Lancet Gastroenterology & Hepatology最新文献

{"title":"Precision surgery for hepatocellular carcinoma","authors":"Christian Tibor Josef Magyar, Luckshi Rajendran, Zhihao Li, Vanessa Banz, Arndt Vogel, Grainne Mary O'Kane, Albert Chi-Yan Chan, Gonzalo Sapisochin","doi":"10.1016/s2468-1253(24)00434-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00434-5","url":null,"abstract":"Hepatocellular carcinoma arises in the setting of cirrhosis in most cases, requiring multidisciplinary input to define resectability. In this regard, more precise surgical management considers patient factors and anatomical states, including resection margins, tumour biology, and perioperative therapy. Together with advances in surgical techniques, this integrated approach has resulted in considerable improvements in patient morbidity and oncological outcomes. Despite this, recurrence rates in hepatocellular carcinoma remain high. As the systemic treatment landscape in hepatocellular carcinoma continues to evolve and locoregional options are increasingly used, we review current and future opportunities to individualise the surgical management of patients with hepatocellular carcinoma.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"11 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471005","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":"Hepatitis C incidence targets among people who inject drugs: a long road ahead","authors":"Ruth Zimmermann, Renke Lars Biallas","doi":"10.1016/s2468-1253(25)00043-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00043-3","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"89 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470997","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":"Emerging evidence-based role for external-beam radiation therapy in hepatocellular carcinoma","authors":"Stephanie O Dudzinski, Neil B Newman, Jeff McIntyre, Reena Engineer, Nina N Sanford, Jennifer Y Wo, Jinsil Seong, Chandan Guha, Daniel T Chang, Theodore S Hong, Laura A Dawson, Eugene J Koay, Ethan B Ludmir","doi":"10.1016/s2468-1253(24)00267-x","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00267-x","url":null,"abstract":"The primary curative therapies for hepatocellular carcinoma are resection or liver transplantation. For patients requiring downstaging or who are unresectable at presentation, the landscape of local treatment options has vastly changed over the past decades. This change is partly due to the paucity of high-level evidence to guide the selection of liver-directed therapies, where physician preference and treatment patterns have historically resulted in relegating external-beam radiation therapy (EBRT) to a secondary option in the treatment of hepatocellular carcinoma in cases where arterially directed therapies or thermal ablations were not possible. However, technology advancements have substantially improved the ability to treat liver malignancies with high doses of radiation therapy and to minimise doses to uninvolved hepatic parenchyma and other nearby organs. These advancements have enabled safe treatment of hepatocellular carcinoma with EBRT, with low risk of toxicity. Recent randomised trials support the role of EBRT in the treatment of hepatocellular carcinoma from early to advanced stages. These trials identified that EBRT improved several key patient-centred outcomes, including overall survival when using stereotactic body radiotherapy and sorafenib compared with sorafenib alone in unresectable hepatocellular carcinoma, recurrence-free survival with the use of adjuvant EBRT in select patients after hepatocellular carcinoma resection, and quality of life for patients with painful hepatocellular carcinoma masses treated with palliative EBRT. With emerging high-quality evidence, hepatocellular carcinoma therapeutic guidelines should include the growing role of EBRT in improving the quality and quantity of life for patients with liver cancer.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"47 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470998","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":"The bet on PET: detecting liver lesions is not enough","authors":"Marcus Hacker","doi":"10.1016/s2468-1253(25)00023-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00023-8","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"182 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463045","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":"[18F]fluorodeoxyglucose and [18F]fluorocholine PET-CT for staging optimisation and treatment modification in hepatocellular carcinoma (PET-HCC01): a prospective multicentre study","authors":"Jean-Charles Nault, Marouane Boubaya, Myriam Wartski, Anthony Dohan, Stanislas Pol, Gabriel Pop, Michael Soussan, Olivier Sutter, Charlotte Costentin, Julie Roux, Christian Sengel, Marie Lequoy, Françoise Montravers, Yves Menu, Georges-Philippe Pageaux, Denis Mariano Goulart, Boris Guiu, Alain Luciani, Pierre Nahon, Marco Dioguardi Burgio, Mohamed Bouattour","doi":"10.1016/s2468-1253(25)00011-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00011-1","url":null,"abstract":"<h3>Background</h3>The role of PET-CT with [<sup>18</sup>F]fluorodeoxyglucose ([<sup>18</sup>F]FDG) and [<sup>18</sup>F]fluorocholine ([<sup>18</sup>F]FCH) in staging hepatocellular carcinoma and treatment decisions has, to our knowledge, never been prospectively assessed.<h3>Methods</h3>We conducted a multicentre prospective study (PET-HCC01) in nine hospitals in France, including patients aged 18 years or older with a first diagnosis of hepatocellular carcinoma classified as Barcelona Clinic Liver Cancer (BCLC) classification A to C (without metastasis). At study inclusion, patients underwent contrast-enhanced liver MRI and liver, chest, and pelvis CT scans. Patients subsequently underwent [<sup>18</sup>F]FCH and [<sup>18</sup>F]FDG PET-CT. A first tumour staging and treatment decision was recorded by the multidisciplinary tumour board at each centre using morphological imaging, blind to the results of the PET-CTs. After the results of the PET-CTs were revealed, a second tumour staging and treatment decision was recorded. The primary endpoint was the proportion of patients whose treatment was modified by PET-CTs. Analyses were done in the intention-to-image population, consisting of all patients who had undergone at least one PET-CT and were discussed by the multidisciplinary tumour board. This study was registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT04391348</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>.<h3>Findings</h3>Between July 20, 2020, and April 27, 2023, 230 patients were enrolled. Among the 215 patients included in the intention-to-image population, the median age was 66·0 years (IQR 60·0–71·5), 193 (90%) were male, and 155 (73%) had cirrhosis. Hepatocellular carcinoma was classified as BCLC stage A in 140 (65%) patients, B in 48 (22%), and C without metastasis in 27 (13%) on the basis of morphological imaging. Potential new lesions were identified in 19 (9%) patients by PET-CT (eight by both tracers, six by [<sup>18</sup>F]FCH only, and five by [<sup>18</sup>F]FDG only) and in six of these patients, follow-up confirmed the diagnosis of hepatocellular carcinoma (one lesion in the adrenal gland, two in bones, two in the lymph node, and one intrahepatic). PET-CT modified BCLC stage in ten patients: disease stage for two patients moved from BCLC A to B, from BCLC A to C for two patients, from BCLC B to C for two patients, and from BCLC C without metastasis to BCLC C with metastasis for four patients. Planned treatment was modified for four patients (2% [95% CI 1–5]), below the prespecified threshold of clinical significance (10%).<h3>Interpretation</h","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"69 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463046","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":"Non-invasive tests for assessing liver fibrosis and cirrhosis in chronic hepatitis B","authors":"Rui Huang, Chao Wu","doi":"10.1016/s2468-1253(25)00009-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00009-3","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"1 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451641","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":"Staging liver fibrosis and cirrhosis using non-invasive tests in people with chronic hepatitis B to inform WHO 2024 guidelines: a systematic review and meta-analysis","authors":"Antonio Liguori, Mirko Zoncapè, Giovanni Casazza, Philippa Easterbrook, Emmanuel A Tsochatzis","doi":"10.1016/s2468-1253(24)00437-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00437-0","url":null,"abstract":"<h3>Background</h3>Non-invasive tests (aspartate aminotransferase-to-platelet ratio index [APRI] and transient elastography [FibroScan]) were recommended in the 2015 WHO guidelines to guide treatment decisions in people with chronic hepatitis B. We updated the systematic review and meta-analysis that informed the 2015 guidelines to inform new cutoffs for non-invasive tests for the diagnosis of significant fibrosis and cirrhosis for the 2024 WHO guidelines for chronic hepatitis B.<h3>Methods</h3>We searched PubMed (MEDLINE), Embase, and Science Citation Index Expanded (Web of Science) for studies published in any language between Jan 1, 2014, and Feb 15, 2023. We included all studies that reported cross-sectional data on the staging of fibrosis or cirrhosis with APRI, Fibrosis-4 (FIB-4), and FibroScan compared with liver biopsy as the reference standard in people with chronic hepatitis B. We excluded studies in which the maximum interval between liver biopsy and non-invasive fibrosis test was more than 6 months; that reported on fewer than ten patients with advanced fibrosis or cirrhosis; that were done exclusively in children; and did not report diagnostic accuracy across our prespecified ranges of test cutoffs. The results of this updated search were collated with the meta-analysis that informed the 2015 guidelines. Outcomes of interest were the sensitivity and specificity of non-invasive tests using defined index test cutoffs for detecting significant fibrosis (≥F2), advanced fibrosis (≥F3), and cirrhosis (F4) based on the METAVIR staging system. We performed meta-analyses using a bivariate random-effects model.<h3>Findings</h3>Of 19 933 records identified by our search strategy, 195 were eligible for our systematic review and combined with the 69 studies from the previous meta-analysis to total 264. Two studies were at low risk of bias, 31 studies had unclear risk of bias, and 231 studies had a high risk of bias. Of these 264, 211 studies with 61 665 patients were used in the meta-analysis. For the diagnosis of significant fibrosis (≥F2), sensitivity and specificity were 72·9% (95% CI 70·2–75·5) and 64·7% (95% CI 61·0–68·2) for the APRI low cutoff (>0·3 to 0·7), 30·5% (23·7–38·3) and 92·3% (89·3–94·6) for the APRI high cutoff (>1·3 to 1·7), and 75·1% (72·2–77·7) and 79·3% (76·2–82·2) for FibroScan (>6·0 to 8·0 kPa), respectively. For the diagnosis of cirrhosis (F4), sensitivity and specificity were 59·4% (53·2–65·2) and 73·9% (70·1–77·4) for the APRI low cutoff (>0·8 to 1·2), 30·2% (24·2–36·9) and 88·2% (85·4–90·6) for the APRI high cutoff (>1·8 to 2·2), and 82·6% (77·8–86·5) and 89·0% (86·3–91·2) for FibroScan (>11·0 to 14·0 kPa), respectively. Using a hypothetical population of 1000 unselected patients with chronic hepatitis B with a 25% prevalence of significant fibrosis (≥F2), the APRI low cutoff for significant fibrosis (≥F2) would result in 262 (26·2%) false positives but only 68 (6·8%) false negatives. The FibroScan cu","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"19 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451644","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":"US policy changes put elimination of viral hepatitis at high risk","authors":"","doi":"10.1016/s2468-1253(25)00055-x","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00055-x","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"30 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427378","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":"Management of alcohol use disorder: a gastroenterology and hepatology-focused perspective","authors":"Luis Antonio Díaz, Daniel König, Sabine Weber, Gustavo Ayares, José Miguel Fuentealba, Valeria Vázquez, Ramon Bataller, Patrick S Kamath, Gerald Scott Winder, Lorenzo Leggio, Juan Pablo Arab","doi":"10.1016/s2468-1253(24)00380-7","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00380-7","url":null,"abstract":"Alcohol use disorder is a prevalent and major but preventable cause of morbidity and mortality worldwide, causing several important health consequences, including chronic liver disease. Despite its substantial effects, most clinicians do not adequately assess alcohol intake in clinical practice, and there are several barriers to providing integrated management to patients with alcohol use disorder. Standardised questionnaires, such as the Alcohol Use Identification Test (AUDIT), can facilitate the identification of individuals at risk of alcohol use disorder, and alcohol biomarkers such as phosphatidylethanol aid in quantifying levels of alcohol consumption. Non-pharmacological interventions—including brief interventions, twelve-step facilitation, motivational enhancement therapy, contingency management, and cognitive behavioural therapy—are effective for patients with alcohol use disorder, regardless of the presence of advanced liver disease. Pharmacological treatments should be considered according to the severity of liver disease and other comorbidities, safety profile, and local availability. The management of patients with alcohol use disorder and associated liver disease should ideally be performed in the setting of integrated multidisciplinary teams.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"79 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417415","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":"Thank you to The Lancet Gastroenterology & Hepatology's statistical and peer reviewers in 2024","authors":"","doi":"10.1016/s2468-1253(25)00020-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00020-2","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"78 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401258","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}