Hepatology Research最新文献

Introduction: No reports described the deep-learning (DL) models using computed tomography (CT) as an imaging biomarker for predicting postoperative long-term outcomes in patients with hepatocellular carcinoma (HCC). This study aimed to validate the DL models for individualized prognostication after HCC resection using CT as an imaging biomarker.

Methods: This study included 1733 patients undergoing hepatic resection for solitary HCC. Participants were classified into training, validation, and test datasets. DL predictive models were developed using clinical variables and CT imaging to predict recurrence within 2 and 5 years and overall survival (OS) of > 5 and > 10 years postoperatively. Youden index was utilized to identify cutoff values. Permutation importance was used to calculate the importance of each explanatory variable.

Results: DL predictive models for recurrence within 2 and 5 years and OS of > 5 and > 10 years postoperatively were developed in the test datasets, with the area under the curve of 0.70, 0.70, 0.80, and 0.80, respectively. Permutation importance demonstrated that CT imaging analysis revealed the highest importance value. The postoperative recurrence rates within 2 and 5 years were 52.6% versus 18.5% (p < 0.001) and 78.9% versus 46.7% (p < 0.001) and overall mortality within 5 and 10 years postoperatively were 45.1% versus 9.2% (p < 0.001) and 87.1% versus 43.2% (p < 0.001) in the high-risk versus low-risk groups, respectively.

Conclusions: Our DL models using CT as an imaging biomarker are useful for individualized prognostication and may help optimize treatment planning for patients with HCC.

Background and aim: Acute pancreatitis is a recognized complication of acute liver failure (ALF), but its incidence and predictive factors remain poorly defined. Current risk stratification relies primarily on conventional laboratory markers with limited discriminatory ability for pancreatic complications. This study aimed to determine the incidence and prognostic impact of acute pancreatitis in ALF patients and evaluate whether liver volumetry improves prediction beyond conventional markers.

Methods: This cross-sectional retrospective study utilized data from a nationwide survey-based registry conducted by the Intractable Hepato-Biliary Disease Study Group of Japan (2011-2021). We analyzed 142 ALF patients with available liver volumetry data and 90-day outcome information. Patients with pre-existing acute pancreatitis were excluded. Predictive models were developed comparing conventional markers (MELD score) versus an enhanced model incorporating computed tomography liver volume to standard liver volume ratio (CTLV/SLV). Model performance was evaluated using ROC analysis, net reclassification index, and clinical validation.

Results: Acute pancreatitis developed in 19 patients (13.4%), typically within the first 8 weeks (84.3% of cases). Logistic regression identified acute pancreatitis as an independent risk factor for poor prognosis (β = 0.2556, p = 0.031). The CTLV/SLV ratio was significantly lower in patients developing pancreatitis (0.80 vs. 1.07, p < 0.001). The enhanced model (MELD + CTLV/SLV) achieved superior discrimination (AUC 0.810) compared to MELD alone (AUC 0.704), with 81% relative risk reduction in the low-risk category.

Conclusion: Incorporating liver volumetry significantly improves acute pancreatitis prediction in ALF patients, enabling more precise risk stratification and potentially optimizing clinical management strategies.

Background: Hepatocellular carcinoma (HCC) with Vp4 portal vein tumor thrombosis (PVTT) has an extremely poor prognosis, and evidence for effective systemic therapy is limited. Preclinical studies suggest that hypofractionated radiation therapy (HFRT) may enhance immune checkpoint inhibitor (ICI) efficacy through immunogenic cell death and modulation of the tumor microenvironment.

Methods: We conducted a retrospective feasibility study of HFRT combined with ICIs for unresectable HCC. Patients receiving atezolizumab plus bevacizumab (Atz/Bev) or durvalumab plus tremelimumab (Dur/Tre) as first-line therapy between October 2020 and March 2025 were analyzed. Since July 2022, those with Vp4 PVTT received HFRT (5 Gy × 5) targeting PVTT with ICIs. Outcomes were compared among Vp4 patients with HFRT, Vp4 patients without HFRT, and patients without Vp4 invasion (non-Vp4).

Results: Eight Vp4 patients received HFRT plus ICIs (Atz/Bev, n = 5; Dur/Tre, n = 3). The best responses of the main intrahepatic lesions by RECIST 1.1 were complete response (CR) in 1 (12.5%), partial response (PR) in 6 (75%), and stable disease in 1 (12.5%), yielding a high objective response rate (ORR) of 87.5%. By mRECIST, CR was achieved in 3 patients (37.5%). Overall survival in Vp4 patients with HFRT was comparable to non-Vp4 patients and significantly better than Vp4 patients without HFRT. No gastrointestinal bleeding or perforation occurred, and ALBI scores were preserved at 12 weeks.

Conclusions: HFRT combined with ICIs is feasible, well tolerated, and may improve outcomes in HCC with Vp4 PVTT. Prospective studies are warranted to confirm efficacy and determine optimal treatment protocols.

Aim: The effects of partial splenic embolization (PSE) on hepatic encephalopathy, a portal hypertension-related disease, are not well established. This study aimed to investigate changes in ammonia levels by PSE and to identify determinants of postprocedural changes in patients with or without portosystemic shunts (PSSs).

Methods: The present retrospective study included 136 patients with hypersplenism who underwent PSE at our hospital. The patients were divided into the PSS (-) group, comprising 90 patients without PSSs with a diameter of ≥ 8 mm, and the PSS (+) group, comprising 46 patients with PSSs with a diameter of ≥ 8 mm. Ammonia levels were evaluated, and biochemical and imaging findings were assessed before and at 1 month after PSE.

Results: Overall, PSE significantly increased ammonia levels despite postprocedural hepatic function amelioration and hepatic venous pressure gradient reduction. Increased ammonia levels were observed postoperatively in 73.3% and 63.0% of patients in the PSS (-) and PSS (+) groups, respectively. The procedure induced a significant increase in ammonia levels in the PSS (-) group; in contrast, the increase was not statistically significant in the PSS (+) group. Preprocedural Child-Pugh scores of < 8 and splenic non-infarction volume of ≥ 120.32 cm³ in the PSS (-) group, as well as preprocedural splenic artery diameter-to-common hepatic artery diameter ratios of < 1.4 and concomitant splenic vein-derived shunt vessels in the PSS (+) group, were significant and independent determinants of postprocedural ammonia-level increase.

Conclusions: PSE generally poses a high risk of short-term increase in ammonia levels, particularly in patients without PSSs.

Aim: Liver and spleen stiffness (LS and SS) measurements in predicting high risk varices (HRVs) are reported useful in biliary atresia (BA). In children, inability to temporarily hold their breath may pose challenges in obtaining accurate measurements. This cross-sectional prospective study aimed to evaluate the diagnostic accuracy of LS and SS measurements obtained under general anesthesia during brief pauses in ventilation compared with those obtained in the awake state, in predicting HRVs.

Methods: Among patients with BA aged 15 years or younger who underwent esophagogastroduodenoscopy under general anesthesia for evaluation of varices, 43 patients with LS and SS measured both in the awake and anaesthetized states were enrolled. HRVs were defined as large esophagogastric varices or esophagogastric varices of any size with red color signs.

Results: The median age was 4 years. Nineteen patients had HRVs. In the HRVs group compared with the non-HRVs group, awake-LS, awake-SS, anesthesia-LS, and anesthesia-SS were significantly higher: 2.23 versus 1.71, 4.40 versus 3.45, 2.56 versus 1.73, and 4.13 versus 3.62 m/s, respectively. The area under the curve for awake-LS, awake-SS, anesthesia-LS, and anesthesia-SS were 0.784, 0.794, 0.814, and 0.698, respectively. Awake-LS and anesthesia-LS showed a strong positive correlation (ρ = 0.894), whereas awake-SS and anesthesia-SS showed a weak correlation (ρ = 0.468).

Conclusions: As anesthetics and mechanical ventilation affect abdominal hemodynamics, SS measurements obtained under general anesthesia deviated from those obtained during the awake state. Further research is needed to determine whether mild sedation could help optimize measurement conditions.

Trial registration: This study was registered on the University Hospital Medical Information Network (UMIN000033123).

Aim: Patients with chronic liver disease often experience significant physical, psychological, and financial burdens. These burdens result from repeated long-term hospital visits or admissions caused by progression to decompensated cirrhosis or hepatocellular carcinoma. Patients with viral liver disease may fear discrimination or social prejudice. This study aimed to clarify the employment status of patients with liver disease in Japan and provide basic data to promote support for balancing treatment and work responsibilities.

Methods: A cross-sectional questionnaire survey on employment was conducted among patients attending 22 hospitals across Japan.

Results: Of the 4022 respondents, 2183 were analyzed, including 1694 (77.6%) participants with liver disease. Patients with liver disease were predominantly male and in their 60 s. Disclosure of health information to the workplace was significantly lower among patients with viral liver disease (80.8%) than among those without liver disease or with nonviral liver disease. The intention to continue working after diagnosis was significantly higher among patients with malignancies than among those without. However, this intention did not significantly differ between liver disease and non-liver disease groups. The awareness rate of the support system for balancing treatment and work program was 27.1%, with no significant difference observed between the liver disease and malignancy groups. Awareness was significantly higher in large workplaces, where full-time occupational health physicians are mandated.

Conclusion: Workers with viral liver disease may hesitate to disclose their condition owing to fear of discrimination or prejudice. Therefore, raising awareness of support systems that protect all workers with illnesses, while considering stigma and discrimination, is essential.

Introduction: Liver stiffness measurement (LSM) values decrease after hepatitis C virus eradication. However, whether this reduction translates into a reduced risk of hepatocellular carcinoma (HCC) development in patients who achieve sustained virological response (SVR) remains unclear.

Methods: We retrospectively analyzed 501 patients with chronic hepatitis C who achieved SVR after direct-acting antiviral (DAA) treatment. LSM and FIB-4 levels were measured before DAA treatment and at multiple follow-up points. Time-dependent Cox proportional hazards models evaluated the association between these time-dependent markers and HCC development.

Results: LSM and FIB-4 significantly decreased after DAA treatment in 80.4% and 70.8% of patients, respectively. During a mean follow-up of 5.7 years, 28 patients developed HCC, and in 57% of them, LSM was reduced to < 10 kPa and FIB-4 to < 3.25 at HCC diagnosis. Multivariable analysis revealed higher pre-treatment LSM (adjusted hazard ratio [aHR], 8.10; 95% confidence interval [CI], 1.82-35.95) and higher pre-treatment FIB-4 (aHR, 1.29; 95% CI, 1.11-1.51) as independent predictors of HCC, while post-treatment values at any time point showed no significant association. Patients with LSM < 10 kPa at HCC diagnosis showed better liver function and less fibrosis, but more metabolic risk factors and excessive alcohol consumption than those with LSM ≥ 10 kPa.

Conclusion: Pre-treatment LSM and FIB-4 were stronger predictors of post-SVR HCC risk than post-treatment values. Patients with higher pre-treatment values remained at an increased risk of HCC development even if these values decreased after DAA treatment, emphasizing the importance of continued HCC surveillance in this group.