Hepatobiliary & Pancreatic Diseases International最新文献

Pre-retrieval imaging has a pivotal role in liver transplantation, donor selection, operative planning, and the prevention of postoperative complications. Conventional modalities (ultrasound, computed tomography, and magnetic resonance imaging) remain the foundation of liver graft evaluation. However, their diagnostic performance remains constrained by physiological factors, operator dependence and inter-institutional variability and thus, intraoperative and pre-retrieval biopsies are still important. Emerging innovations in radiomics and artificial intelligence are redefining the landscape of graft evaluation, offering unprecedented opportunities for non-invasive characterization, heightened diagnostic precision, and establishment of self-sustaining feedback loops to advance clinical practice. This work provides a systematic synthesis of current radiological evidence on steatosis detection, appraisal of vascular anomalies in deceased donors, and delineation of biliary variants and volumetry in living donors. While these innovations hold considerable promises, progresses are still limited by methodological heterogeneity, modest cohort sizes, and absence of robust multicenter validation. Universally accepted imaging protocols and advanced analytic tools with intraoperative and histological reference standards will be pivotal to realizing their transformative potential. Within the framework of a learning health system, imaging could move beyond a diagnostic tool to become a driver of precision liver graft selection, reducing reliance on invasive biopsy and enhancing safety for both donors and recipients.

Pancreatic cancer, mainly pancreatic ductal adenocarcinoma (PDAC), is aggressive with poor prognosis. Because its clinical manifestations appear at advanced stages, only less than 20 % of patients with PDAC can undergo radical surgery. Chemotherapy, with strong toxic side effects, remains the main therapy. Therefore, developing more effective strategies for PDAC is warranted. Because of its heterogeneity and highly immunosuppressive tumor microenvironment (TME), the discovery of new drug targets and development of new therapeutic modalities for PDAC remain difficult. Antibody-drug conjugates (ADCs)-which have demonstrated efficacy against various types of cancers-improve the antitumor effects of a drug by enhancing tumor targeting, reducing toxic side effects, and increasing TME interactions via antigen presentation regulation and immunosuppressive cell inhibition. Here, we summarized the effects of ADCs on TME of PDAC, as well as the future research prospects.

Background: Tumor micronecrosis is a feature of hepatocellular carcinoma (HCC) and might mirror tumor characteristics and patient prognosis. However, the specific influence of tumor micronecrosis on the recurrence patterns of HCC remains unclear. This study aimed to investigate the effects of tumor micronecrosis on HCC recurrence patterns, particularly examining any changes after liver resection.

Methods: A cohort of 938 patients with primary HCC who underwent R0 liver resection between June 2014 and October 2019 were included in the study. A second R0 resection was performed in 340 patients with tumor recurrence between November 2014 and October 2021. Tumor micronecrosis was evaluated for primary (938 cases) and recurrent (340 cases) tumors. The recurrence pattern and prognosis were analyzed, and independent prognostic factors were identified using Cox regression analysis. Nomograms were then constructed to predict tumor recurrence and prognosis after liver resection.

Results: HCC recurrence was observed in 400 (42.6%) patients during the follow-up period. Tumor micronecrosis independently affected recurrence-free survival (P = 0.002). Among micronecrosis (+) patients, a higher extrahepatic recurrence, multiple tumors, elevated albumin-bilirubin grade, advanced Barcelona Clinic Liver Cancer stage, and increased alpha-fetoprotein level were observed. Additionally, more micronecrosis (-) patients underwent positive treatments after recurrence (P = 0.017), leading to a superior post-recurrence prognosis in this group (P < 0.001). Nearly half of the recurrent HCCs displayed changes in tumor micronecrosis scores. The presence of micronecrosis in primary lesions was significantly associated with poor patient survival after recurrence (P = 0.006), whereas no significant association was observed in patients with recurrent lesions after second R0 resection (P = 0.138). Furthermore, early recurrence, multinodular recurrence, intrahepatic and extrahepatic recurrent tumors, and the treatment modality were identified as independent prognostic factors. The developed nomogram for patient survival achieved a concordance index of 0.753.

Conclusions: Patients with HCC displaying tumor micronecrosis experienced increased recurrent risks and more aggressive recurrent patterns, and encountered poorer prognosis compared to those without micronecrosis. Notably, micronecrosis status often varied between primary and recurrent HCCs. However, micronecrosis predicted survival only when evaluated in the primary tumor, not in the recurrent tumors.

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy characterized by late-stage diagnosis, resistance to conventional chemotherapy, and a dismal 5-year survival rate of approximately 12 %. These challenges underscore the urgent need for more effective therapeutic strategies. Recent advances in the understanding of PDAC pathophysiology, combined with the successful implementation of targeted therapies and immunotherapies in other cancer types, offer promising avenues for improving PDAC outcomes. This review summarized the latest developments in targeted and immune-based therapies for PDAC. A comprehensive literature search was conducted using PubMed (MEDLINE) and Web of Science, identifying 36 studies on targeted therapies and 24 studies on immunotherapies relevant to PDAC. Several investigational and approved agents, including KRAS inhibitors (MRTX1133, sotorasib), PARP inhibitors (olaparib), and immune checkpoint inhibitors (pembrolizumab), have demonstrated encouraging results, particularly in combination regimens. These findings provide valuable insights into future research and clinical strategies aiming at improving the prognosis of PDAC.

Background: Ex vivo liver resection and autotransplantation (ELRA) offers new therapeutic perspectives and possibilities for R0 resection in patients with hepatic alveolar echinococcosis (AE) combined with cavernous transformation of the portal vein (CTPV).

Methods: We analyzed 49 hepatic AE patients with CTPV treated at our center from January 2010 to June 2023. We compared the different outcomes with different treatments for the 49 patients: ELRA for 12 and conservative for 9 patients. After propensity score matching, we compared the ELRA treatment outcomes for 12 patients with CTPV and 24 patients without CTPV. Kaplan-Meier analysis was used to compare overall survival, and Cox regression to identify factors influencing postoperative survival.

Results: In the ELRA cohort, both CTPV and non-CTPV patients had no intraoperative mortality; 90-day mortality rate for both groups was 16.7 % (2/12 in CTPV patients and 4/24 in non-CTPV patients). Pleural effusion was the most common postoperative complication. CTPV patients required significantly longer operative time and more intraoperative blood transfusions (P < 0.05). However, no significant difference was observed in long-term overall survival between CTPV and non-CTPV patients after ELRA (71.4 % vs. 74.5 %, P > 0.05). In the CTPV cohort, patients who underwent ELRA had significantly better long-term survival compared to those who did not receive surgery (72.9 % vs. 29.6 %, P < 0.05). Extrahepatic AE disease, rather than CTPV, was identified as an independent risk factor for postoperative survival (P < 0.05).

Conclusions: ELRA is a safe and effective approach for hepatic AE patients with CTPV, significantly improving long-term survival. CTPV itself does not negatively impact postoperative survival, further emphasizing the benefits of this procedure in this particular population.