Alcohol consumption poses an escalating public health challenge.However,the impact of alcoholic liver disease(ALD)on post-transplant hepatitis B virus(HBV)reactivation and surgical outcomes remains inadequately charac...Alcohol consumption poses an escalating public health challenge.However,the impact of alcoholic liver disease(ALD)on post-transplant hepatitis B virus(HBV)reactivation and surgical outcomes remains inadequately characterized.Herein,we retrospectively analyzed our cohort(NCT06114251)comprising 453 patients with an HBV background.Propensity score matching(PSM)and sensitivity analyses were employed to assess the influence of ALD on surgical outcomes.Benchmark analysis compared the predictive performance of 21 models for post-transplant HBV reactivation.The Shapley additive explanation(SHAP)algorithm facilitated feature ranking and model interpretation.Patients were stratified into three subgroups based on the alcohol-modified HBV reactivation index(AMBRI).Among the cohort,113 patients(24.9%)had concurrent pre-transplant diagnoses of ALD and HBV infection,while 340(75.1%)had HBV infection alone.The presence of ALD was associated with an elevated risk of HBV reactivation and liver metastasis.PSM and sensitivity analyses revealed significantly lower five-year HBV reactivation-free survival(74.9%vs 85.4%),overall survival(OS,56.2%vs 70.5%),and tumor recurrence-free survival(RFS,47.8%vs 63.3%)in the ALD cohort.In recipients without HBV reactivation,hepatocellular carcinomas(HCCs)arising from both ALD and HBV exhibited inferior RFS(log-rank P=0.026)and OS beyond one year(landmark P=0.032)compared to HBV-related HCC alone.Benchmark analysis identified the surv.cforest model as the optimal predictor,achieving an area under the receiver operating characteristic(AUC)curve of 0.914 in internal validation and 0.884 in external validation,outperforming the published Cox model(AUC=0.78).AMBRI-based stratification delineated three distinct risk subgroups,with the intermediate-and high-risk groups exhibiting significantly worse OS and RFS than the low-risk group.In this study,stratification by AMBRI identified intermediate-and high-risk groups with poorer post-transplant outcomes,underscoring the necessity for intensified surveillance and enhanced HBV treatment regimens,particularly in recipients with pre-transplant ALD.展开更多
Background:This study aimed to compare the clinical outcomes and toxicity between small hepatocellular carcinoma(HCC)patients treated with stereotactic body radiation therapy(SBRT)and those treated with radiofrequency...Background:This study aimed to compare the clinical outcomes and toxicity between small hepatocellular carcinoma(HCC)patients treated with stereotactic body radiation therapy(SBRT)and those treated with radiofrequency ablation(RFA).Methods:We searched databases for relevant clinical studies.The primary outcomes of interest were overall survival(OS)at 1 and 2 years,freedom from local progression(FFLP)rate at 2 years,and complications.Results:Five cohorts from 5 retrospective studies and 4,814 patients with HCC were included.Pooled OS at 2 years was significantly lower for SBRT than for RFA[odds ratio(OR):0.63;95%confidence interval(CI):0.51-0.79;P<0.0001],but the pooled FFLP rate at 2 years was higher for SBRT than for RFA(OR:1.66;95%CI:1.05-2.61;P=0.03).In addition,there was no significant difference in the local and liver toxicities of the two treatments.The contradictory conclusion between the OS and FFLP outcome may be attributed to the difference in radiological dose and location,but there were no uniform criteria to illustrate the radiological dose and location in the included studies.Conclusions:SBRT had a higher local control ratio but poorer prognosis than RFA in patients with small HCC.The local toxicity was comparable in both treatments.Further trials should be designed with uniform standards for SBRT and RFA treatments.展开更多
Cholangiocarcinoma(CCA),a malignant carcinoma originating from biliary epithelium,is the second largest primary liver malignancy,accounting for 10-15%of hepatobiliary malignancies.Macroscopically,CCA is a fatal malign...Cholangiocarcinoma(CCA),a malignant carcinoma originating from biliary epithelium,is the second largest primary liver malignancy,accounting for 10-15%of hepatobiliary malignancies.Macroscopically,CCA is a fatal malignancy,with a 5-year survival rate of less than 10%(1).The lack of typical symptoms and signs makes early CCA difficult to identify and diagnose by early health screening.The diagnosis of CCA mainly relies on radiography,tumor biomarkers,invasive diagnosis,as well as pathological examination,which results in the majority of patients being detected in the middle and late stages,and only about one-third of CCA patients have access to treatment(1).展开更多
基金supported by the National Natural Science Foun-dation of China(92159202)the National Science and Technology Major Project of China(2017ZX10203205)+4 种基金the Fundamental Research Funds for the Central Universities(2022ZFJH003)the Major Research Plan of Key Research and Development Project of Zhejiang Province(2024C03149 and 2023C03046)the National Key Research and Development Program of China(2021YFF1200404 and 2021YFA1201200)the Zhejiang Provincial Natural Science Foundation of China(LQ24C050005 and LQ22H160052)the Medical and Health Technology Program Project of Zhejiang Province(2021434810).
文摘Alcohol consumption poses an escalating public health challenge.However,the impact of alcoholic liver disease(ALD)on post-transplant hepatitis B virus(HBV)reactivation and surgical outcomes remains inadequately characterized.Herein,we retrospectively analyzed our cohort(NCT06114251)comprising 453 patients with an HBV background.Propensity score matching(PSM)and sensitivity analyses were employed to assess the influence of ALD on surgical outcomes.Benchmark analysis compared the predictive performance of 21 models for post-transplant HBV reactivation.The Shapley additive explanation(SHAP)algorithm facilitated feature ranking and model interpretation.Patients were stratified into three subgroups based on the alcohol-modified HBV reactivation index(AMBRI).Among the cohort,113 patients(24.9%)had concurrent pre-transplant diagnoses of ALD and HBV infection,while 340(75.1%)had HBV infection alone.The presence of ALD was associated with an elevated risk of HBV reactivation and liver metastasis.PSM and sensitivity analyses revealed significantly lower five-year HBV reactivation-free survival(74.9%vs 85.4%),overall survival(OS,56.2%vs 70.5%),and tumor recurrence-free survival(RFS,47.8%vs 63.3%)in the ALD cohort.In recipients without HBV reactivation,hepatocellular carcinomas(HCCs)arising from both ALD and HBV exhibited inferior RFS(log-rank P=0.026)and OS beyond one year(landmark P=0.032)compared to HBV-related HCC alone.Benchmark analysis identified the surv.cforest model as the optimal predictor,achieving an area under the receiver operating characteristic(AUC)curve of 0.914 in internal validation and 0.884 in external validation,outperforming the published Cox model(AUC=0.78).AMBRI-based stratification delineated three distinct risk subgroups,with the intermediate-and high-risk groups exhibiting significantly worse OS and RFS than the low-risk group.In this study,stratification by AMBRI identified intermediate-and high-risk groups with poorer post-transplant outcomes,underscoring the necessity for intensified surveillance and enhanced HBV treatment regimens,particularly in recipients with pre-transplant ALD.
基金This work was supported by the National Natural Science Foundation of China under grant no.81570591 and the Science and Technology Department of Zhejiang Province under grant no.LGF19H030017。
文摘Background:This study aimed to compare the clinical outcomes and toxicity between small hepatocellular carcinoma(HCC)patients treated with stereotactic body radiation therapy(SBRT)and those treated with radiofrequency ablation(RFA).Methods:We searched databases for relevant clinical studies.The primary outcomes of interest were overall survival(OS)at 1 and 2 years,freedom from local progression(FFLP)rate at 2 years,and complications.Results:Five cohorts from 5 retrospective studies and 4,814 patients with HCC were included.Pooled OS at 2 years was significantly lower for SBRT than for RFA[odds ratio(OR):0.63;95%confidence interval(CI):0.51-0.79;P<0.0001],but the pooled FFLP rate at 2 years was higher for SBRT than for RFA(OR:1.66;95%CI:1.05-2.61;P=0.03).In addition,there was no significant difference in the local and liver toxicities of the two treatments.The contradictory conclusion between the OS and FFLP outcome may be attributed to the difference in radiological dose and location,but there were no uniform criteria to illustrate the radiological dose and location in the included studies.Conclusions:SBRT had a higher local control ratio but poorer prognosis than RFA in patients with small HCC.The local toxicity was comparable in both treatments.Further trials should be designed with uniform standards for SBRT and RFA treatments.
基金the Natural Science Foundation of Zhejiang Province(LQ21H160025).
文摘Cholangiocarcinoma(CCA),a malignant carcinoma originating from biliary epithelium,is the second largest primary liver malignancy,accounting for 10-15%of hepatobiliary malignancies.Macroscopically,CCA is a fatal malignancy,with a 5-year survival rate of less than 10%(1).The lack of typical symptoms and signs makes early CCA difficult to identify and diagnose by early health screening.The diagnosis of CCA mainly relies on radiography,tumor biomarkers,invasive diagnosis,as well as pathological examination,which results in the majority of patients being detected in the middle and late stages,and only about one-third of CCA patients have access to treatment(1).
