Pub Date : 2025-12-01DOI: 10.1016/j.jhepr.2025.101633
Stijn Franssen , Merve Rousian , Victorien van Verschuer , Marco Bruno , Michail Doukas , Lydi van Driel , Marjolein Homs , Behnam Mohseny , Roeland de Wilde , Jeroen de Jonge , Wojciech Polak , Robert Porte , Diederik Bijdevaate , Adriaan Moelker , Bas Groot Koerkamp
{"title":"Corrigendum to ‘Primary percutaneous stenting for palliative biliary drainage of patients with malignant hilar biliary obstruction: TESLA trial’ [JHEP Reports 7 (2025) 101541]","authors":"Stijn Franssen , Merve Rousian , Victorien van Verschuer , Marco Bruno , Michail Doukas , Lydi van Driel , Marjolein Homs , Behnam Mohseny , Roeland de Wilde , Jeroen de Jonge , Wojciech Polak , Robert Porte , Diederik Bijdevaate , Adriaan Moelker , Bas Groot Koerkamp","doi":"10.1016/j.jhepr.2025.101633","DOIUrl":"10.1016/j.jhepr.2025.101633","url":null,"abstract":"","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 12","pages":"Article 101633"},"PeriodicalIF":7.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-29DOI: 10.1016/j.jhepr.2025.101699
Maria de Brito Nunes , Maria Gabriela Delgado , Jaume Bosch , Annalisa Berzigotti
Background & Aims
Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension (variceal bleeding and refractory ascites). Sarcopenia affects 40–70% of patients with cirrhosis. We evaluated the improvement in sarcopenia after TIPS, the proportion of patients developing overt hepatic encephalopathy (HE) after TIPS and its association with sarcopenia, and the association between sarcopenia and mortality after TIPS.
Methods
We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies included adults with cirrhosis and sarcopenia assessed by computed tomography (CT), using the skeletal muscle index (L3-SMI), or psoas muscle index (L3-PMI). We searched in eight databases for randomized trials, cohort studies, and case–control, cross-sectional, and case series studies.
Results
Twenty studies were included. The pooled prevalence of sarcopenia in patients with cirrhosis undergoing TIPS was 55.4% (95% CI 41.7–68.2%). Among these, sarcopenia improved in 57% of patients (95% CI 48–65%) after TIPS, with a mean L3-SMI increase of 4.53 cm2/m2 (range: 2.4–6.9 cm2/m2). Sarcopenia was associated with higher odds of overt HE (pooled odds ration [OR] = 3.40, 95% CI 1.85–6.25, p <0.001) and a higher proportion of overt HE (43%, 95% CI 26–61%) than in patients without sarcopenia (12%, 95% CI 7–20%). The proportionate mortality after TIPS was 18.3% (95% CI 14.6–22.8%), across 6–33.6 months of follow-up. The association between sarcopenia and mortality was not significant (HR: 1.95, 95% CI 0.89–4.31, p = 0.078).
Conclusions
In patients with cirrhosis and sarcopenia, TIPS is often followed by an improvement in sarcopenia. Sarcopenia is associated with higher odds of overt HE, whereas the effect of sarcopenia on mortality after TIPS remains uncertain.
Impact and implications
Sarcopenia affects over half of patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement. This meta-analysis shows that TIPS is associated with sarcopenia improvement in >50% of patients, suggesting potential benefits beyond portal pressure reduction. Sarcopenia increases the risk of overt hepatic encephalopathy, whereas its effect on post-TIPS mortality remains inconclusive. These findings support routine assessment of sarcopenia to improve risk stratification and clinical decision-making. However, results should be interpreted cautiously because of study heterogeneity and the retrospective nature of the included data. Prospective studies are needed to confirm these findings and refine patient selection for TIPS.
背景：经颈静脉肝内门静脉系统分流术（TIPS）是治疗门静脉高压并发症（静脉曲张出血和难治性腹水）的常用方法。40-70%的肝硬化患者患有肌肉减少症。我们评估了TIPS后肌肉减少症的改善情况，TIPS后发生显性肝性脑病（HE）的患者比例及其与肌肉减少症的关系，以及TIPS后肌肉减少症与死亡率的关系。方法根据系统评价和荟萃分析首选报告项目（PRISMA）指南进行系统评价和荟萃分析。符合条件的研究包括肝硬化和肌肉减少症的成年人，通过计算机断层扫描（CT）评估，使用骨骼肌指数（L3-SMI）或腰肌指数（L3-PMI）。我们在8个数据库中检索了随机试验、队列研究、病例对照、横断面和病例系列研究。结果共纳入20项研究。接受TIPS治疗的肝硬化患者中肌肉减少症的总患病率为55.4% （95% CI 41.7-68.2%）。其中，57%的患者（95% CI 48-65%）在TIPS后肌肉减少症得到改善，L3-SMI平均增加4.53 cm2/m2（范围：2.4-6.9 cm2/m2）。肌少症患者明显HE发生率较高（合并比值比[OR] = 3.40, 95% CI 1.85-6.25, p <0.001），且明显HE发生率（43%,95% CI 26-61%）高于无肌少症患者（12%,95% CI 7-20%）。在6-33.6个月的随访中，TIPS后的比例死亡率为18.3% （95% CI 14.6-22.8%）。肌肉减少症与死亡率之间的相关性不显著（HR: 1.95, 95% CI 0.89-4.31, p = 0.078）。结论肝硬化合并肌少症患者，TIPS治疗后肌少症常得到改善。肌少症与明显HE的几率较高相关，而肌少症对TIPS术后死亡率的影响仍不确定。影响和意义超过一半的肝硬化患者接受经颈静脉肝内门静脉系统分流术（TIPS）。这项荟萃分析显示，TIPS与50%患者肌肉减少症的改善有关，提示除了降低门静脉压力之外的潜在益处。肌少症增加明显肝性脑病的风险，而其对tips术后死亡率的影响仍不确定。这些发现支持对肌肉减少症进行常规评估，以改善风险分层和临床决策。然而，由于研究的异质性和纳入数据的回顾性性质，结果应谨慎解释。需要前瞻性研究来证实这些发现并完善TIPS的患者选择。
{"title":"Outcomes after TIPS in patients with cirrhosis and sarcopenia: A systematic review and meta-analysis","authors":"Maria de Brito Nunes , Maria Gabriela Delgado , Jaume Bosch , Annalisa Berzigotti","doi":"10.1016/j.jhepr.2025.101699","DOIUrl":"10.1016/j.jhepr.2025.101699","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension (variceal bleeding and refractory ascites). Sarcopenia affects 40–70% of patients with cirrhosis. We evaluated the improvement in sarcopenia after TIPS, the proportion of patients developing overt hepatic encephalopathy (HE) after TIPS and its association with sarcopenia, and the association between sarcopenia and mortality after TIPS.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies included adults with cirrhosis and sarcopenia assessed by computed tomography (CT), using the skeletal muscle index (L3-SMI), or psoas muscle index (L3-PMI). We searched in eight databases for randomized trials, cohort studies, and case–control, cross-sectional, and case series studies.</div></div><div><h3>Results</h3><div>Twenty studies were included. The pooled prevalence of sarcopenia in patients with cirrhosis undergoing TIPS was 55.4% (95% CI 41.7–68.2%). Among these, sarcopenia improved in 57% of patients (95% CI 48–65%) after TIPS, with a mean L3-SMI increase of 4.53 cm<sup>2</sup>/m<sup>2</sup> (range: 2.4–6.9 cm<sup>2</sup>/m<sup>2</sup>). Sarcopenia was associated with higher odds of overt HE (pooled odds ration [OR] = 3.40, 95% CI 1.85–6.25, <em>p</em> <0.001) and a higher proportion of overt HE (43%, 95% CI 26–61%) than in patients without sarcopenia (12%, 95% CI 7–20%). The proportionate mortality after TIPS was 18.3% (95% CI 14.6–22.8%), across 6–33.6 months of follow-up. The association between sarcopenia and mortality was not significant (HR: 1.95, 95% CI 0.89–4.31, <em>p</em> = 0.078).</div></div><div><h3>Conclusions</h3><div>In patients with cirrhosis and sarcopenia, TIPS is often followed by an improvement in sarcopenia. Sarcopenia is associated with higher odds of overt HE, whereas the effect of sarcopenia on mortality after TIPS remains uncertain.</div></div><div><h3>Impact and implications</h3><div>Sarcopenia affects over half of patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement. This meta-analysis shows that TIPS is associated with sarcopenia improvement in >50% of patients, suggesting potential benefits beyond portal pressure reduction. Sarcopenia increases the risk of overt hepatic encephalopathy, whereas its effect on post-TIPS mortality remains inconclusive. These findings support routine assessment of sarcopenia to improve risk stratification and clinical decision-making. However, results should be interpreted cautiously because of study heterogeneity and the retrospective nature of the included data. Prospective studies are needed to confirm these findings and refine patient selection for TIPS.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"8 2","pages":"Article 101699"},"PeriodicalIF":7.5,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-26DOI: 10.1016/j.jhepr.2025.101687
Zhuoshuai Liang , Huizhen Jin , Wenhui Gao , Xinmeng Hu , Ruofei Li , Hongrui Zhang , Yi Cheng , Jikang Shi , Yawen Liu
<div><h3>Background & Aims</h3><div>Advanced liver fibrosis is a pivotal predictor of liver-related outcomes (LROs), yet existing non-invasive tests offer limited prognostic accuracy. We aimed to identify novel plasma protein biomarkers that enhance long-term risk stratification for LROs.</div></div><div><h3>Methods</h3><div>Proteomic analyses were first conducted in 191 patients with metabolic dysfunction-associated steatotic liver disease (MASLD), including 79 with advanced fibrosis and 112 with mild fibrosis, to identify differential plasma proteins. These proteomic findings were then integrated with liver transcriptional profiling from 206 patients with MASLD, comprising 68 with advanced fibrosis and 138 with mild fibrosis, to determine candidate biomarkers. The prognostic utility of these biomarkers was validated in 42,979 participants from the UK Biobank with a median follow-up of 13 years. Discriminatory performance and cumulative incidence were assessed using competing-risk methodologies.</div></div><div><h3>Results</h3><div>Proteo-transcriptomic integration identified 123 concordant candidates, among which four plasma proteins (ADAMTSL2, IGFBP7, MFAP4, and CLSTN2) demonstrated robust diagnostic performance for advanced fibrosis (AUCs 0.821–0.889). In the UK Biobank cohort, IGFBP7 emerged as the strongest predictor of LROs, outperforming Fibrosis-4, AST to Platelet Ratio Index, and Chronic Liver Disease<sub>lab</sub> score (CLivD<sub>lab</sub>), with time-dependent AUCs of 0.815, 0.773, and 0.761 for cirrhosis prediction at 5, 10, and 15 years, respectively. Elevated IGFBP7 levels were detectable up to 15 years prior to diagnosis and, when combined with CLivD<sub>lab</sub>, identified a high-risk subgroup with a 20% 15-year incidence of cirrhosis. Subgroup analyses showed consistent prognostic value across MASLD, metabolic dysfunction-associated alcohol-related liver disease, and alcohol-related liver disease, with particularly strong performance in MASLD (15-year AUCs >0.85).</div></div><div><h3>Conclusions</h3><div>Plasma IGFBP7 is a robust and independent predictor of liver-related outcomes and significantly enhances risk stratification beyond conventional clinical tools.</div></div><div><h3>Impact and implications</h3><div>This study demonstrates that IGFBP7 is both a biomarker of advanced liver fibrosis and a strong long-term predictor of liver-related outcomes. The integration of IGFBP7 with conventional non-invasive tests enhances the refinement of risk prediction. Among individuals with low CLivD scores, those with high IGFBP7 levels had a substantially increased incidence of liver-related outcomes (2.5%), while low IGFBP7 levels were associated with favorable outcomes even in high CLivD groups (0.8%). This enables more precise identification of patients who may benefit from early referral <em>vs.</em> those suitable for reduced monitoring, potentially optimizing care pathways in resource-limited settings. Moreover, IGFBP7
{"title":"Plasma IGFBP7 improves risk reclassification for liver-related outcomes: Insights from proteo-transcriptomic profiling","authors":"Zhuoshuai Liang , Huizhen Jin , Wenhui Gao , Xinmeng Hu , Ruofei Li , Hongrui Zhang , Yi Cheng , Jikang Shi , Yawen Liu","doi":"10.1016/j.jhepr.2025.101687","DOIUrl":"10.1016/j.jhepr.2025.101687","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Advanced liver fibrosis is a pivotal predictor of liver-related outcomes (LROs), yet existing non-invasive tests offer limited prognostic accuracy. We aimed to identify novel plasma protein biomarkers that enhance long-term risk stratification for LROs.</div></div><div><h3>Methods</h3><div>Proteomic analyses were first conducted in 191 patients with metabolic dysfunction-associated steatotic liver disease (MASLD), including 79 with advanced fibrosis and 112 with mild fibrosis, to identify differential plasma proteins. These proteomic findings were then integrated with liver transcriptional profiling from 206 patients with MASLD, comprising 68 with advanced fibrosis and 138 with mild fibrosis, to determine candidate biomarkers. The prognostic utility of these biomarkers was validated in 42,979 participants from the UK Biobank with a median follow-up of 13 years. Discriminatory performance and cumulative incidence were assessed using competing-risk methodologies.</div></div><div><h3>Results</h3><div>Proteo-transcriptomic integration identified 123 concordant candidates, among which four plasma proteins (ADAMTSL2, IGFBP7, MFAP4, and CLSTN2) demonstrated robust diagnostic performance for advanced fibrosis (AUCs 0.821–0.889). In the UK Biobank cohort, IGFBP7 emerged as the strongest predictor of LROs, outperforming Fibrosis-4, AST to Platelet Ratio Index, and Chronic Liver Disease<sub>lab</sub> score (CLivD<sub>lab</sub>), with time-dependent AUCs of 0.815, 0.773, and 0.761 for cirrhosis prediction at 5, 10, and 15 years, respectively. Elevated IGFBP7 levels were detectable up to 15 years prior to diagnosis and, when combined with CLivD<sub>lab</sub>, identified a high-risk subgroup with a 20% 15-year incidence of cirrhosis. Subgroup analyses showed consistent prognostic value across MASLD, metabolic dysfunction-associated alcohol-related liver disease, and alcohol-related liver disease, with particularly strong performance in MASLD (15-year AUCs >0.85).</div></div><div><h3>Conclusions</h3><div>Plasma IGFBP7 is a robust and independent predictor of liver-related outcomes and significantly enhances risk stratification beyond conventional clinical tools.</div></div><div><h3>Impact and implications</h3><div>This study demonstrates that IGFBP7 is both a biomarker of advanced liver fibrosis and a strong long-term predictor of liver-related outcomes. The integration of IGFBP7 with conventional non-invasive tests enhances the refinement of risk prediction. Among individuals with low CLivD scores, those with high IGFBP7 levels had a substantially increased incidence of liver-related outcomes (2.5%), while low IGFBP7 levels were associated with favorable outcomes even in high CLivD groups (0.8%). This enables more precise identification of patients who may benefit from early referral <em>vs.</em> those suitable for reduced monitoring, potentially optimizing care pathways in resource-limited settings. Moreover, IGFBP7 ","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"8 2","pages":"Article 101687"},"PeriodicalIF":7.5,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Elexacaftor–tezacaftor–ivacaftor and cystic fibrosis liver disease: A turning point that calls for cautious optimism","authors":"Pierre-Emmanuel Rautou , Sophie Hillaire , Simone Gambazza , Carla Colombo","doi":"10.1016/j.jhepr.2025.101688","DOIUrl":"10.1016/j.jhepr.2025.101688","url":null,"abstract":"","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"8 2","pages":"Article 101688"},"PeriodicalIF":7.5,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-26DOI: 10.1016/j.jhepr.2025.101683
Michael Buckstein , Laura A. Dawson
External beam radiation therapy is becoming an increasingly useful tool in the management of hepatocellular carcinoma at all clinical stages. The data supporting its use is now maturing, with randomised trials showing excellent results in early, intermediate, advanced, and palliative stages. This review details the current best evidence available and makes a compelling case that external beam radiation therapy should be included in clinical guidelines. Doing so will benefit patients with an effective, low cost, and globally available treatment that can dramatically improve outcomes.
{"title":"External beam radiation for HCC: Ready for incorporation into guidelines?","authors":"Michael Buckstein , Laura A. Dawson","doi":"10.1016/j.jhepr.2025.101683","DOIUrl":"10.1016/j.jhepr.2025.101683","url":null,"abstract":"<div><div>External beam radiation therapy is becoming an increasingly useful tool in the management of hepatocellular carcinoma at all clinical stages. The data supporting its use is now maturing, with randomised trials showing excellent results in early, intermediate, advanced, and palliative stages. This review details the current best evidence available and makes a compelling case that external beam radiation therapy should be included in clinical guidelines. Doing so will benefit patients with an effective, low cost, and globally available treatment that can dramatically improve outcomes.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"8 2","pages":"Article 101683"},"PeriodicalIF":7.5,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/j.jhepr.2025.101648
Maja Thiele
{"title":"Old blood, new results: Will CORE fulfil the need for liver prognostication","authors":"Maja Thiele","doi":"10.1016/j.jhepr.2025.101648","DOIUrl":"10.1016/j.jhepr.2025.101648","url":null,"abstract":"","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"8 1","pages":"Article 101648"},"PeriodicalIF":7.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.jhepr.2025.101682
Fan Li , Ruishan Liu , Jin-ming Cao , Ping Lin , Xu Feng , Yangyang Xie , Ye Xiang , Hong-wei Li , Jin Zhang , Haibo Qu , Gang Ning , Lihua Zhuo
Background & Aims
Microvascular invasion (MVI) is a key determinant of recurrence and poor outcomes in hepatocellular carcinoma (HCC), yet accurate preoperative detection remains challenging. A deep-learning model integrating multiphase MRI and clinical features was developed and externally validated to non-invasively predict MVI and stratify postoperative recurrence risk.
Methods
Clinico-radiological data from 924 patients with resected HCC (2014–2023, five tertiary centers in China) were retrospectively assembled. A deep-learning model (DL-TriFusion) integrating multiphase MRI and clinical variables for MVI prediction was trained (n = 361), internally validated (n = 155), and externally validated across three centers (n = 408; 188/136/84); whether recurrence risk stratification using imaging-based surrogates is superior to pathology-confirmed MVI alone was also evaluated. Statistical analysis included classification and detection metrics.
Results
DL-TriFusion achieved AUCs ranging from 0.957 to 0.959, significantly outperforming all unimodal and bimodal models (p <0.001). Ablation studies confirmed incremental value from combining clinical variables with imaging features. Prognostically, DL-TriFusion outperformed pathology-based MVI, with C-indices of 0.837/0.755 vs. 0.447/0.520 (both p <0.001); in the external cohort, AUCs were 0.846 vs. 0.485 at 2 years and 0.938 vs. 0.501 at 5 years (p <0.001). Performance was consistent across HBV, histological, and center-based subgroups.
Conclusions
DL-TriFusion enables robust preoperative prediction of MVI. It also improves postoperative stratification of early and late recurrence.
Impact and implications
DL-TriFusion represents a reliable, non-invasive biomarker with strong potential for clinical translation. By leveraging routinely available MRI and clinical data, it enables accurate preoperative assessment of microvascular invasion and stratification of recurrence risk. This capability could optimize surgical planning, identify candidates for neoadjuvant or adjuvant therapy, refine surveillance strategies, and reduce unnecessary overtreatment – ultimately supporting personalized management of hepatocellular carcinoma.
{"title":"Integrating multiphase MRI surrogates to improve microvascular invasion detection and recurrence risk stratification in HCC","authors":"Fan Li , Ruishan Liu , Jin-ming Cao , Ping Lin , Xu Feng , Yangyang Xie , Ye Xiang , Hong-wei Li , Jin Zhang , Haibo Qu , Gang Ning , Lihua Zhuo","doi":"10.1016/j.jhepr.2025.101682","DOIUrl":"10.1016/j.jhepr.2025.101682","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Microvascular invasion (MVI) is a key determinant of recurrence and poor outcomes in hepatocellular carcinoma (HCC), yet accurate preoperative detection remains challenging. A deep-learning model integrating multiphase MRI and clinical features was developed and externally validated to non-invasively predict MVI and stratify postoperative recurrence risk.</div></div><div><h3>Methods</h3><div>Clinico-radiological data from 924 patients with resected HCC (2014–2023, five tertiary centers in China) were retrospectively assembled. A deep-learning model (DL-TriFusion) integrating multiphase MRI and clinical variables for MVI prediction was trained (n = 361), internally validated (n = 155), and externally validated across three centers (n = 408; 188/136/84); whether recurrence risk stratification using imaging-based surrogates is superior to pathology-confirmed MVI alone was also evaluated. Statistical analysis included classification and detection metrics.</div></div><div><h3>Results</h3><div>DL-TriFusion achieved AUCs ranging from 0.957 to 0.959, significantly outperforming all unimodal and bimodal models (<em>p</em> <0.001). Ablation studies confirmed incremental value from combining clinical variables with imaging features. Prognostically, DL-TriFusion outperformed pathology-based MVI, with C-indices of 0.837/0.755 <em>vs</em>. 0.447/0.520 (both <em>p</em> <0.001); in the external cohort, AUCs were 0.846 <em>vs.</em> 0.485 at 2 years and 0.938 <em>vs.</em> 0.501 at 5 years (<em>p</em> <0.001). Performance was consistent across HBV, histological, and center-based subgroups.</div></div><div><h3>Conclusions</h3><div>DL-TriFusion enables robust preoperative prediction of MVI. It also improves postoperative stratification of early and late recurrence.</div></div><div><h3>Impact and implications</h3><div>DL-TriFusion represents a reliable, non-invasive biomarker with strong potential for clinical translation. By leveraging routinely available MRI and clinical data, it enables accurate preoperative assessment of microvascular invasion and stratification of recurrence risk. This capability could optimize surgical planning, identify candidates for neoadjuvant or adjuvant therapy, refine surveillance strategies, and reduce unnecessary overtreatment – ultimately supporting personalized management of hepatocellular carcinoma.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"8 2","pages":"Article 101682"},"PeriodicalIF":7.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号