。机器人辅助的ESD在处理较大病变方面很有前景，而传统的ESD通常具有挑战性。

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引用次数: 0

Rifaximin for Primary prophylaxis of overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: A cohort analysis 利福昔明用于经颈静脉肝内门静脉系统分流术后显性肝性脑病的初级预防：一项队列分析。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-24 DOI: 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.

背景和目的：经颈静脉肝内门静脉系统分流术（TIPS）与显性肝性脑病（OHE）的风险升高有关，但支持TIPS后OHE初级预防的证据仍然有限。本研究旨在评估利福昔明是否能降低肝硬化患者tips后OHE的发生率。方法：回顾性分析72例TIPS（利福昔明组）术后6个月接受利福昔明（400 mg，每日2次）治疗的患者。从随机临床试验（ChiCTR-INR-17012479）中招募匹配的对照组（n=72）。主要终点为6个月内OHE的发生。次要终点包括1年死亡率、再出血发生率、支架功能障碍和肝功能改善。结果：利福昔明组6个月OHE发生率（21%,15/72）显著低于对照组（40%,29/72，P=0.011）。风险差异为-19.5%(95%可信区间[CI]: -34.2%至-4.7%)，优势比（OR）为0.39 （95% CI: 0.19-0.82）。Kaplan-Meier分析显示，利福昔明组OHE累积风险显著降低（log-rank P=0.009）。在死亡率、再出血或支架功能障碍方面，组间无显著差异（均P < 0.05）。结论：TIPS后6个月的利福昔明预防可显著降低肝硬化患者早期OHE的发生率。

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引用次数: 0

Comparison of repeat hepatectomy with radiofrequency ablation for the survival of hepatocellular carcinoma with solitary intrahepatic recurrence after hepatectomy 重复肝切除术与射频消融术对肝切除术后单发肝内复发肝细胞癌生存率的比较。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-20 DOI: 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.

目的：比较重复肝切除术（RHT）和射频消融术（RFA）治疗原发性肝内复发肝细胞癌（HCC）患者的生存结果，并确定相关预后因素。患者和方法：本研究纳入377例肝切除术后单发肝内复发的HCC患者（RHT=280， RFA=97）。倾向得分匹配（PSM）用于平衡组间特征。生存结局（OS和rRFS）采用Kaplan-Meier法分析，log-rank检验比较。在单因素分析中显著的变量进一步纳入多因素分析。结果：RFA组和RHT组在术前（OS组P = 0.37；rRFS组P = 0.30）和术后（OS组P = 0.58；rRFS组P = 0.76）的OS或rRFS均无显著差异。时代分层分析（早期队列[1996-2005]:OS组P = 0.40，rRFS组P = 0.62；后期队列[2006-2010]:OS组P = 0.18，rRFS组P = 0.08）证实了这一发现。亚组分析证实，在肿瘤≤3cm或> 3cm但≤5cm的患者中，RFA和RHT的生存结果相当。多因素分析发现，HBsAg阳性和肿瘤直径bbb2.0 cm是OS的独立危险因素，复发时间≤24个月是OS和rRFS的独立危险因素。结论：对于肝切除术后≤5 cm单发肝内复发的HCC患者，RFA提供的OS和rRFS与RHT相当。

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引用次数: 0

Prevalence and risk factors of portopulmonary hypertension in chronic liver disease: systematic review and meta-analysis 慢性肝病中门脉肺动脉高压的患病率和危险因素：系统回顾和荟萃分析。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-16 DOI: 10.1016/j.clinre.2025.102748

Tareq Alsaleh , Amir Harb , Parikshit Chapagain , Bassel Dakkak , Prachi Mann , Nouman Shafique , Nihal Khan , Mohamad Khaled Almujarkesh , Ayman Koteish

Background

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.

背景：门脉肺动脉高压（PoPH）增加肝移植围手术期死亡率，强调早期发现的必要性。为了更好地量化其负担并改进检测，我们对报告慢性肝病（CLD）成人中PoPH患病率和危险因素的研究进行了系统回顾和荟萃分析。方法：我们检索了截至2025年3月的多个数据库，以报告CLD中PoPH的患病率和危险因素。研究的主要结局是总患病率，次要结局是危险因素。采用随机效应模型采用标准荟萃分析方法，产生95%置信区间（CI）的合并效应估计。采用I2%统计量评估异质性。结果：共纳入48项研究，包括16351例CLD患者（平均年龄55.5岁，60%为男性）。RHC中PoPH的总患病率为2.4% (95% CI: 1.4, 4.1; 2 = 93.3%)，而TTE的总患病率为8.7% （95% CI: 5.9, 12.7）。TTE患者PoPH的显著危险因素为女性（OR 1.83）、自身免疫性肝炎（AIH）（OR 1.92）、年龄较大（MD 2.19）和较高的INR （MD 0.11）。AIH是RHC患者发生PoPH的重要危险因素（OR 2.28）。meta回归显示，rhc患病率随时间显著下降（-0.07% /年；p=0.007）。Egger的检验没有显示发表偏倚。结论：RHC证实的PoPH不常见，但TTE对其估计过高。女性、AIH患者、老年和凝血功能障碍患者可能受益于早期筛查。需要标准化的超声心动图阈值和前瞻性多中心研究来完善患病率和风险预测。

{"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}

引用次数: 0

Evaluating the accuracy of the histological diagnosis in unexplained liver injury: A retrospective study 评价不明原因肝损伤组织学诊断的准确性：一项回顾性研究。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-16 DOI: 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.

背景与目的：肝活检是诊断病因不明的肝脏疾病的一种有价值的工具，但有时不能提供明确的诊断。本研究旨在确定不明原因肝损伤的原因，并评估组织学诊断的准确性。方法：回顾性分析2019年9月至2024年6月在南昌大学第二附属医院行肝活检的不明原因慢性肝病患者的临床和组织学资料。诊断分为入院诊断组、组织学诊断组和最终临床诊断组。结果：共纳入104例患者，其中女性64例（61.5%），男性40例（38.5%），其中96例（92.3%）通过肝活检得到明确诊断。主要疾病为自身免疫性肝病（AILD， 49例，47.1%）、非酒精性脂肪性肝病（NAFLD， 26例，25.0%）、药物性肝损伤（DILI， 22例，21.2%）、其他疾病（11例，10.6%）和原因不明的肝病（8例，6.9%）。AILD在女性中最常见（40例，55.6%），而NAFLD在男性中最常见（19例，40.4%）。与入院诊断相比，组织学诊断具有更高的敏感性、特异性、阳性预测值（PPVs）和阴性预测值（npv）。维恩图分析显示，入院与组织学诊断吻合率为57.7%，入院与最终临床诊断吻合率为60.6%，组织学与最终临床诊断吻合率为92.3%。结论：组织学诊断对于确定不明原因肝损伤的原因是有效的，肝活检仍然是一个重要的工具。

{"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}

引用次数: 0

Switch from cetuximab to panitumumab during encorafenib-based therapy in BRAF V600E mutated metastatic colorectal cancer: An international multicenter analysis from the AGEO group 在BRAF V600E突变的转移性结直肠癌的以恩可非尼为基础的治疗中，从西妥昔单抗切换到帕尼单抗：来自AGEO组的国际多中心分析

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-16 DOI: 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.

BRAF V600E突变（BRAFm）存在于约8%的转移性结直肠癌（mCRC）中，并与不良预后相关。恩科非尼-西妥昔单抗联合治疗（ENCO-CET）目前是BRAFm mCRC的标准二线治疗。然而，2-5%接受西妥昔单抗治疗的患者出现3-4级输液相关反应（IRRs），导致停药。此外，BRAF抑制剂必须与抗egfr联合使用才能对BRAFm mCRC有效。由于帕尼单抗（panitumumab， PANI）与较低的IRR风险相关，本研究旨在评估ENCO-PANI作为一种替代策略在经历IRR至CET的患者中的安全性和有效性。我们回顾性收集BRAFm mCRC患者，这些患者在IRR到CET后将ENCO-CET换成ENCO-PANI。在来自4个国家的12个中心确定了20名患者。多数为男性（12/20），11/20为右侧原发肿瘤，5/20为dMMR/MSI。中位年龄66岁，85%为二线治疗，15%为三线治疗；19例患者开始使用ENCO-CET并切换到ENCO-PANI（第2或3周期），1例患者由于患者的选择而提前接受了ENCO-PANI。有效率25%，疾病控制率85%。中位无进展生存期为6.2个月，中位总生存期为11个月。ENCO-PANI期间不良事件（ae）发生在15/20，以G1-G2居多。没有新的IRRs和中毒死亡报告。ENCO-PANI在BRAFm mCRC无法继续CET治疗的患者中似乎是安全有效的，可能是这种情况下有效的替代治疗选择。

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引用次数: 0

Hematologic focal hepatic lesions in the absence of liver cirrhosis: Consider lymphoma and myeloma 没有肝硬化的血液局灶性肝脏病变：考虑淋巴瘤和骨髓瘤。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-16 DOI: 10.1016/j.clinre.2025.102749

Daniela Tirotta , Claudia Lena , Mario Torre , Paolo Muratori

Background

Solitary liver lesions in patients without underlying liver disease or elevated tumor markers (AFP, CEA, CA19-9) are uncommon and can represent hematologic malignancies, including primary hepatic lymphoma (PHL) and, more rarely, hepatic involvement by multiple myeloma. Early recognition is crucial to guide appropriate management and avoid unnecessary surgery.

Methods

A systematic literature review was conducted using PubMed, Scopus, and Google Scholar up to August 2025. Search terms included “primary hepatic lymphoma,” “hepatic plasmacytoma,” “multiple myeloma liver involvement,” and “solitary liver lesion.” Articles reporting epidemiology, clinical presentation, imaging characteristics, histopathology, and management of solitary hepatic lesions due to lymphoma or myeloma were included.

Results

Hematologic hepatic solitary lesions typically present as hypodense lesions on CT or hypointense on T1-weighted MRI with variable enhancement. Clinical manifestations are often nonspecific, including mild hepatomegaly or abdominal discomfort, while liver function tests are frequently normal. Definitive diagnosis relies on histopathology via biopsy. Management strategies differ: chemotherapy is first-line for lymphoma, whereas myeloma-related hepatic lesions may require systemic therapy or, rarely, surgical resection if diagnosis is uncertain.

Conclusions

In patients with solitary liver lesions, normal tumor markers, and no chronic liver disease, clinicians should maintain a high index of suspicion for hematologic malignancies. Accurate imaging assessment and tissue diagnosis are essential for optimal treatment planning.

背景：没有潜在肝脏疾病或肿瘤标志物（AFP， CEA, CA19-9）升高的患者的孤立性肝脏病变并不常见，可能代表血液系统恶性肿瘤，包括原发性肝淋巴瘤（PHL），更罕见的是多发性骨髓瘤累及肝脏。早期识别是指导适当治疗和避免不必要手术的关键。方法：采用截至2025年8月的PubMed、Scopus、谷歌Scholar进行系统文献综述。搜索词包括“原发性肝淋巴瘤”、“肝浆细胞瘤”、“累及肝脏的多发性骨髓瘤”和“孤立性肝脏病变”。文章报道流行病学，临床表现，影像学特征，组织病理学，和处理孤立性肝脏病变淋巴瘤或骨髓瘤纳入。结果：肝脏孤立性血液学病变在CT上表现为低密度病变，在t1加权MRI上表现为低密度病变，增强程度不一。临床表现通常是非特异性的，包括轻度肝肿大或腹部不适，而肝功能检查通常正常。最终诊断依赖于组织病理学活检。治疗策略各不相同：化疗是淋巴瘤的一线治疗，而骨髓瘤相关的肝脏病变可能需要全身治疗，如果诊断不确定，很少需要手术切除。结论：对于孤立性肝脏病变、肿瘤标志物正常、无慢性肝病的患者，临床医生应保持对血液系统恶性肿瘤的高度怀疑。准确的影像评估和组织诊断对于最佳治疗计划至关重要。

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引用次数: 0

Creating and validating an anastomotic leakage risk prediction model after laparoscopic low anterior resection for rectal cancer 腹腔镜直肠癌低位前切除术后吻合口漏风险预测模型的建立与验证。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-13 DOI: 10.1016/j.clinre.2025.102745

Wenqiang Li , Susu Zhou , Qikai Zhong , Luqiao Huang , Ning Li , Chengyu Sun , Liang Zhang , Zhengguo Zhang

Purpose

Anastomotic leakage (AL) is a serious complication after rectal cancer surgery, and there is still a lack of effective prediction tools. This study aims to provide a basis for the development of individualized AL prevention plans.

Methods

585 patients who underwent laparoscopic low anterior resection for rectal cancer in Xuzhou Central Hospital from 2019 to 2023 were retrospectively enrolled and randomly divided into a training set (410 cases) and a validation set (175 cases). Predictors were screened by LASSO regression, and a nomogram prediction model based on logistic regression was constructed. The area under the curve (AUC), calibration curve, decision curve and clinical impact curve were used to evaluate the model performance.

Results

The incidence of AL was approximately 13 % (76/585). According to LASSO regression, 8 predictors were identified: male gender, larger tumor diameter, a shorter distance between the tumor's lower margin and the anal verge, non-preservation of the left colic artery during surgery, preoperative neoadjuvant therapy, higher levels of carbohydrate antigen 19–9, no preventive stoma, and prolonged operative time. The AUC of the model in the training set and validation set was 0.745 (95 % CI: 0.675–0.814) and 0.733 (95 % CI: 0.606–0.859), respectively, and the calibration and clinical practicality were also favorable.

Conclusions

The prediction model is relatively accurate and can provide a basis for the formulation of individualized AL prevention strategies.

目的：吻合口漏（AL）是直肠癌术后的严重并发症，目前仍缺乏有效的预测工具。本研究旨在为制定个体化AL预防方案提供依据。方法：回顾性纳入2019 - 2023年在徐州市中心医院行腹腔镜直肠癌低位前切除术的585例患者，随机分为训练组（410例）和验证组（175例）。采用LASSO回归筛选预测因子，构建基于logistic回归的nomogram预测模型。采用曲线下面积（AUC）、校正曲线、决策曲线和临床影响曲线评价模型的性能。结果：AL的发生率约为13%（76/585）。通过LASSO回归，确定了8个预测因素：男性、肿瘤直径较大、肿瘤下缘与肛缘距离较短、术中未保留左结肠动脉、术前新辅助治疗、碳水化合物抗原19-9水平较高、无预防性造口、手术时间延长。该模型在训练集和验证集的AUC分别为0.745 （95% CI: 0.675-0.814）和0.733 (95% CI: 0.606-0.859)，校准和临床实用性也较好。结论：该预测模型较为准确，可为制定个体化AL预防策略提供依据。

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引用次数: 0

Low muscle density and five times sit-to-stand test predict poor outcome in liver transplant candidates 低肌肉密度和5次坐立试验预测肝移植候选人预后不良。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-10 DOI: 10.1016/j.clinre.2025.102743

Maxence Lepour , Alicia Delorme , Alexis Goffaux , Pierre Trefois , Elodie Dubois , Caroline Catoul , Frédéric Braem , David de Azevedo , Alix Collard , Nicolas Lanthier , Geraldine Dahlqvist

Background

Muscle-related parameters (myopenia, sarcopenia, myosteatosis, frailty) are linked to increased mortality in liver transplant candidates but have not been prospectively compared in the same cohort.

Aim

This study aimed to identify the most accurate muscle predictor of morbidity and mortality in patients with cirrhosis on the liver transplant waiting list.

Methods

A prospective, single-center study included all consenting adult liver transplant candidates from June 2021 to October 2023. Skeletal muscle mass index, muscle density, and myosteatosis were assessed via computed tomography at third lumbar vertebrae. Frailty was evaluated using the liver frailty index and the 6-minute walk test.

Results

Among 194 screened patients, 135 were listed for transplant, including 108 with cirrhosis. Alcohol-related liver disease was the leading etiology, 47 % were listed for hepatocellular carcinoma. Myopenia was present in 31 %, myosteatosis in 34 %, and 20 % were frail. One-year survival was 82 %. Myosteatosis was the strongest univariate predictor of mortality, but in multivariate analysis, the five times sit to stand test was the best predictor of morbi-mortality.

Conclusion

The five times sit to stand test emerged as the most robust predictor in multivariate analysis. Its simplicity and reliability make it a valuable tool for identifying high-risk patients on the liver transplant waiting list.

背景：在肝移植候选者中，肌肉相关参数（肌减少症、肌肉减少症、肌骨增生症、虚弱）与死亡率增加有关，但尚未在同一队列中进行前瞻性比较。目的：本研究旨在确定肝移植等待名单上肝硬化患者发病率和死亡率最准确的肌肉预测因子。方法：一项前瞻性单中心研究纳入了2021年6月至2023年10月期间所有同意的成人肝移植候选人。通过第三腰椎计算机断层扫描评估骨骼肌质量指数、肌肉密度和骨骼肌骨化症。使用肝衰弱指数和6分钟步行试验来评估衰弱程度。结果：194例患者中，135例被列入移植名单，其中肝硬化患者108例。酒精相关性肝病是主要病因，47%被列为肝细胞癌。31%的患者有肌肉萎缩，34%的患者有肌骨化症，20%的患者身体虚弱。一年生存率为82%。肌骨化病是死亡率最强的单因素预测因子，但在多因素分析中，5次坐位测试是发病率-死亡率的最佳预测因子。结论：在多变量分析中，5次坐站立检验是最可靠的预测因子。它的简单性和可靠性使其成为识别肝移植等待名单上高危患者的宝贵工具。

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引用次数: 0