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The flaming and pulled up anorectal line: Ulcerative colitis-associated squamous metaplasia of the lower rectum 燃烧和拉起的肛肠线:溃疡性结肠炎相关的下直肠鳞状皮化生。
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.clinre.2024.102513
Vincent Zimmer
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引用次数: 0
Prognostic role of tumor-infiltrating lymphocytes in gastric cancer: A systematic review and meta-analysis 肿瘤浸润淋巴细胞在胃癌预后中的作用:一项系统综述和荟萃分析。
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.clinre.2024.102510
Xiaoqing Cao , Yurou Kang , Ping Tai, Pei Zhang, Xin Lin, Fei Xu, Zhenlin Nie, Bangshun He

Background

To analyze the relationship between tumor-infiltrating lymphocytes (TILs) subtypes and infiltration locations and the prognosis of gastric cancer (GC) patients.

Methods

Eligible articles were obtained through systematic retrieval and rigorous screening, collecting study information and extracting hazard ratio (HR), 95 % confidence interval (CI) for pooled analyses of disease-free survival (DFS) and overall survival (OS).

Results

Higher CD4+ TILs were correlated with favorable OS (HR=0.79, 95 %CI: 0.66–0.94, P = 0.009), the similar results were observed in tumor center and in infiltration margin. Higher CD8+ TILs prolonged DFS (HR=0.69, 95 %CI: 0.51–0.95, P = 0.02) and OS (HR=0.96, 95 %CI: 0.94–0.99, P = 0.006); For OS, tumor center and infiltration margin groups showed positive results. Neither the overall analysis nor the subgroup analyses indicated that the level of FOXP3+ TILs was associated with prognosis (DFS: HR=0.89, 95 %CI: 0.66–1.19, P = 0.42; OS: HR=0.98, 95 %CI: 0.85–1.13, P = 0.75). Pooled results revealed that higher CD3+ TILs were correlated with favorable DFS (HR=0.69, 95 %CI: 0.56–0.84, P = 0.0003) but not OS (HR=1.00, 95 %CI: 0.99–1.01, P = 0.48).

Conclusions

High infiltrating CD3+, CD4+, CD8+ T cells prolong survival, and FOXP3+ subset is not related to prognosis in GC. For CD4+ and CD8+, positive correlations between the infiltration level and OS were present in tumor center and infiltration margin groups.
背景:分析胃癌(GC)患者肿瘤浸润淋巴细胞(tumor-浸润淋巴细胞,TILs)亚型及浸润部位与预后的关系。方法:通过系统检索和严格筛选,收集研究信息,提取风险比(HR)和95%置信区间(CI),对无病生存期(DFS)和总生存期(OS)进行合并分析,获得符合条件的文献。结果:CD4+ TILs越高,OS越好(HR=0.79, 95%CI: 0.66 ~ 0.94, P=0.009),肿瘤中心和浸润边缘的结果相似。较高的CD8+ TILs延长DFS (HR=0.69, 95%CI: 0.51 ~ 0.95, P=0.02)和OS (HR=0.96, 95%CI: 0.94 ~ 0.99, P=0.006);肿瘤中心组和浸润边缘组OS阳性。总体分析和亚组分析均未显示FOXP3+ TILs水平与预后相关(DFS: HR=0.89, 95%CI: 0.66-1.19, P=0.42;Os: hr =0.98, 95%ci: 0.85-1.13, p =0.75)。综合结果显示,较高的CD3+ TILs与较好的DFS相关(HR=0.69, 95%CI: 0.56 ~ 0.84, P=0.0003),但与OS无关(HR=1.00, 95%CI: 0.99 ~ 1.01, P=0.48)。结论:高浸润的CD3+、CD4+、CD8+ T细胞延长了胃癌患者的生存期,FOXP3+亚群与预后无关。肿瘤中心组和浸润边缘组CD4+、CD8+浸润水平与OS呈正相关。
{"title":"Prognostic role of tumor-infiltrating lymphocytes in gastric cancer: A systematic review and meta-analysis","authors":"Xiaoqing Cao ,&nbsp;Yurou Kang ,&nbsp;Ping Tai,&nbsp;Pei Zhang,&nbsp;Xin Lin,&nbsp;Fei Xu,&nbsp;Zhenlin Nie,&nbsp;Bangshun He","doi":"10.1016/j.clinre.2024.102510","DOIUrl":"10.1016/j.clinre.2024.102510","url":null,"abstract":"<div><h3>Background</h3><div>To analyze the relationship between tumor-infiltrating lymphocytes (TILs) subtypes and infiltration locations and the prognosis of gastric cancer (GC) patients.</div></div><div><h3>Methods</h3><div>Eligible articles were obtained through systematic retrieval and rigorous screening, collecting study information and extracting hazard ratio (HR), 95 % confidence interval (CI) for pooled analyses of disease-free survival (DFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>Higher CD4<sup>+</sup> TILs were correlated with favorable OS (HR=0.79, 95 %CI: 0.66–0.94, <em>P</em> = 0.009), the similar results were observed in tumor center and in infiltration margin. Higher CD8<sup>+</sup> TILs prolonged DFS (HR=0.69, 95 %CI: 0.51–0.95, <em>P</em> = 0.02) and OS (HR=0.96, 95 %CI: 0.94–0.99, <em>P</em> = 0.006); For OS, tumor center and infiltration margin groups showed positive results. Neither the overall analysis nor the subgroup analyses indicated that the level of FOXP3<sup>+</sup> TILs was associated with prognosis (DFS: HR=0.89, 95 %CI: 0.66–1.19, <em>P</em> = 0.42; OS: HR=0.98, 95 %CI: 0.85–1.13, <em>P</em> = 0.75). Pooled results revealed that higher CD3<sup>+</sup> TILs were correlated with favorable DFS (HR=0.69, 95 %CI: 0.56–0.84, <em>P</em> = 0.0003) but not OS (HR=1.00, 95 %CI: 0.99–1.01, <em>P</em> = 0.48).</div></div><div><h3>Conclusions</h3><div>High infiltrating CD3<sup>+</sup>, CD4<sup>+</sup>, CD8<sup>+</sup> T cells prolong survival, and FOXP3<sup>+</sup> subset is not related to prognosis in GC. For CD4<sup>+</sup> and CD8<sup>+</sup>, positive correlations between the infiltration level and OS were present in tumor center and infiltration margin groups.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102510"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766915","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
Exploring gender disparities in hepatocellular carcinoma: Insights from a French study 探讨肝细胞癌的性别差异:来自法国研究的见解。
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.clinre.2024.102518
Héloïse Giudicelli, Manon Allaire
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引用次数: 0
Telomere-methylation genes: Novel prognostic biomarkers for hepatocellular carcinoma 端粒甲基化基因:肝细胞癌的新型预后生物标志物
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.clinre.2024.102516
Jia-Wen Xie , Hui-Ling Wang , Ling-Qing Lin , Yin-Feng Guo , Mao Wang , Xiao-Zhen Zhu , Jian-Jun Niu , Li-Rong Lin

Background

Since telomere length and DNA methylation both correlate with hepatocellular carcinoma (HCC) prognosis, telomere-methylation genes could be novel prognostic markers for HCC.

Method

This study first investigated the interaction between telomere length and DNA methylation in HCC through Mendelian randomization analysis. Then, this study identified telomere-methylation genes in HCC by employing the TCGA-LIHC cohort, and explored the expression patterns of these genes in the tumor microenvironment of HCC and potential underlying mechanisms. Finally, the HCC risk-scoring model and prognostic model based on these genes were established, and the performance of the model was assessed.

Result

The findings revealed a bidirectional relationship between telomere length and DNA methylation in HCC. Fifty telomere-methylation genes were identified, and the prognosis-related telomere-methylation genes were closely associated with Treg and Tprolif cell subsets within the HCC tumor microenvironment. Telomere-methylation genes could potentially impact the prognosis of HCC patients by modulating chromosome stability and regulating the cell cycle. Additionally, the constructed risk scoring model and prognostic prediction model showcased compelling clinical applicability, as evidenced by the receiver operating characteristic curve, the decision curve analysis, and the calibration curves.

Conclusion

This study elucidated the potential of telomere-methylation genes as prognostic biomarkers for HCC and paves the way for novel approaches in prognostication and treatment management for HCC patients.
背景:由于端粒长度和DNA甲基化都与肝细胞癌(HCC)的预后相关,端粒甲基化基因可能成为HCC预后的新标志物。方法:本研究首先通过孟德尔随机化分析研究HCC端粒长度与DNA甲基化之间的相互作用。随后,本研究利用TCGA-LIHC队列技术鉴定HCC中端粒甲基化基因,并探讨这些基因在HCC肿瘤微环境中的表达模式及其潜在机制。最后建立基于这些基因的HCC风险评分模型和预后模型,并对模型的性能进行评估。结果:发现端粒长度和DNA甲基化在HCC中存在双向关系。共鉴定出50个端粒甲基化基因,其中与预后相关的端粒甲基化基因与HCC肿瘤微环境中的Treg和tproif细胞亚群密切相关。端粒甲基化基因可能通过调节染色体稳定性和细胞周期影响HCC患者的预后。此外,构建的风险评分模型和预后预测模型的临床适用性较强,从受试者工作特征曲线、决策曲线分析和校准曲线均可看出。结论:本研究阐明了端粒甲基化基因作为HCC预后生物标志物的潜力,为HCC患者预后和治疗管理的新方法铺平了道路。
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引用次数: 0
Predictive factors of spontaneous common bile duct clearance and unnecessary ERCP in patients with choledocholithiasis 胆总管结石患者自发胆总管清扫和不必要的 ERCP 的预测因素。
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.clinre.2024.102515
Fábio Pereira Correia , Henrique Coelho , Mónica Francisco , Gonçalo Alexandrino , Joana Carvalho Branco , Jorge Canena , David Horta , Luís Carvalho Lourenço

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line procedure for choledocholithiasis treatment. However, it is associated with a 10 % rate of adverse events. Spontaneous migration of common bile duct (CBD) stones occurs in 6–33 % of choledocholithiasis cases, making ERCP avoidable. This study aimed to identify predictors of spontaneous CBD stones’ migration.

Methods

Retrospective study including patients diagnosed with choledocholithiasis and submitted to ERCP. Patients were divided into 2 groups considering spontaneous stone migration (i.e.: the absence of CBD stones on ERCP). Data on patients’ characteristics, imaging findings, biochemical analysis, and ERCP procedure were analyzed to identify predictors of spontaneous migration of CBD stones.

Results

334 patients with a mean age of 71.7 years were included in the study: 76.6 % without and 23.4 % with spontaneous migration of CBD stones. Although some patients’ features (gender and clinical presentation), imaging findings (diameters of the largest stone and CBD), biochemical analysis (bilirubin levels at diagnosis and pre-ERCP), and ERCP procedure characteristics (time from diagnosis to ERCP) were different between groups, only three variables were defined as predictors: the absence of acute cholangitis, the largest stone diameter ≤5 mm, and the bilirubin levels pre-ERCP ≤ 2mg/dL. When using those variables together there was a chance of 81–86 % to correctly distinguishing patients with and without spontaneous CBD stone migration.

Conclusion

The size of the largest stone at diagnosis was validated as a predictor of CBD stones’ spontaneous migration. Furthermore, two new predictors were identified: bilirubin levels pre-ERCP ≤ 2 mg/dL, and no acute cholangitis at the clinical presentation of choledocholithiasis. EUS and ERCP in the same session should be considered in patients with factors predictive of stone migration, especially when combined, to minimize unnecessary ERCP and possible complications.
背景:内镜逆行胆管造影术(ERCP)是治疗胆总管结石的一线方法。然而,它与10%的不良事件发生率相关。6-33%的胆总管结石发生自发的胆总管结石迁移,使ERCP可以避免。本研究旨在确定自发性CBD结石迁移的预测因素。方法:对诊断为胆总管结石并行ERCP的患者进行回顾性研究。根据自发性结石迁移(即ERCP上没有CBD结石)将患者分为两组。分析患者特征、影像学表现、生化分析和ERCP程序的数据,以确定CBD结石自发迁移的预测因素。结果:334例患者纳入研究,平均年龄71.7岁,其中76.6%无CBD结石自发迁移,23.4%有CBD结石自发迁移。虽然患者的一些特征(性别和临床表现)、影像学表现(最大结石直径和CBD)、生化分析(诊断时胆红素水平和ERCP前期)和ERCP手术特征(从诊断到ERCP的时间)在两组之间存在差异,但只有三个变量被定义为预测因素:没有急性胆管炎、最大结石直径≤5mm、ERCP前期胆红素水平≤2mg/dL。当这些变量一起使用时,正确区分有和没有自发性CBD结石迁移的患者的机会为81-86%。结论:诊断时最大结石的大小可作为CBD结石自发迁移的预测指标。此外,确定了两个新的预测因素:ercp前胆红素水平≤2 mg/dL,在临床表现为胆总管结石时无急性胆管炎。对于有结石迁移预测因素的患者,应同时考虑EUS和ERCP,特别是当合并时,以尽量减少不必要的ERCP和可能的并发症。
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引用次数: 0
Primary hepatic large B-cell lymphoma 原发性肝大 B 细胞淋巴瘤。
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-22 DOI: 10.1016/j.clinre.2024.102506
Dan-Lei Han , Jian Zha , Lin-Yan Wan , Wei Liu
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引用次数: 0
Safety and efficacy of the enhanced recovery after surgery protocol in hepatectomy for liver cancer 肝癌肝切除术中加强术后恢复方案的安全性和有效性。
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-20 DOI: 10.1016/j.clinre.2024.102493
Quan Lv , Ying-Chun Xiang , Yan-Yu Qiu , Zheng Xiang

Purpose

The aim of this research was to evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) protocol in hepatectomy patients with liver cancer.

Materials and methods

We searched three databases, including PubMed, Embase, and the Cochrane Library database, from inception to April 25, 2023. The outcomes were postoperative complications, and postoperative length of stay (PLOS). This study was performed by Stata (V. 16.0) software.

Results

Twelve investigations involving 1,892 patients were included in this study. The ERAS group had lower overall postoperative complications [odds ratio (OR) = 0.49, I² = 54.89 %, 95 % confidence interval (CI) = 0.33–0.74, P = 0.00], postoperative Clavien-Dindo Grade 1–2 complications (OR = 0.39, I² = 55.14 %, 95 %CI = 0.23–0.69, P = 0.00), Clavien-Dindo Grade 3–4 complications (OR = 0.56, I² = 0.00 %, 95 %CI = 0.38–0.83, P = 0.00) , pneumonia (OR = 0.34, I² = 0.00 %, 95 %CI = 0.15–0.76, P = 0.01), ascites (OR = 0.25, I² = 0.00 %, 95 %CI = 0.09–0.68, P = 0.01), vomit (OR = 0.39, I² = 0.00 %, 95 %CI = 0.21–0.73, P = 0.00), intraoperative blood loss [mean difference (MD) = 1.69, I² = 0.00 %, 95 %CI = 1.15–2.47, P = 0.01], PLOS (MD = -0.42, I² = 94.87 %, 95 %CI = -0.86–0.03, P = 0.07), duration of abdominal drain (MD = -1.23, I² = 96.96 %, 95 %CI = -2.04 to -0.42, P = 0.00), and hospital readmission (OR = 0.44, I² = 0.00 %, 95 %CI = 0.23–0.85, P = 0.01) compared to the non-ERAS group.

Conclusion

For patients with liver cancer treated with ERAS. The ERAS protocol reduces the percentage of overall postoperative complications. Moreover, ERAS does not increase the rate of blood transfusions, hospital readmission, reoperation, or mortality.
目的:本研究旨在评估肝癌肝切除术患者术后增强恢复(ERAS)方案的有效性和安全性:我们检索了从开始到 2023 年 4 月 25 日的三个数据库,包括 PubMed、Embase 和 Cochrane Library 数据库。研究结果为术后并发症和术后住院时间(PLOS)。本研究由Stata(V. 16.0)软件完成:本研究共纳入了 12 项调查,涉及 1,892 名患者。ERAS组的总体术后并发症[几率比(OR)= 0.49,I² = 54.89 %,95 %置信区间(CI)= 0.33-0.74,P = 0.00]、术后Clavien-Dindo 1-2级并发症(OR = 0.39,I² = 55.14 %,95 %CI = 0.23-0.69, P = 0.00)、Clavien-Dindo 3-4 级并发症(OR = 0.56,I² = 0.00 %,95 %CI = 0.38-0.83, P = 0.00)、肺炎(OR = 0.34,I² = 0.00 %,95 %CI = 0.15-0.76, P = 0.01)、腹水(OR = 0.25,I² = 0.00 %,95 %CI = 0.09-0.68, P = 0.01)、呕吐(OR = 0.39, I² = 0.00 %, 95 %CI = 0.21-0.73, P = 0.00)、术中失血[平均差(MD)= 1.69, I² = 0.00 %, 95 %CI = 1.15-2.47, P = 0.01]、PLOS(MD = -0.42, I² = 94.87 %, 95 %CI = -0.86-0.03,P = 0.07)、腹腔引流持续时间(MD = -1.23, I² = 96.96 %, 95 %CI = -2.04 to -0.42,P = 0.00)以及再入院率(OR = 0.44, I² = 0.00 %, 95 %CI = 0.23-0.85, P = 0.01):结论:对于接受ERAS治疗的肝癌患者,ERAS方案降低了肝癌发生率。结论:对于接受ERAS治疗的肝癌患者,ERAS方案降低了术后并发症的发生率。此外,ERAS 不会增加输血率、再入院率、再次手术率或死亡率。
{"title":"Safety and efficacy of the enhanced recovery after surgery protocol in hepatectomy for liver cancer","authors":"Quan Lv ,&nbsp;Ying-Chun Xiang ,&nbsp;Yan-Yu Qiu ,&nbsp;Zheng Xiang","doi":"10.1016/j.clinre.2024.102493","DOIUrl":"10.1016/j.clinre.2024.102493","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this research was to evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) protocol in hepatectomy patients with liver cancer.</div></div><div><h3>Materials and methods</h3><div>We searched three databases, including PubMed, Embase, and the Cochrane Library database, from inception to April 25, 2023. The outcomes were postoperative complications, and postoperative length of stay (PLOS). This study was performed by Stata (V. 16.0) software.</div></div><div><h3>Results</h3><div>Twelve investigations involving 1,892 patients were included in this study. The ERAS group had lower overall postoperative complications [odds ratio (OR) = 0.49, I² = 54.89 %, 95 % confidence interval (CI) = 0.33–0.74, <em>P</em> = 0.00], postoperative Clavien-Dindo Grade 1–2 complications (OR = 0.39, I² = 55.14 %, 95 %CI = 0.23–0.69, <em>P</em> = 0.00), Clavien-Dindo Grade 3–4 complications (OR = 0.56, I² = 0.00 %, 95 %CI = 0.38–0.83, <em>P</em> = 0.00) , pneumonia (OR = 0.34, I² = 0.00 %, 95 %CI = 0.15–0.76, <em>P</em> = 0.01), ascites (OR = 0.25, I² = 0.00 %, 95 %CI = 0.09–0.68, <em>P</em> = 0.01), vomit (OR = 0.39, I² = 0.00 %, 95 %CI = 0.21–0.73, <em>P</em> = 0.00), intraoperative blood loss [mean difference (MD) = 1.69, I² = 0.00 %, 95 %CI = 1.15–2.47, <em>P</em> = 0.01], PLOS (MD = -0.42, I² = 94.87 %, 95 %CI = -0.86–0.03, <em>P</em> = 0.07), duration of abdominal drain (MD = -1.23, I² = 96.96 %, 95 %CI = -2.04 to -0.42, <em>P</em> = 0.00), and hospital readmission (OR = 0.44, I² = 0.00 %, 95 %CI = 0.23–0.85, <em>P</em> = 0.01) compared to the non-ERAS group.</div></div><div><h3>Conclusion</h3><div>For patients with liver cancer treated with ERAS. The ERAS protocol reduces the percentage of overall postoperative complications. Moreover, ERAS does not increase the rate of blood transfusions, hospital readmission, reoperation, or mortality.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 10","pages":"Article 102493"},"PeriodicalIF":2.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686262","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
Prolonged survival in women with hepatocellular carcinoma: A French observational study 延长肝细胞癌女性患者的生存期:一项法国观察性研究。
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-15 DOI: 10.1016/j.clinre.2024.102498
Cécilia Busso , Jean-Charles Nault , Richard Layese , Alix Demory , Lorraine Blaise , Gisèle Nkontchou , Véronique Grando , Pierre Nahon , Nathalie Ganne-Carrié
Background and Aim: Less than 25 % of hepatocellular carcinoma (HCC) occurs in women, in whom prognosis could be better. Due to the lack of date in Europe, this study aims to assess survival of patients with HCC according sex in a tertiary French liver center.
Patients and Methods: Every patient diagnosed with a first diagnosis of HCC presented at our weekly multidisciplinary tumor board between 2013 and 2017 were included. Baseline characteristics of patients and tumors were compared according sex using the Mann-Whitney test for Continuous variables and the Fisher or Chi-square test for dichotomous variables. Survival analyses according sex were conducted using the Kaplan-Meier method, the log-rank test, Cox models and a propensity score.
Results: 694 patients were included, of whom 130 (18.7 %) were women. Among them, 587 (86 %) had cirrhosis, mainly compensated (Child A 62.7 %), and related to alcohol (48.7 %), HCV (27.2 %), and/or metabolic-associated fatty liver disease (25.8 %). HCC was unifocal in 54 % of cases, with a mean main nodule size of 37 mm. Curative treatment was administered in 45.4 % of cases (percutaneous ablation 93 %). Compared to men, women diagnosed with HCC were older (73 vs. 65 years, p < 0.001), were more frequently HCV-infected (40 % vs. 24 %, p = 0.0003) and presented more often with a solitary HCC (63 % vs. 52 %, p = 0.020). After a median follow-up of 57 months, overall survival was significantly longer in women both in multivariate analysis (aHR 1.39 (CI95 %: 1.07-1.81) p=0.014) and using a propensity score (HR 1.51 (1.13-2.02, p=0.005)).
Conclusion: Despite being diagnosed at an older age, women with HCC exhibit significant better overall survival.
背景和目的:不到25%的肝细胞癌(HCC)发生在女性身上,而女性的预后可能更好。由于欧洲缺乏相关数据,本研究旨在评估法国一家三级肝病中心的HCC患者的性别存活率:纳入2013年至2017年期间每周在本院多学科肿瘤委员会首次诊断为HCC的所有患者。对连续变量采用曼-惠特尼检验,对二分变量采用费雪或卡方检验,根据性别比较患者和肿瘤的基线特征。使用卡普兰-梅耶法、对数秩检验、Cox模型和倾向评分对不同性别的患者进行生存分析:共纳入 694 例患者,其中 130 例(18.7%)为女性。其中,587 人(86%)患有肝硬化,主要是代偿性肝硬化(Child A 62.7%),与酒精(48.7%)、HCV(27.2%)和/或代谢相关性脂肪肝(25.8%)有关。54%的病例为单灶 HCC,主要结节平均大小为 37 毫米。45.4%的病例接受了根治性治疗(经皮消融占93%)。与男性相比,确诊为 HCC 的女性年龄更大(73 岁对 65 岁,p < 0.001),更常感染 HCV(40% 对 24%,p = 0.0003),更常表现为单发 HCC(63% 对 52%,p = 0.020)。在中位随访57个月后,无论是多变量分析(aHR 1.39 (CI95%: 1.07-1.81) p=0.014)还是使用倾向评分(HR 1.51 (1.13-2.02, p=0.005)),女性的总生存期都明显更长:结论:尽管女性HCC患者确诊时年龄较大,但她们的总生存率明显更高。
{"title":"Prolonged survival in women with hepatocellular carcinoma: A French observational study","authors":"Cécilia Busso ,&nbsp;Jean-Charles Nault ,&nbsp;Richard Layese ,&nbsp;Alix Demory ,&nbsp;Lorraine Blaise ,&nbsp;Gisèle Nkontchou ,&nbsp;Véronique Grando ,&nbsp;Pierre Nahon ,&nbsp;Nathalie Ganne-Carrié","doi":"10.1016/j.clinre.2024.102498","DOIUrl":"10.1016/j.clinre.2024.102498","url":null,"abstract":"<div><div>Background and Aim: Less than 25 % of hepatocellular carcinoma (HCC) occurs in women, in whom prognosis could be better. Due to the lack of date in Europe, this study aims to assess survival of patients with HCC according sex in a tertiary French liver center.</div><div>Patients and Methods: Every patient diagnosed with a first diagnosis of HCC presented at our weekly multidisciplinary tumor board between 2013 and 2017 were included. Baseline characteristics of patients and tumors were compared according sex using the Mann-Whitney test for Continuous variables and the Fisher or Chi-square test for dichotomous variables. Survival analyses according sex were conducted using the Kaplan-Meier method, the log-rank test, Cox models and a propensity score.</div><div>Results: 694 patients were included, of whom 130 (18.7 %) were women. Among them, 587 (86 %) had cirrhosis, mainly compensated (Child A 62.7 %), and related to alcohol (48.7 %), HCV (27.2 %), and/or metabolic-associated fatty liver disease (25.8 %). HCC was unifocal in 54 % of cases, with a mean main nodule size of 37 mm. Curative treatment was administered in 45.4 % of cases (percutaneous ablation 93 %). Compared to men, women diagnosed with HCC were older (73 vs. 65 years, p &lt; 0.001), were more frequently HCV-infected (40 % vs. 24 %, p = 0.0003) and presented more often with a solitary HCC (63 % vs. 52 %, p = 0.020). After a median follow-up of 57 months, overall survival was significantly longer in women both in multivariate analysis (aHR 1.39 (CI95 %: 1.07-1.81) p=0.014) and using a propensity score (HR 1.51 (1.13-2.02, p=0.005)).</div><div>Conclusion: Despite being diagnosed at an older age, women with HCC exhibit significant better overall survival.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 10","pages":"Article 102498"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A review investigating delays in Crohn's disease diagnosis 研究克罗恩病诊断延误的综述。
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-15 DOI: 10.1016/j.clinre.2024.102500
Christophe Souaid, Eddy Fares, Paul Primard, Gilles Macaigne, Weam El Hajj, Stephane Nahon
Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract where early diagnosis and timely, appropriate management are essential to prevent severe complications and reduce the need for surgery. This review sought to investigate factors contributing to diagnostic delays in CD, which typically ranged from 5 to 16 months. Delays were often due to nonspecific symptoms that could be mistaken for irritable bowel syndrome (IBS) and were influenced by various factors including age, education level, smoking, NSAID use, and disease characteristics like isolated ileal involvement. Healthcare system disparities also played a significant role, with delays varying by access to care. The review highlighted that delayed diagnosis was linked to worse disease outcomes, such as increased severity and complications, and underscored the importance of early intervention combined with timely management. Strategies to mitigate delays included implementing red flag tools, using inflammatory biomarkers like fecal calprotectin, and enhancing public and healthcare provider awareness. Addressing these factors and improving referral pathways and healthcare system efficiencies were crucial for enhancing early diagnosis and patient outcomes.
克罗恩病(Crohn's disease,CD)是一种慢性胃肠道炎症,早期诊断和及时、适当的治疗对于预防严重并发症和减少手术需求至关重要。本综述旨在研究导致 CD 诊断延误的因素,延误时间通常为 5 到 16 个月不等。延误往往是由于非特异性症状造成的,这些症状可能会被误认为是肠易激综合征(IBS),而且受到各种因素的影响,包括年龄、教育水平、吸烟、非甾体抗炎药的使用以及疾病特征(如孤立回肠受累)。医疗保健系统的差异也起着重要作用,不同的医疗机构延误诊断的情况也不尽相同。审查强调,延误诊断与疾病恶化的结果有关,如严重程度和并发症增加,并强调了早期干预与及时管理相结合的重要性。减少延误的策略包括采用红旗工具、使用炎症生物标志物(如粪便钙蛋白)以及提高公众和医疗服务提供者的认识。解决这些因素并改善转诊途径和医疗保健系统的效率,对于提高早期诊断和患者预后至关重要。
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引用次数: 0
Superiority of frailty over age in predicting outcomes among clostridium difficile patients: Evidence from national data 在预测梭状芽孢杆菌患者的预后方面,虚弱程度优于年龄:来自全国数据的证据。
IF 2.6 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-15 DOI: 10.1016/j.clinre.2024.102499
Ali Jaan , Umer Farooq , Abdulrahman Alyounes Alayoub , Hamna Nadeem , Effa Zahid , Ashish Dhawan , Savanna Thor , Asad Ur Rahman

Background

Clostridium difficile infection (CDI) has become a significant healthcare issue with increasing morbidity and mortality in the US and Europe. Frailty, characterized by reduced physical reserves and resistance to stressors, is linked to poor outcomes but its impact on CDI patients remains underexplored. This study seeks to address this gap through a nationwide analysis.

Methods

Using the National Readmission Database from 2016 to 2020, we employed the International Classification of Diseases, 10th revision, Clinical Modifications codes to identify adult patients admitted with CDI. We further stratified CDI hospitalizations based on frailty. Utilizing a regression model, we assessed the impact of frailty on CDI outcomes.

Results

We included 144,611 CDI patients of whom 98,167 (67.88 %) were frail. Multivariate analysis showed that frail CDI patients had significantly higher mortality (adjusted odds ratio (aOR) 4.87), acute kidney injury requiring dialysis (aOR 9.50), septic shock (aOR 14.23), and intensive care unit admission (aOR 6.80). CDI-specific complications were more likely in frail patients, including toxic megacolon (aOR 10.22), intestinal perforation (aOR 2.30), need for colectomy (aOR 3.90) and CDI recurrence (aOR 3.65). Resource utilization, indicated by hospitalization charges, length of stay, and 30-day readmission rates, was greater among frail patients.

Conclusion

Our study underscores the significant association between frailty and various critical endpoints of CDI, including its incidence, mortality, and recurrence. Additionally, frailty independently predicts higher resource utilization and elevated 30-day readmission. Recognizing frailty as a determinant of CDI outcomes can aid clinicians in risk stratification and guide tailored interventions for this population.
背景:艰难梭菌感染(CDI)已成为美国和欧洲的一个重大医疗问题,发病率和死亡率不断上升。体弱的特点是体能储备和抗压能力下降,与不良预后有关,但其对 CDI 患者的影响仍未得到充分探讨。本研究试图通过一项全国性分析来填补这一空白:利用 2016 年至 2020 年的全国再入院数据库,我们采用《国际疾病分类》第 10 版临床修改代码来识别因 CDI 而入院的成人患者。我们根据虚弱程度对 CDI 住院患者进行了进一步分层。利用回归模型,我们评估了体弱对 CDI 结果的影响:我们纳入了 144,611 名 CDI 患者,其中 98,167 人(67.88%)体弱。多变量分析表明,体弱的 CDI 患者死亡率(调整后的几率比 (aOR) 4.87)、急性肾损伤(需要透析)(aOR 9.50)、脓毒性休克(aOR 14.23)和入住重症监护室(aOR 6.80)均明显较高。体弱患者更容易出现 CDI 特异性并发症,包括中毒性巨结肠(aOR 10.22)、肠穿孔(aOR 2.30)、结肠切除术(aOR 3.90)和 CDI 复发(aOR 3.65)。从住院费用、住院时间和 30 天再入院率来看,体弱患者的资源利用率更高:我们的研究强调了体弱与 CDI 的各种关键终点(包括发病率、死亡率和复发率)之间的显著关联。此外,体弱还可独立预测较高的资源利用率和较高的 30 天再入院率。认识到体弱是 CDI 结果的决定因素,有助于临床医生进行风险分层,并指导针对这一人群的干预措施。
{"title":"Superiority of frailty over age in predicting outcomes among clostridium difficile patients: Evidence from national data","authors":"Ali Jaan ,&nbsp;Umer Farooq ,&nbsp;Abdulrahman Alyounes Alayoub ,&nbsp;Hamna Nadeem ,&nbsp;Effa Zahid ,&nbsp;Ashish Dhawan ,&nbsp;Savanna Thor ,&nbsp;Asad Ur Rahman","doi":"10.1016/j.clinre.2024.102499","DOIUrl":"10.1016/j.clinre.2024.102499","url":null,"abstract":"<div><h3>Background</h3><div>Clostridium difficile infection (CDI) has become a significant healthcare issue with increasing morbidity and mortality in the US and Europe. Frailty, characterized by reduced physical reserves and resistance to stressors, is linked to poor outcomes but its impact on CDI patients remains underexplored. This study seeks to address this gap through a nationwide analysis.</div></div><div><h3>Methods</h3><div>Using the National Readmission Database from 2016 to 2020, we employed the International Classification of Diseases, 10th revision, Clinical Modifications codes to identify adult patients admitted with CDI. We further stratified CDI hospitalizations based on frailty. Utilizing a regression model, we assessed the impact of frailty on CDI outcomes.</div></div><div><h3>Results</h3><div>We included 144,611 CDI patients of whom 98,167 (67.88 %) were frail. Multivariate analysis showed that frail CDI patients had significantly higher mortality (adjusted odds ratio (aOR) 4.87), acute kidney injury requiring dialysis (aOR 9.50), septic shock (aOR 14.23), and intensive care unit admission (aOR 6.80). CDI-specific complications were more likely in frail patients, including toxic megacolon (aOR 10.22), intestinal perforation (aOR 2.30), need for colectomy (aOR 3.90) and CDI recurrence (aOR 3.65). Resource utilization, indicated by hospitalization charges, length of stay, and 30-day readmission rates, was greater among frail patients.</div></div><div><h3>Conclusion</h3><div>Our study underscores the significant association between frailty and various critical endpoints of CDI, including its incidence, mortality, and recurrence. Additionally, frailty independently predicts higher resource utilization and elevated 30-day readmission. Recognizing frailty as a determinant of CDI outcomes can aid clinicians in risk stratification and guide tailored interventions for this population.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102499"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643891","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
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Clinics and research in hepatology and gastroenterology
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