Pub Date : 2023-10-01DOI: 10.1136/egastro-2023-100014
Bo Chang Wu, Jakub Wlodarczyk, Sanaz Nourmohammadi Abadchi, Niloufar Shababi, John L Cameron, John W Harmon
The History Maker paper focuses on the extraordinary revolution that dramatically improved the surgical results for the Whipple procedure (pancreaticoduodenectomy) in the 1980s and identifies Dr. Cameron as the leader of this revolution, who reported a mortality rate of approximately 1%. The revolutionary reduction of postoperative mortality for the Whipple procedure was achieved by adherence to gentle and precise Halstedian surgical techniques with adequate drainage of pancreatico-jejunal anastomosis with closed-suction silastic drains, along with the development of high-volume surgeons and hospitals. Excellent teamwork in patient care, including but not limited to preoperative evaluation by multidisciplinary teams, intraoperative communication between surgeons and anaesthesiologists, and postoperative management, contributed to a successful Whipple procedure.
{"title":"Revolutionary transformation lowering the mortality of pancreaticoduodenectomy: a historical review","authors":"Bo Chang Wu, Jakub Wlodarczyk, Sanaz Nourmohammadi Abadchi, Niloufar Shababi, John L Cameron, John W Harmon","doi":"10.1136/egastro-2023-100014","DOIUrl":"https://doi.org/10.1136/egastro-2023-100014","url":null,"abstract":"The History Maker paper focuses on the extraordinary revolution that dramatically improved the surgical results for the Whipple procedure (pancreaticoduodenectomy) in the 1980s and identifies Dr. Cameron as the leader of this revolution, who reported a mortality rate of approximately 1%. The revolutionary reduction of postoperative mortality for the Whipple procedure was achieved by adherence to gentle and precise Halstedian surgical techniques with adequate drainage of pancreatico-jejunal anastomosis with closed-suction silastic drains, along with the development of high-volume surgeons and hospitals. Excellent teamwork in patient care, including but not limited to preoperative evaluation by multidisciplinary teams, intraoperative communication between surgeons and anaesthesiologists, and postoperative management, contributed to a successful Whipple procedure.","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1136/egastro-2023-100021
Armando Andres Roca Suarez, Fabien Zoulim
In spite of the fact that safe and effective vaccines have been available for over 40 years, hepatitis B virus (HBV) remains a major public health problem, as there are 296 million chronically HBV-infected individuals worldwide and 820 000 HBV-related deaths taking place every year. Achieving the goal of HBV cure remains a challenge due to the particularities of the HBV cycle underlying viral persistence. The new understanding of HBV biology and antiviral immune responses has allowed to identify novel drug targets. This has led to a renewed interest in developing new curative strategies and combinations for HBV. In the present review, we aim to summarise the biological and clinical challenges associated with chronic HBV infection. Moreover, we consider the lessons that have been learnt in the past years regarding the preclinical and clinical evaluation of compounds against HBV and how this is driving the field to explore new directions.
{"title":"Opportunities and challenges for hepatitis B cure","authors":"Armando Andres Roca Suarez, Fabien Zoulim","doi":"10.1136/egastro-2023-100021","DOIUrl":"https://doi.org/10.1136/egastro-2023-100021","url":null,"abstract":"In spite of the fact that safe and effective vaccines have been available for over 40 years, hepatitis B virus (HBV) remains a major public health problem, as there are 296 million chronically HBV-infected individuals worldwide and 820 000 HBV-related deaths taking place every year. Achieving the goal of HBV cure remains a challenge due to the particularities of the HBV cycle underlying viral persistence. The new understanding of HBV biology and antiviral immune responses has allowed to identify novel drug targets. This has led to a renewed interest in developing new curative strategies and combinations for HBV. In the present review, we aim to summarise the biological and clinical challenges associated with chronic HBV infection. Moreover, we consider the lessons that have been learnt in the past years regarding the preclinical and clinical evaluation of compounds against HBV and how this is driving the field to explore new directions.","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"2010 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136093656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1136/egastro-2023-100041
Chris Zielinski
{"title":"Time to treat the climate and nature crisis as one indivisible global health emergency","authors":"Chris Zielinski","doi":"10.1136/egastro-2023-100041","DOIUrl":"https://doi.org/10.1136/egastro-2023-100041","url":null,"abstract":"","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136167829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1136/egastro-2023-100020
Yankai Wen, Lichun Ma, Cynthia Ju
Viral hepatitis, alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are the three major causes of chronic liver diseases, which account for approximately 2 million deaths per year worldwide. The current direct-acting antiviral drugs and vaccinations have effectively reduced and ameliorated viral hepatitis infection, but there are still no effective drug treatments for ALD, NAFLD and liver cancer due to the poor understanding of their pathogenesis. To better understand the pathogenesis, the fifth Chinese American Liver Society/Society of Chinese Bioscientists in America Hepatology Division Annual Symposium, which was held virtually on 21–22 October 2022, focused on the topics related to ALD, NAFLD and liver cancer. Here, we briefly highlight the presentations that focus on the current progress in basic and translational research in ALD, NAFLD and liver cancer. The roles of non-coding RNA, autophagy, extrahepatic signalling, macrophages, etc in liver diseases are deliberated, and the application of single-cell RNA sequencing in the study of liver disease is also discussed.
{"title":"Recent insights into the pathogenesis and therapeutic targets of chronic liver diseases","authors":"Yankai Wen, Lichun Ma, Cynthia Ju","doi":"10.1136/egastro-2023-100020","DOIUrl":"https://doi.org/10.1136/egastro-2023-100020","url":null,"abstract":"Viral hepatitis, alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are the three major causes of chronic liver diseases, which account for approximately 2 million deaths per year worldwide. The current direct-acting antiviral drugs and vaccinations have effectively reduced and ameliorated viral hepatitis infection, but there are still no effective drug treatments for ALD, NAFLD and liver cancer due to the poor understanding of their pathogenesis. To better understand the pathogenesis, the fifth Chinese American Liver Society/Society of Chinese Bioscientists in America Hepatology Division Annual Symposium, which was held virtually on 21–22 October 2022, focused on the topics related to ALD, NAFLD and liver cancer. Here, we briefly highlight the presentations that focus on the current progress in basic and translational research in ALD, NAFLD and liver cancer. The roles of non-coding RNA, autophagy, extrahepatic signalling, macrophages, etc in liver diseases are deliberated, and the application of single-cell RNA sequencing in the study of liver disease is also discussed.","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135964076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1136/egastro-2023-100016
Xiusen Qin, Zifeng Yang, Yang Li, Jian Luo, Hui Wang, Huaiming Wang
Background Treatment of colorectal cancer (CRC) with synchronous peritoneal metastases (SPM) is controversial, and its prognosis remains poor. Here, we analysed the association between treatment strategies and the outcomes of patients with colorectal SPM and devised a nomogram to improve their prognosis prediction. Methods We retrospectively analysed patients with colorectal SPM treated at The Sixth Affiliated Hospital, Sun Yat-sen University from June 2007 to June 2018. The Kaplan-Meier method with log-rank tests was used to compare the overall survival (OS) among patients undergoing different therapeutic regimens. Cox proportional hazards regression analysis was used to identify the prognostic factors. After variable selection, a nomogram was developed to predict the OS of patients with colorectal SPM. Results A total of 371 patients with colorectal SPM were eligible for this study. The median OS of all patients was 15.0 months (95% CI, 13.1 to 16.9), with a 3-year and 5-year OS rate of 23.7% and 16.9%, respectively. Patients who underwent complete cytoreductive surgery (CC0–1) had a better median OS of 49 months (p<0.001). Cox multivariate analysis showed that age >65 years; cancer antigen 125 level >35 U/mL; peritoneal carcinomatosis index >16 scores; and undergoing cytoreductive surgery, chemotherapy and hyperthermic intraperitoneal chemotherapy were independent prognostic factors for OS. The c-index of the prognostic nomogram was 0.747 (95% CI, 0.474 to 1.020). Conclusions Our study suggests that patients with colorectal SPM who receive comprehensive treatment might achieve better prognoses. The prognostic nomogram demonstrated good predictive performance for patients with colorectal SPM.
{"title":"Treatment and prognosis of colorectal cancer with synchronous peritoneal metastases: 11-year single institute experience","authors":"Xiusen Qin, Zifeng Yang, Yang Li, Jian Luo, Hui Wang, Huaiming Wang","doi":"10.1136/egastro-2023-100016","DOIUrl":"https://doi.org/10.1136/egastro-2023-100016","url":null,"abstract":"Background Treatment of colorectal cancer (CRC) with synchronous peritoneal metastases (SPM) is controversial, and its prognosis remains poor. Here, we analysed the association between treatment strategies and the outcomes of patients with colorectal SPM and devised a nomogram to improve their prognosis prediction. Methods We retrospectively analysed patients with colorectal SPM treated at The Sixth Affiliated Hospital, Sun Yat-sen University from June 2007 to June 2018. The Kaplan-Meier method with log-rank tests was used to compare the overall survival (OS) among patients undergoing different therapeutic regimens. Cox proportional hazards regression analysis was used to identify the prognostic factors. After variable selection, a nomogram was developed to predict the OS of patients with colorectal SPM. Results A total of 371 patients with colorectal SPM were eligible for this study. The median OS of all patients was 15.0 months (95% CI, 13.1 to 16.9), with a 3-year and 5-year OS rate of 23.7% and 16.9%, respectively. Patients who underwent complete cytoreductive surgery (CC0–1) had a better median OS of 49 months (p<0.001). Cox multivariate analysis showed that age >65 years; cancer antigen 125 level >35 U/mL; peritoneal carcinomatosis index >16 scores; and undergoing cytoreductive surgery, chemotherapy and hyperthermic intraperitoneal chemotherapy were independent prognostic factors for OS. The c-index of the prognostic nomogram was 0.747 (95% CI, 0.474 to 1.020). Conclusions Our study suggests that patients with colorectal SPM who receive comprehensive treatment might achieve better prognoses. The prognostic nomogram demonstrated good predictive performance for patients with colorectal SPM.","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135389415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1136/egastro-2023-100019
Mohammed Eslam, Jacob George
To provide clarity for research studies and clinical care, a set of positive criteria for adults and children with metabolic (dysfunction) associated fatty liver disease (MAFLD) was recently published and has subsequently been widely endorsed. The development and subsequent validation of the criteria for MAFLD has created a positive momentum for change. During the course of the ongoing discussion on the redefinition, some concerns have surfaced that we thought needs clarification. In this review, we provide a perspective on MAFLD and bringing clarity to some of the key aspects that have been recently raised.
{"title":"Two years on, a perspective on MAFLD","authors":"Mohammed Eslam, Jacob George","doi":"10.1136/egastro-2023-100019","DOIUrl":"https://doi.org/10.1136/egastro-2023-100019","url":null,"abstract":"To provide clarity for research studies and clinical care, a set of positive criteria for adults and children with metabolic (dysfunction) associated fatty liver disease (MAFLD) was recently published and has subsequently been widely endorsed. The development and subsequent validation of the criteria for MAFLD has created a positive momentum for change. During the course of the ongoing discussion on the redefinition, some concerns have surfaced that we thought needs clarification. In this review, we provide a perspective on MAFLD and bringing clarity to some of the key aspects that have been recently raised.","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135255183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1136/egastro-2023-100024
Robim M Rodrigues, Joost Boeckmans, Tamara Vanhaecke
Liver regeneration is a process that ensures the restauration of liver size and weight on loss of hepatic cells due to acute liver injury, chronic liver disease or partial hepatectomy.[1][1] The regenerative activity of parenchymal and non-parenchymal cells is essential for the maintenance of the
{"title":"Macrophages clear out necrotic liver lesions: a new magic trick revealed","authors":"Robim M Rodrigues, Joost Boeckmans, Tamara Vanhaecke","doi":"10.1136/egastro-2023-100024","DOIUrl":"https://doi.org/10.1136/egastro-2023-100024","url":null,"abstract":"Liver regeneration is a process that ensures the restauration of liver size and weight on loss of hepatic cells due to acute liver injury, chronic liver disease or partial hepatectomy.[1][1] The regenerative activity of parenchymal and non-parenchymal cells is essential for the maintenance of the","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135429366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1136/egastro-2023-100010
A. Brouillet, Fouad Lafdil
Primary liver cancers ranked as the sixth most commonly diagnosed cancers and the third-leading cause of cancer-related death in 2020. Despite encouraging findings on diagnosis and treatments, liver cancer remains a life-threatening disease with a still increasing incidence.Therefore, it is of interest to better characterise and understand the mechanistic process occurring at early steps of carcinogenesis. Inflammatory responses in liver diseases participate in the activation of liver progenitor cells (LPCs) facultative compartment but also to their transformation into cancer stem cells (CSCs) and give rise to primary liver cancer including hepatocellular carcinoma and cholangiocarcinoma. Higher intratumoural heterogeneity has been associated with poorer prognosis and linked to tumour escape from the immune surveillance and to resistance to chemotherapy. A better understanding of the malignant transformation of LPC as tumour initiating cells (ie, CSC) should also provide a potential new therapeutic target for anticancer therapy. In this review, we summarise the recent reports identifying underlying mechanisms by which chronic liver inflammatory responses could trigger the early steps in liver carcinogenesis, notably through the transformation of LPCs into tumour initiating cells.
{"title":"Risk factors of primary liver cancer initiation associated with tumour initiating cell emergence: novel targets for promising preventive therapies","authors":"A. Brouillet, Fouad Lafdil","doi":"10.1136/egastro-2023-100010","DOIUrl":"https://doi.org/10.1136/egastro-2023-100010","url":null,"abstract":"Primary liver cancers ranked as the sixth most commonly diagnosed cancers and the third-leading cause of cancer-related death in 2020. Despite encouraging findings on diagnosis and treatments, liver cancer remains a life-threatening disease with a still increasing incidence.Therefore, it is of interest to better characterise and understand the mechanistic process occurring at early steps of carcinogenesis. Inflammatory responses in liver diseases participate in the activation of liver progenitor cells (LPCs) facultative compartment but also to their transformation into cancer stem cells (CSCs) and give rise to primary liver cancer including hepatocellular carcinoma and cholangiocarcinoma. Higher intratumoural heterogeneity has been associated with poorer prognosis and linked to tumour escape from the immune surveillance and to resistance to chemotherapy. A better understanding of the malignant transformation of LPC as tumour initiating cells (ie, CSC) should also provide a potential new therapeutic target for anticancer therapy. In this review, we summarise the recent reports identifying underlying mechanisms by which chronic liver inflammatory responses could trigger the early steps in liver carcinogenesis, notably through the transformation of LPCs into tumour initiating cells.","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83811209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1136/egastro-2023-100005
Jianghua Zhou, Dan-Qin Sun, Giovanni Targher, Christopher D Byrne, Byung-wan Lee, Masahide Hamaguchi, Seung Up Kim, Xuhong Hou, Gian Paolo Fadini, Michio Shimabukuro, Masato Furuhashi, Ning-Jian Wang, Herbert Tilg, Ming-Hua Zheng
Background and aim Metabolic dysfunction-associated fatty liver disease (MAFLD) is an alternative description and classification of non-alcoholic fatty liver disease (NAFLD) that may have better utility than NAFLD in clinical practice. We performed a meta-analysis to quantify the magnitude of the association between MAFLD and risk of both prevalent and incident chronic kidney disease (CKD). Methods We systematically searched PubMed, Medline (OVID), Embase (OVID), Web of Science and Cochrane Library from database inception until 29 May 2022. We included observational studies examining the association between MAFLD and risk of CKD, defined by estimated glomerular filtration rate ≤60 mL/min/1.73 m 2 or presence of abnormal albuminuria. Meta-analysis was performed using random-effects models to obtain summary HRs or ORs with 95% CIs. Results Seventeen observational studies with aggregate data on 845 753 participants were included in meta-analysis. In the 7 cohort studies, the pooled random-effects HR for incident CKD in patients with MAFLD was 1.29 (95% CI 1.17 to 1.41, I 2 =87.0%). In the 10 cross-sectional studies, the pooled random-effects OR for prevalent CKD in patients with MAFLD was 1.35 (95% CI 1.11 to 1.64, I 2 =92.6%). Conclusion MAFLD is significantly associated with an increased prevalence and incidence of CKD. PROSPERO registration number CRD42022352366.
背景和目的代谢功能障碍相关脂肪性肝病(MAFLD)是非酒精性脂肪性肝病(NAFLD)的另一种描述和分类，在临床实践中可能比NAFLD有更好的效用。我们进行了一项荟萃分析，以量化MAFLD与流行和突发慢性肾脏疾病(CKD)风险之间的关联程度。方法系统检索PubMed、Medline (OVID)、Embase (OVID)、Web of Science和Cochrane Library从建库到2022年5月29日的数据库。我们纳入了观察性研究，以肾小球滤过率≤60ml /min/1.73 m2或存在异常蛋白尿来确定MAFLD与CKD风险之间的关系。采用随机效应模型进行meta分析，获得95% ci的总hr或or。meta分析纳入17项观察性研究，共纳入845753名受试者。在这7项队列研究中，MAFLD患者发生CKD的随机效应HR为1.29 (95% CI 1.17 ~ 1.41, i2 =87.0%)。在10项横断面研究中，MAFLD患者中流行CKD的合并随机效应OR为1.35 (95% CI 1.11至1.64,i2 =92.6%)。结论MAFLD与CKD患病率和发病率增高有显著相关性。普洛斯彼罗注册号CRD42022352366。
{"title":"Metabolic dysfunction-associated fatty liver disease increases risk of chronic kidney disease: a systematic review and meta-analysis","authors":"Jianghua Zhou, Dan-Qin Sun, Giovanni Targher, Christopher D Byrne, Byung-wan Lee, Masahide Hamaguchi, Seung Up Kim, Xuhong Hou, Gian Paolo Fadini, Michio Shimabukuro, Masato Furuhashi, Ning-Jian Wang, Herbert Tilg, Ming-Hua Zheng","doi":"10.1136/egastro-2023-100005","DOIUrl":"https://doi.org/10.1136/egastro-2023-100005","url":null,"abstract":"Background and aim Metabolic dysfunction-associated fatty liver disease (MAFLD) is an alternative description and classification of non-alcoholic fatty liver disease (NAFLD) that may have better utility than NAFLD in clinical practice. We performed a meta-analysis to quantify the magnitude of the association between MAFLD and risk of both prevalent and incident chronic kidney disease (CKD). Methods We systematically searched PubMed, Medline (OVID), Embase (OVID), Web of Science and Cochrane Library from database inception until 29 May 2022. We included observational studies examining the association between MAFLD and risk of CKD, defined by estimated glomerular filtration rate ≤60 mL/min/1.73 m 2 or presence of abnormal albuminuria. Meta-analysis was performed using random-effects models to obtain summary HRs or ORs with 95% CIs. Results Seventeen observational studies with aggregate data on 845 753 participants were included in meta-analysis. In the 7 cohort studies, the pooled random-effects HR for incident CKD in patients with MAFLD was 1.29 (95% CI 1.17 to 1.41, I 2 =87.0%). In the 10 cross-sectional studies, the pooled random-effects OR for prevalent CKD in patients with MAFLD was 1.35 (95% CI 1.11 to 1.64, I 2 =92.6%). Conclusion MAFLD is significantly associated with an increased prevalence and incidence of CKD. PROSPERO registration number CRD42022352366.","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"207 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134951699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1136/egastro-2023-100008
Wei-Yue Chen, Chao Li, Zhi-Peng Liu, Qingnan Kong, Liyang Sun, Y-Y. Zeng, Ying-Jian Liang, Yahao Zhou, Ting-Hao Chen, Zi-Xiang Chen, Ming-Da Wang, Lan-Qing Yao, Wanyee Lau, T. Pawlik, F. Shen, J. Ji, Tian Yang
The role of adjuvant transarterial chemoembolisation (TACE) to reduce postoperative recurrence varies widely among patients undergoing hepatectomy with curative intent for hepatocellular carcinoma (HCC). Personalised predictive tool to select which patients may benefit from adjuvant TACE is lacking. This study aimed to develop and validate an online calculator for estimating the reduced risk of early recurrence from adjuvant TACE for patients with HCC.From a multi-institutional database, 2590 eligible patients undergoing curative-intent hepatectomy for HCC were enrolled, and randomly assigned to the training and validation cohorts. Independent predictors of early recurrence within 1 year of surgery were identified in the training cohort, and subsequently used to construct a model and corresponding prediction calculator. The predictive performance of the model was validated using concordance indexes (C-indexes) and calibration curves, and compared with conventional HCC staging systems. The reduced risk of early recurrence when receiving adjuvant TACE was used to estimate the expected benefit from adjuvant TACE.The prediction model was developed by integrating eight factors that were independently associated with risk of early recurrence: alpha-fetoprotein level, maximum tumour size, tumour number, macrovascular and microvascular invasion, satellite nodules, resection margin and adjuvant TACE. The model demonstrated good calibration and discrimination in the training and validation cohorts (C-indexes: 0.799 and 0.778, respectively), and performed better among the whole cohort than four conventional HCC staging systems (C-indexes: 0.797 vs 0.562–0.673, all p<0.001). An online calculator was built to estimate the reduced risk of early recurrence from adjuvant TACE for patients with resected HCC.The proposed calculator can be adopted to assist decision-making for clinicians and patients to determine which patients with resected HCC can significantly benefit from adjuvant TACE.
辅助经动脉化疗栓塞(TACE)减少术后复发的作用在接受肝切除术的肝细胞癌(HCC)患者中差异很大。缺乏个性化的预测工具来选择哪些患者可能从辅助TACE中受益。本研究旨在开发和验证一个在线计算器，用于评估HCC患者辅助TACE早期复发风险的降低。从一个多机构数据库中，2590名接受HCC治疗目的肝切除术的符合条件的患者被纳入研究，并随机分配到培训和验证队列。在训练队列中确定1年内手术早期复发的独立预测因素，并随后用于构建模型和相应的预测计算器。通过一致性指数(c指数)和校准曲线验证模型的预测性能，并与传统的HCC分期系统进行比较。接受辅助TACE治疗后早期复发风险的降低被用来评估辅助TACE治疗的预期获益。该预测模型综合了与早期复发风险独立相关的8个因素:甲胎蛋白水平、最大肿瘤大小、肿瘤数量、大血管和微血管侵犯、卫星结节、切除边缘和辅助TACE。该模型在训练和验证队列(c指数分别为0.799和0.778)中表现出良好的校准和辨别能力，在整个队列中表现优于四种传统的HCC分期系统(c指数:0.797 vs 0.562-0.673，均p<0.001)。建立了一个在线计算器来估计肝癌切除患者接受辅助TACE后早期复发风险的降低。建议的计算器可用于帮助临床医生和患者决策，以确定哪些切除的HCC患者可以从辅助TACE中显着获益。
{"title":"Novel online calculator to predict reduced risk of early recurrence from adjuvant transarterial chemoembolisation for patients with hepatocellular carcinoma","authors":"Wei-Yue Chen, Chao Li, Zhi-Peng Liu, Qingnan Kong, Liyang Sun, Y-Y. Zeng, Ying-Jian Liang, Yahao Zhou, Ting-Hao Chen, Zi-Xiang Chen, Ming-Da Wang, Lan-Qing Yao, Wanyee Lau, T. Pawlik, F. Shen, J. Ji, Tian Yang","doi":"10.1136/egastro-2023-100008","DOIUrl":"https://doi.org/10.1136/egastro-2023-100008","url":null,"abstract":"The role of adjuvant transarterial chemoembolisation (TACE) to reduce postoperative recurrence varies widely among patients undergoing hepatectomy with curative intent for hepatocellular carcinoma (HCC). Personalised predictive tool to select which patients may benefit from adjuvant TACE is lacking. This study aimed to develop and validate an online calculator for estimating the reduced risk of early recurrence from adjuvant TACE for patients with HCC.From a multi-institutional database, 2590 eligible patients undergoing curative-intent hepatectomy for HCC were enrolled, and randomly assigned to the training and validation cohorts. Independent predictors of early recurrence within 1 year of surgery were identified in the training cohort, and subsequently used to construct a model and corresponding prediction calculator. The predictive performance of the model was validated using concordance indexes (C-indexes) and calibration curves, and compared with conventional HCC staging systems. The reduced risk of early recurrence when receiving adjuvant TACE was used to estimate the expected benefit from adjuvant TACE.The prediction model was developed by integrating eight factors that were independently associated with risk of early recurrence: alpha-fetoprotein level, maximum tumour size, tumour number, macrovascular and microvascular invasion, satellite nodules, resection margin and adjuvant TACE. The model demonstrated good calibration and discrimination in the training and validation cohorts (C-indexes: 0.799 and 0.778, respectively), and performed better among the whole cohort than four conventional HCC staging systems (C-indexes: 0.797 vs 0.562–0.673, all p<0.001). An online calculator was built to estimate the reduced risk of early recurrence from adjuvant TACE for patients with resected HCC.The proposed calculator can be adopted to assist decision-making for clinicians and patients to determine which patients with resected HCC can significantly benefit from adjuvant TACE.","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82477497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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