Hepatobiliary & Pancreatic Diseases International最新文献

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.

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.