Hepatobiliary & Pancreatic Diseases International最新文献

Bile acids (BAs) represent the terminal products of cholesterol catabolism and are integral to a wide range of physiological processes. The maintenance of BAs homeostasis is essential for human health, with disruptions being implicated in various liver and intestinal disorders. The gut-liver axis, a bidirectional communication network connecting multiple organ systems, plays a crucial role in preserving both metabolic and immune homeostasis. Recent evidence suggests that BAs are key modulators within this axis, influencing intestinal barrier function, immune responses, and the composition of the gut microbiome. This review synthesizes recent advances in our understanding of BAs, including their origins, circulation within the gut-liver axis, and diverse roles in physiology, thereby highlighting the critical functional significance of this BAs-mediated network.

Background: Subcutaneous adipose tissue (SAT) is among the components of body composition. SAT radiodensity (SATr) is an indirect surrogate marker of adipose tissue quality and is associated with a poor prognosis in various malignancies. The present study aimed to evaluate the association of chronological changes in SATr during the preoperative waiting period with postoperative overall survival (OS) in patients with perihilar cholangiocarcinoma undergoing major hepatectomy.

Methods: This study included patients with perihilar cholangiocarcinoma who underwent major hepatectomy and extrahepatic bile duct resection as curative treatment. SATr was evaluated using plain computed tomography images. The chronological changes in SATr were calculated as SATr at surgery minus SATr at diagnosis. SATr changes of > 0 or ≤ 0 Hounsfield units were defined as positive (P-SATr) or negative SATr changes (N-SATr), respectively. The primary outcome was postoperative OS according to the change in SATr. The prognostic factors for OS were also evaluated using a Cox proportional hazard model.

Results: The study enrolled 104 patients, including 75 and 29 patients with P-SATr and N-SATr, respectively. P-SATr was associated with higher serum carcinoembryonic antigen levels and greater amount of adjusted blood loss during the operation. There were no significant differences in the in-hospital mortality and complication rates as well as postoperative hospital stay between the P-SATr and N-SATr groups. The median OS durations were 37.3 and 78.0 months in the P-SATr and N-SATr groups (P < 0.01). Multivariate analysis revealed P-SATr [hazard ratio (HR) = 1.95; 95% confidence interval (CI): 1.02-3.75; P = 0.04], serum carbohydrate antigen 19-9 level > 300 U/mL (HR = 3.68; 95% CI: 1.68-8.07; P < 0.01), presence of lymph node metastasis (HR = 2.04; 95% CI: 1.19-3.50; P < 0.01), and positive residual tumor status (HR = 4.61; 95% CI: 2.21-9.60; P < 0.01) as independent predictive factors for OS.

Conclusions: P-SATr during the preoperative waiting period was associated with poor prognosis in patients with perihilar cholangiocarcinoma undergoing major hepatectomy.

Background: Cholangiocarcinomas (CCAs), including perihilar CCA (pCCA) and extrahepatic CCA (eCCA), are aggressive cancers with poor prognosis. Most patients are diagnosed at advanced stages. Jaundice and infection, commonly present at diagnosis, can delay treatment initiation. This study aimed to evaluate the impact of these conditions on time to treatment and patient prognosis in a real-world setting.

Methods: This study included 104 patients with advanced pCCA and eCCA who were evaluated in multidisciplinary team discussions at the University Hospital of Bordeaux between July 2015 and July 2022. We assessed overall survival (OS) and progression-free survival (PFS) in relation to time to treatment initiation, jaundice, biliary drainage, and infection.

Results: Among all patients, 71 (68.3%) patients had metastatic disease and 47 (45.2%) patients had previously received curative intend treatment. Pathological confirmation was obtained in 95 (91.3%) cases, with 26 patients requiring multiple biopsy attempts. Biliary drainage was performed in 59 (56.7%) patients. The median time from diagnosis to treatment initiation was 6.8 weeks [interquartile range (IQR): 3.5-13.5]. The median OS for the cohort was 67.5 weeks (IQR: 36.6-88.7), and the median PFS was 25.8 weeks (IQR: 14.0-51.6). Analysis revealed no significant differences in OS or PFS related to the time to treatment or the presence of jaundice, biliary drainage, or infection.

Conclusions: Although jaundice and infection are common at the time of CCA diagnosis and can delay treatment, these factors did not significantly influence prognosis in patients with advanced pCCA and eCCA, whose outcomes remained poor.