Precision liver surgery has advanced significantly with the improvements of technology,and led to a significant decrease in mortality and complication rates.We argued for the necessity of a paradigm shift in liver sur...Precision liver surgery has advanced significantly with the improvements of technology,and led to a significant decrease in mortality and complication rates.We argued for the necessity of a paradigm shift in liver surgery,and advocated“precision liver resection”as a surgical concept for the first time in 2006.The aim of precision liver surgery involves personalized surgery planning based on individual patient status.The core of the precision liver surgery is to be visualizable,quantifiable,and controllable also known as three essential elements.Since precision paradigm is essential in modern surgery,characterized by multi-objective optimization accommodating therapeutic effectiveness,surgical safety,and minimal invasiveness,it had expanded to different surgery,such as neurosurgery and gastrointestinal surgery.Techniques such as three-dimensional(3D)reconstruction,intraoperative navigation systems,and indocyanine green(ICG)fluorescence imaging facilitate precise identification and removal of liver tumors while preserving healthy liver tissue.These advancements not only promote the certainty,predictability,and controllability in surgical practice,and achieve the balance of these three essential elements.As technological progress continues,precision liver surgery holds the promise of safer and more effective treatments.Precision medicine aims to balance operative risk against survival benefit by removing targeted lesions,protecting liver function,minimizing surgical trauma.The ultimate aim of precision medicine is the maximization of patient benefit(Fig.1).展开更多
Background and aims:Hepatocellular carcinoma(HCC)is the third leading cause of cancer-related deaths worldwide.The mechanisms driving the transition from hepatitis to cirrhosis,and eventually,to HCC are unclear.This s...Background and aims:Hepatocellular carcinoma(HCC)is the third leading cause of cancer-related deaths worldwide.The mechanisms driving the transition from hepatitis to cirrhosis,and eventually,to HCC are unclear.This study aimed to clarify the metabolic changes that underly the progression of HCC and identify potential prognostic and therapeutic biomarkers.Methods:This prospective study collected serum samples from patients with chronic hepatitis,cirrhosis,or HCC,hospitalized at the Fifth Medical Center of the PLA General Hospital,from December 2022 to December 2023.The samples were analyzed using non-targeted,ultra-high-performance liquid chromatography and mass spectrometry.Partial least squares-discriminant analysis modeling and t-tests were used to identify key differentially expressed metabolites associated with the progression from hepatitis to cirrhosis to HCC.Pathway enrichment analysis was conducted to determine the key metabolic pathways involved,while machine learning models were applied to identify the metabolite signatures.Results:We identified 153 differentially expressed metabolites in the progression from hepatitis to cirrhosis to HCC,many of which were involved in ammonia cycling or the metabolism of methylhistidine,alanine,arginine,proline,or betaine.We also identified L-histidine and adenosine as the metabolites that demonstrated significant sensitivity and specificity for distinguishing among the hepatitis,cirrhosis,and HCC stages.Conclusions:Our study comprehensively characterized the metabolic profiles of the different stages of the hepatitis-cirrhosis-HCC transition.We showed that serum metabolite detection is a viable diagnostic tool for identifying and monitoring high-risk individuals,which could potentially be used to halt the development of HCC.展开更多
Background and aims:Methane has shown protective effects against ischemia and reperfusion injury(IRI)in the liver,but the mechanism underlying these beneficial effects is unclear.To investigate the hypothesis that ita...Background and aims:Methane has shown protective effects against ischemia and reperfusion injury(IRI)in the liver,but the mechanism underlying these beneficial effects is unclear.To investigate the hypothesis that itaconate facilitates in methane-induced Nrf2 pathway activation to mitigate liver IRI.Methods:An oxygen and glucose derivation(OGD)model using RAW 264.7 cells and a liver IRI model in mice were established.Methane's beneficial effects were assessed through hematoxylin and eosin(HE)staining,Suzuki's score,serum alanine transferase level,superoxide dismutase(SOD)level,malondialdehyde(MDA)level,and cell viability.The relative expression levels of Nrf2,its downstream molecules and some inflammatory factors were detected via western blotting.Itaconate levels were analyzed using liquid chromatography.RAW 264.7 cells were transfected with short hairpin RNA targeting mouse aconitate decarboxylase 1(Acod1)mRNA for itaconate downregulation.Results:Methane significantly alleviated liver IRI,as shown by the significant reduction in Suzuki's scores and alanine transferase(ALT)levels in vivo.Methane treatment significantly increased MTT and SOD levels and decreased MDA levels in the OGD injury model in vitro.Methane also increased the total and nuclear Nrf2 expression levels,activated downstream molecules including heme oxygenase-1(HO-1),NQO1 and affected the production of inflammatory cytokines such as IL-10,IL-1β,and IL-12.Itaconate levels were significantly elevated after methane treatment compared with the OGD injury group.The protective effects of methane were abolished after itaconate downregulation through Acod1 knockdown.Conclusions:Methane alleviates liver IRI through itaconate/Nrf2 pathway activation,with itaconate being critical for methane's beneficial effects.展开更多
In a recent issue of the International Journal of Surgery,Li et al.1 conducted a multi-institutional study across 11 centers in China,eval-uating the outcomes of patients undergoing minimally invasive anatomical hepat...In a recent issue of the International Journal of Surgery,Li et al.1 conducted a multi-institutional study across 11 centers in China,eval-uating the outcomes of patients undergoing minimally invasive anatomical hepatectomy using the Laennec approach.Among the 445 patients included,106 underwent the traditional approach,while 339 received the Laennec approach.The study's most significant finding was that the Laennec approach was associated with a shorter operation time,including reduced hepatic pedicle isolation duration,compared to the traditional approach.Additionally,the authors conducted a subgroup analysis,stratifying patients by tumor pathology and surgical technique(laparoscopic vs.robotic).展开更多
We read with great interest the multinational retrospective study by Scheiner and coworkers1 on patients with advanced hepatocellular carcinoma who achieved complete remission after first-line systemic immunotherapy.T...We read with great interest the multinational retrospective study by Scheiner and coworkers1 on patients with advanced hepatocellular carcinoma who achieved complete remission after first-line systemic immunotherapy.Their excellent study provides strong evidence in support of systemic immunotherapy for certain patients with advanced disease,as well as for using modified Response Evaluation Criteria In Solid Tumours(mRECIST)rather than stricter RECIST 1.1 guidelines when deciding how to manage these patients.展开更多
Hepatobiliary surgeries,particularly hepatectomy and liver transplantation,are critical interventions for hepatic malignancies and end-stage liver diseases.These complex procedures face challenges due to the liver'...Hepatobiliary surgeries,particularly hepatectomy and liver transplantation,are critical interventions for hepatic malignancies and end-stage liver diseases.These complex procedures face challenges due to the liver's intricate anatomy and vascularization.The integration of Mixed Reality(MR),Augmented Reality(AR),and Artificial Intelligence(AI)is increasingly enhancing the precision,safety,and outcomes of these surgeries.MR and AR improve visualization of anatomical structures,assist in preoperative planning,and support patient education through immersive 3D models.AI-driven technologies provide real-time intraoperative feedback and navigation,optimizing surgical decisions and minimizing risks.Postoperatively,these technologies aid in patient education and recovery management,ultimately improving outcomes.This review explores the applications of MR,AR,and AI in liver surgeries and their potential to transform surgical practice by enhancing precision,safety,and patient engagement.展开更多
Liver diseases,including liver inflammation,fatty liver disease,cirrhosis,and hepatocellular carcinoma,represent significant global health challenges.Traditional treatments often emphasize symptom management,leading t...Liver diseases,including liver inflammation,fatty liver disease,cirrhosis,and hepatocellular carcinoma,represent significant global health challenges.Traditional treatments often emphasize symptom management,leading to increased interest in natural bioactive compounds for their potential therapeutic benefits.This review examines the role of natural bioactive compounds in managing hepatic disorders,with a particular focus on their mechanisms of action and supporting clinical evidence.Compounds such as curcumin,silymarin,resveratrol,triterpenoids,apigenin,and delphinidin derivatives have demonstrated promising hepatoprotective effects in preclinical studies,largely due to their anti-inflammatory,antioxidant,and anti-fibrotic properties.Nevertheless,further research is necessary to determine optimal dosing,safety profiles,and long-term effects.Understanding the mechanisms of action and therapeutic potential of these bioactive compounds may provide critical insights into their role in the treatment of hepatic diseases.展开更多
Liver cancer is a leading cause of cancer-related death worldwide,and its complexity and heterogeneity pose considerable challenges to conventional treatment.In recent years,the rise of organoid technology has provide...Liver cancer is a leading cause of cancer-related death worldwide,and its complexity and heterogeneity pose considerable challenges to conventional treatment.In recent years,the rise of organoid technology has provided new perspectives and tools for precision medicine in oncology.The use of high-fidelity organoids capable of recapitulating patients'genotypic and phenotypic features can further facilitate personalised treatment.In this review,we discuss 1)the advantages of liver cancer organoids as disease models over traditional models;2)the origin and establishment of liver cancer organoids;3)the application of liver cancer organoids technology in tumour precision medicine;4)the technical tools of liver cancer-derived organoids;and 5)current solutions for the deficiencies and challenges of liver cancer organoids.This review should provide both a deeper under-standing of the research progress and application prospects of liver cancer organoids,as well as theoretical support and practical guidance for more complete integration of liver cancer research and precision medicine.展开更多
Liver diseases continue to pose formidable challenges to global health in 2025,characterized by their broad disease spectrum and therapeutic complexity.Among the diverse array of hepatic disorders,hepatocellular carci...Liver diseases continue to pose formidable challenges to global health in 2025,characterized by their broad disease spectrum and therapeutic complexity.Among the diverse array of hepatic disorders,hepatocellular carcinoma(HCC)ranks as the sixth most common cancer and third leading cause of cancer-related mortality worldwide.1 Reflecting changing global health patterns and lifestyle factors,the landscape of liver diseases is experiencing profound changes:while successful viral hepatitis control programs in many regions have led to a gradual decline in virus-related HCC incidence.展开更多
Background and aims:Metabolic dysfunction-associated fatty liver disease(MAFLD)is associated with coronary artery disease(CAD),but existing risk assessment tools lack precision and scalability.We developed an AI-drive...Background and aims:Metabolic dysfunction-associated fatty liver disease(MAFLD)is associated with coronary artery disease(CAD),but existing risk assessment tools lack precision and scalability.We developed an AI-driven multimodal framework integrating traditional Chinese medicine(TCM)tongue-based diagnosis with clinical biomarkers to stratify CAD risk in MAFLD.Methods:In this cross-sectional study with prospective data collection,which comprised 1073 MAFLD patients stratified by CAD status(MAFLD without CAD,n=942;MAFLD with CAD,n=131),baseline characteristics were compared using chi-square tests for categorical variables and Mann-Whitney U tests for continuous vari-ables,with p<0.05 considered significant.We developed two distinct deep learning models:Model-1(non-invasive)using ResNet18 combined tongue image features with demographic and comorbidity data,and Model-2(comprehensive)incorporated blood biomarkers alongside the features used in Model-1.Multimodal feature fusion was achieved through a dedicated cross-attention network.Model performance was rigorously evaluated using 10-fold cross-validation,with area under the curve(AUC),sensitivity,and specificity as primary metrics.Focal loss was employed to address class imbalance.Results:The coexistence of CAD was associated with significantly higher rates of hypertension,diabetes,and familial cardiovascular history in patients with MAFLD(p<0.001),along with distinct metabolic profiles:elevated systemic inflammation(neutrophil-lymphocyte ratio),advanced fibrosis(FIB-4),elevated fasting glucose levels,and attenuated hepatic inflammation(ALT and AST).Model-1 achieved an AUC of 0.858(sensitivity 0.778,specificity 0.908),while Model-2 demonstrated superior discrimination(AUC 0.933),particularly in tertiary care.Conclusion:Our AI-driven dual-model framework addresses the critical unmet need for CAD identification in MAFLD patients,providing a community-scalable screening tool(Model-1)and a precision clinical assessment model(Model-2),while offering empirical support for TCM tongue diagnosis.Pending external validation to confirm its generalizability,this approach may serve as a cost-efficient non-invasive screening strategy for this high-risk population.展开更多
Breast cancer is the most prevalent malignancy in women globally,with metastatic disease accounting for approximately 90%of breast cancer-related deaths.The development of breast cancer liver metastases in patients no...Breast cancer is the most prevalent malignancy in women globally,with metastatic disease accounting for approximately 90%of breast cancer-related deaths.The development of breast cancer liver metastases in patients not only significantly reduces survival rates but also severely impairs quality of life.This review systematically examines therapeutic advances in the treatment of breast cancer liver metastases from 2010 to 2023,focusing on novel targeted agents(CDK4/6 inhibitors,PI3K/mTOR pathway inhibitors),immune checkpoint inhibitors,and local interventions.We provide evidence-based recommendations to optimize personalized treatment strategies and improve clinical outcomes for patients with breast cancer liver metastases.展开更多
Background and aims:Contrast-enhanced ultrasound(CEUS)is widely used in the diagnosis of complications after liver transplantation.This study compared the diagnostic efficacy of CEUS with that of contrast-enhanced com...Background and aims:Contrast-enhanced ultrasound(CEUS)is widely used in the diagnosis of complications after liver transplantation.This study compared the diagnostic efficacy of CEUS with that of contrast-enhanced computed tomography(CECT)for focal liver lesions in liver transplant recipients.Methods:We retrospectively reviewed 115 liver transplant recipients who were diagnosed to have focal liver lesions at our hospital between June 2015 and June 2023.All patients were examined by CEUS and CECT and had a definitive pathological diagnosis.Based on the diagnostic outcomes,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of these imaging modalities in differentiating between benign and malignant lesions were calculated using a four-table method.Differences in diagnostic efficacy between CEUS and CECT with respect to pathological findings were compared using the chi-squared test and Fisher's exact test.The consistency of diagnosis between these modalities was assessed using the linear weighted kappa test.Results:CEUS identified 79 malignant and 36 benign lesions,while CECT detected 81 malignant and 34 benign lesions.The sensitivity,specificity,positive predictive value,negative predictive value,and overall accuracy of CEUS and CECT in diagnosis of focal lesions in transplanted livers were 95.7%vs 97.2%,97.2%vs 96.1%,97.9%vs 97.5%,97.2%vs 98.6%,and 96.4%vs 97.1%,respectively.Both CEUS and CECT demonstrated comparable diagnostic efficacy(κ¼0.899).CEUS showed strong diagnostic consistency with pathological results(κ¼0.912)and was more effective than CECT in diagnosing focal normal liver tissue and fat infiltration(p<0.05).Both methods were equally effective for diagnosis of focal inflammatory lesions,infarction,and hemangioma.Conclusion:CEUS is as effective as CECT for diagnosis of benign and malignant lesions in transplanted livers but surpasses CECT in differentiating benign lesions,particularly focal normal liver tissue and fat infiltration.展开更多
Background:This study sought to evaluate the efficacy and safety of programmed cell death protein-1(PD-1)inhibitor immunotherapy specifically in metabolic dysfunction-associated fatty liver disease(MAFLD)-associated i...Background:This study sought to evaluate the efficacy and safety of programmed cell death protein-1(PD-1)inhibitor immunotherapy specifically in metabolic dysfunction-associated fatty liver disease(MAFLD)-associated intrahepatic cholangiocarcinoma(ICC)patients,in comparison to those without MAFLD.Methods:We retrospectively included 161 ICC patients,both with and without MAFLD,who underwent PD-1 inhibitors between March 2019 and August 2024.Subsequent locoregional interventions(e.g.,hepatic arterial infusion chemotherapy)and second-line systemic agents(e.g.,lenvatinib)were allowed.The primary endpoints included overall survival(OS)and progression-free survival(PFS),while the secondary endpoints comprised objective response rate(ORR),disease control rate(DCR),and adverse events(AEs).Results:The MAFLD group included 20 patients,while the Non-MAFLD group comprised 141 patients.The OS was 18.0 months for the MAFLD group and 20.1 months for the Non-MAFLD group,while the median PFS was 8.0 and 11.5 months,respectively.According to the modified RECIST(mRECIST)criteria,the Non-MAFLD group exhibited a greater clinical benefit,reflected in higher ORR and DCR(45.4%vs.20.0%,p=0.031;92.9%vs.75.0%,p=0.024).Multivariate Cox proportional hazard analysis identified carcinoembryonic antigen(CEA),tumor number,and C-reactive protein(CRP)as independent prognostic factors for OS,whereas CEA and tumor number were significant predictors of PFS.Additionally,the overall incidence of AEs was notably lower in the Non-MAFLD group compared to the MAFLD group.Conclusion:This study demonstrated that PD-1 inhibitors resulted in similarly prolonged OS and PFS between ICC patients with and without MAFLD,but a superior tumor response was observed in patients without MAFLD.Additionally,the Non-MAFLD group experienced a significantly lower incidence of AEs than the MAFLD group undergoing PD-1 inhibitors.展开更多
Laennec's capsule is a dense fibrous membrane that has recently been confirmed to exist across the entire liver surface,Glissonean pedicles,and major hepatic veins,forming a continuous fibrous system.Minimally inv...Laennec's capsule is a dense fibrous membrane that has recently been confirmed to exist across the entire liver surface,Glissonean pedicles,and major hepatic veins,forming a continuous fibrous system.Minimally invasive anatomical liver resection based on Laennec's capsule-guided dissection leverages natural avascular planes to enable safe and efficient resection.This approach significantly reduces intraoperative bleeding,improves sur-gical precision and R0 resection rates,and contributes to better long-term survival in patients.This review discusses the anatomical concept of Laennec's capsule and its clinical application in minimally invasive anatomical liver resection.It outlines the advantages,limitations,and strategic use of various preoperative navigation techniques;analyses the indications for intrafascial/extrafascial Glissonean approaches and the technical aspects of their selection;analyses outer/inner dissection of Laennec's capsule around the hepatic veins according to the type of tumour;and proposes technical refinements based on outflow control and precision surgery.Finally,it explores the debate about the origins of Laennec's capsule and suggests directions for future bastardization and research.This review aims to provide hepatobiliary surgeons with a comprehensive reference based on recent technical advances and application strategies for Laennec's capsule-based anatomical liver resection.展开更多
Background and aims:Hepatocellular carcinoma(HCC)presents a significant challenge in tumor management because of its low resection rates.Conversion therapy aims to transform unresectable tumors into resectable ones th...Background and aims:Hepatocellular carcinoma(HCC)presents a significant challenge in tumor management because of its low resection rates.Conversion therapy aims to transform unresectable tumors into resectable ones through local treatments,thereby providing surgical options for some patients with HCC.However,the overall strategies and efficacy of conversion therapy for HCC remain inadequately defined.This study was performed to evaluate the efficacy of hepatic arterial infusion chemotherapy(HAIC)combined with sintilimab and bevacizumab in patients with unresectable liver cancer.Methods:We conducted a retrospective analysis of patients with initially unresectable HCC who received HAIC in conjunction with sintilimab and bevacizumab.Preoperative demographic data,tumor markers,tumor size,tumor count,conversion outcomes,and surgery-related clinical data were collected and analyzed before and after treatment.Results:Twelve patients were included in this study.All patients exhibited satisfactory antitumor effects.Ten patients underwent one or two treatment cycles,while two completed four cycles.The mean alpha-fetoprotein level decreased from 73,471±138,239 to 2374±6325 ng/mL,and the mean tumor size decreased from 11.4±2.2 to 7.6±1.0 cm.Following evaluation,10 patients were successfully converted,with 6 ultimately undergoing curative liver cancer resection;of these 6 patients,4 achieved a pathological complete response.Conclusion:The combination of HAIC with sintilimab and bevacizumab represents a safe and effective strategy for tumor conversion.This approach can achieve significant tumor reduction and favorable effects on portal vein tumor thrombus within a short timeframe,facilitating curative resection of liver cancer.展开更多
Background and aims:This research aimed to develop an innovative predictive model for estimating overall survival(OS)in patients with ampullary carcinoma and to evaluate the clinical benefits of postoperative chemothe...Background and aims:This research aimed to develop an innovative predictive model for estimating overall survival(OS)in patients with ampullary carcinoma and to evaluate the clinical benefits of postoperative chemotherapy(POCT)tailored to individual risk profiles.Methods:Data from patients with ampullary carcinoma were retrospectively analyzed.Multivariable analysis identified key prognostic factors,which were incorporated into a predictive nomogram.The impact of POCT on OS was assessed within risk groups stratified by the nomogram.Results:Data for 3921 patients were included,with 2744 in the training cohort and 1177 in the validation cohort.A nomogram incorporating age,sex,tumor grade,T stage,N stage,and tumor size outperformed the TNM staging system,with areas under the curve for 3-year,5-year,and 8-year OS of 0.755 vs 0.687,0.752 vs 0.694,and 0.750 vs 0.694,respectively,in the training cohort and 0.705 vs 0.664,0.717 vs 0.679,and 0.734 vs 0.703 in the validation cohort.Calibration plots showed excellent agreement between predicted and observed survival outcomes.Decision curve analysis indicated a net benefit across threshold probabilities above that of TNM staging.Risk stratification based on the model indicated that high-risk patients had a significantly increased mortality risk(p<0.001).Notably,POCT significantly improved OS in high-risk patients(p<0.001)but not in low-risk patients.Conclusion:Not all patients benefit from POCT.The proposed nomogram predicts survival effectively and can guide treatment decisions,optimizing outcomes by providing additional chemotherapy for high-risk patients while sparing low-risk patients from unnecessary treatment.展开更多
Anatomic resection remains a fundamental principle in the surgical management of hepatobiliary diseases,whether performed through traditional open surgery or advanced minimally invasive approaches such as laparoscopic...Anatomic resection remains a fundamental principle in the surgical management of hepatobiliary diseases,whether performed through traditional open surgery or advanced minimally invasive approaches such as laparoscopic or robotic-assisted techniques.However,a universally accepted and clearly defined anatomical framework for intraoperative anatomical delineation remains lacking.The growing clinical adoption of Laennec membrane-guided anatomical strategies has been associated with notable improvements in surgical efficacy and anatomical precision.This approach facilitates clear identification of anatomical layers,enhances visualization of key landmarks,and enables the execution of precise anatomical resections.As a result,it promotes standardi-zation and reproducibility across surgical procedures.This article presents a comprehensive review of operative techniques and critical technical considerations for Laennec membrane-guided anatomical procedures in hep-atobiliary surgery,establishing a three-dimensional anatomical foundation for clinical practice to support the standardization and broader adoption of precision-oriented hepatobiliary surgical methodologies.展开更多
With the global incidence of hepatocellular carcinoma(HCC)on the rise,precise staging has become critical for guiding treatment decisions and improving long-term outcomes.The Barcelona Clinic Liver Cancer(BCLC)staging...With the global incidence of hepatocellular carcinoma(HCC)on the rise,precise staging has become critical for guiding treatment decisions and improving long-term outcomes.The Barcelona Clinic Liver Cancer(BCLC)staging system,widely used for HCC classification,incorporates factors such as Child–Pugh A or B liver function,tumor size and number,absence of cancer-related symptoms,and lack of vascular invasion or extrahepatic metastasis.For intermediate-stage HCC,transarterial chemoembolization(TACE)remains the globally recom-mended standard.However,the substantial heterogeneity in tumor burden and liver function among patients means that not all individuals benefit equally from TACE.As a result,a uniform treatment approach is insuffi-cient.Preserving liver function is now recognized as equally important as achieving high objective response rates,with the ultimate goal of prolonging overall survival.In response,researchers have proposed advanced stratification methods for stage B HCC to optimize therapeutic outcomes.While these stratification criteria remain under debate,there is a growing shift from TACE-centric strategies toward personalized targeted ther-apies for specific subpopulations.This review explores advanced stratification concepts,evaluates corresponding treatment strategies,analyzes ongoing clinical trials,and assesses their potential to transform the management of intermediate-stage HCC—while also outlining future directions for its treatment.展开更多
Background and aims:Hepatocellular carcinoma(HCC)is a prevalent malignancy with poor prognosis.This study uses integrated bioinformatic analyses to explore potential competing endogenous RNA(ceRNA)network chains in HC...Background and aims:Hepatocellular carcinoma(HCC)is a prevalent malignancy with poor prognosis.This study uses integrated bioinformatic analyses to explore potential competing endogenous RNA(ceRNA)network chains in HCC.Methods:HCC expression profile data were obtained from the Gene Expression Omnibus dataset,and differential expression analysis was conducted to identify differentially expressed mRNAs(DEmRNAs),microRNAs(DEmiRNAs),and long non-coding RNAs(DElncRNAs)between HCC and normal liver tissue samples.Univariate Cox regression analysis was performed to identify mRNAs associated with the prognosis of HCC patients.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were used to classify the identified genes functionally.Cytoscape software was used to construct a protein–protein interaction network.Using the intersection method,a ceRNA network was established to align data from two databases(miRTarBase and miRcode).Pearson correlation analysis was conducted to evaluate the relationships between lncRNAs and mRNAs.Results:A total of 106 prognosis-related DEmRNAs were identified between HCC and normal samples.A total of 132 DEmiRNAs and 42 DElncRNAs were dysregulated in HCC.A ceRNA network of three lncRNAs,six miRNAs,and eight mRNAs was constructed.High expression of MCM10,CDKN3,RRM2,KIF3A,and ALYREF correlated with a poor prognosis,while high expression of CPEB2,COLEC10,and PBLD was associated with a better prognosis for HCC patients.Expression analysis confirmed the differential expression of these genes in HCC samples.Correlation analysis revealed that a MAGI2-AS3/hsa-miR-450b-5p/COLEC10 axis might play a crucial role in the progression of HCC.Conclusion:The ceRNA network constructed could provide insight into HCC tumorigenesis and might lead to new molecular biomarkers for diagnosing and treating HCC.展开更多
Background and aims:Duodenal varices(DVs)are a rare complication of portal hypertension.This study analyzed the clinical characteristics of DVs and examined the efficacy of endoscopic cyanoacrylate injection for duode...Background and aims:Duodenal varices(DVs)are a rare complication of portal hypertension.This study analyzed the clinical characteristics of DVs and examined the efficacy of endoscopic cyanoacrylate injection for duodenal variceal bleeding.Methods:The clinical data of patients with DVs treated in our hospital from March 2013 to May 2024 were retrospectively analyzed.Results:During the study period,80,850 patients underwent gastroscopy for a total of 122,040 endoscopy sessions.DVs were diagnosed in 52 patients.Eight patients with DVs exhibited duodenal variceal bleeding(15.4%).The overall prevalence of DVs was 0.08%.The prevalence of DVs among patients with upper gastrointestinal varices was 0.16%.The most common etiology of DVs was liver cirrhosis(92.3%).DVs location was the descending segment of the duodenum in 34 patients(65.4%).Forty-four patients(84.6%)had concomitant esophageal and gastric varices.Successful hemostasis was achieved at the time of endoscopy in all patients undergoing emergency endoscopic treatment using cyanoacrylate injection.The 6-week mortality rate was 12.5%.The rebleeding rate was 12.5%.Conclusions:DVs are uncommon,even in hospitals where liver disease is prevalent.Emergency endoscopic cyanoacrylate embolization appears to be highly effective.Complete vein embolization may be considered for patients in poor condition.Age>65 years and low hemoglobin concentration are predictors of duodenal variceal bleeding.展开更多
基金supported by the Beijing Research Ward Excellence Program,BRWEP(BRWEP2024W032240108 for Wang S)National Natural Science Foundation of China(No.81972726 and 82273074 for Yang T+2 种基金No.81930119,No.82090050,and No.82090053 for Dong J)Shanghai Health and Hygiene Discipline Leader Project(No.2022XD001 for Yang T)Shanghai Outstanding Academic Leader Program(No.23XD1424900 for Yang T).
文摘Precision liver surgery has advanced significantly with the improvements of technology,and led to a significant decrease in mortality and complication rates.We argued for the necessity of a paradigm shift in liver surgery,and advocated“precision liver resection”as a surgical concept for the first time in 2006.The aim of precision liver surgery involves personalized surgery planning based on individual patient status.The core of the precision liver surgery is to be visualizable,quantifiable,and controllable also known as three essential elements.Since precision paradigm is essential in modern surgery,characterized by multi-objective optimization accommodating therapeutic effectiveness,surgical safety,and minimal invasiveness,it had expanded to different surgery,such as neurosurgery and gastrointestinal surgery.Techniques such as three-dimensional(3D)reconstruction,intraoperative navigation systems,and indocyanine green(ICG)fluorescence imaging facilitate precise identification and removal of liver tumors while preserving healthy liver tissue.These advancements not only promote the certainty,predictability,and controllability in surgical practice,and achieve the balance of these three essential elements.As technological progress continues,precision liver surgery holds the promise of safer and more effective treatments.Precision medicine aims to balance operative risk against survival benefit by removing targeted lesions,protecting liver function,minimizing surgical trauma.The ultimate aim of precision medicine is the maximization of patient benefit(Fig.1).
基金funded by the National Natural Science Foundation of China(grant number 81673806)the Medical Education Association Foundation of China(grant number 2020KTY001).
文摘Background and aims:Hepatocellular carcinoma(HCC)is the third leading cause of cancer-related deaths worldwide.The mechanisms driving the transition from hepatitis to cirrhosis,and eventually,to HCC are unclear.This study aimed to clarify the metabolic changes that underly the progression of HCC and identify potential prognostic and therapeutic biomarkers.Methods:This prospective study collected serum samples from patients with chronic hepatitis,cirrhosis,or HCC,hospitalized at the Fifth Medical Center of the PLA General Hospital,from December 2022 to December 2023.The samples were analyzed using non-targeted,ultra-high-performance liquid chromatography and mass spectrometry.Partial least squares-discriminant analysis modeling and t-tests were used to identify key differentially expressed metabolites associated with the progression from hepatitis to cirrhosis to HCC.Pathway enrichment analysis was conducted to determine the key metabolic pathways involved,while machine learning models were applied to identify the metabolite signatures.Results:We identified 153 differentially expressed metabolites in the progression from hepatitis to cirrhosis to HCC,many of which were involved in ammonia cycling or the metabolism of methylhistidine,alanine,arginine,proline,or betaine.We also identified L-histidine and adenosine as the metabolites that demonstrated significant sensitivity and specificity for distinguishing among the hepatitis,cirrhosis,and HCC stages.Conclusions:Our study comprehensively characterized the metabolic profiles of the different stages of the hepatitis-cirrhosis-HCC transition.We showed that serum metabolite detection is a viable diagnostic tool for identifying and monitoring high-risk individuals,which could potentially be used to halt the development of HCC.
基金funded by National Natural Science Foundation of China(82000587,82202382)the Beijing Municipal Natural Science Foundation(7242135)。
文摘Background and aims:Methane has shown protective effects against ischemia and reperfusion injury(IRI)in the liver,but the mechanism underlying these beneficial effects is unclear.To investigate the hypothesis that itaconate facilitates in methane-induced Nrf2 pathway activation to mitigate liver IRI.Methods:An oxygen and glucose derivation(OGD)model using RAW 264.7 cells and a liver IRI model in mice were established.Methane's beneficial effects were assessed through hematoxylin and eosin(HE)staining,Suzuki's score,serum alanine transferase level,superoxide dismutase(SOD)level,malondialdehyde(MDA)level,and cell viability.The relative expression levels of Nrf2,its downstream molecules and some inflammatory factors were detected via western blotting.Itaconate levels were analyzed using liquid chromatography.RAW 264.7 cells were transfected with short hairpin RNA targeting mouse aconitate decarboxylase 1(Acod1)mRNA for itaconate downregulation.Results:Methane significantly alleviated liver IRI,as shown by the significant reduction in Suzuki's scores and alanine transferase(ALT)levels in vivo.Methane treatment significantly increased MTT and SOD levels and decreased MDA levels in the OGD injury model in vitro.Methane also increased the total and nuclear Nrf2 expression levels,activated downstream molecules including heme oxygenase-1(HO-1),NQO1 and affected the production of inflammatory cytokines such as IL-10,IL-1β,and IL-12.Itaconate levels were significantly elevated after methane treatment compared with the OGD injury group.The protective effects of methane were abolished after itaconate downregulation through Acod1 knockdown.Conclusions:Methane alleviates liver IRI through itaconate/Nrf2 pathway activation,with itaconate being critical for methane's beneficial effects.
文摘In a recent issue of the International Journal of Surgery,Li et al.1 conducted a multi-institutional study across 11 centers in China,eval-uating the outcomes of patients undergoing minimally invasive anatomical hepatectomy using the Laennec approach.Among the 445 patients included,106 underwent the traditional approach,while 339 received the Laennec approach.The study's most significant finding was that the Laennec approach was associated with a shorter operation time,including reduced hepatic pedicle isolation duration,compared to the traditional approach.Additionally,the authors conducted a subgroup analysis,stratifying patients by tumor pathology and surgical technique(laparoscopic vs.robotic).
基金supported by the Guangxi Key Research and Development Plan(GuiKe AB24010082)the First-class Discipline Innovation-driven Talent Program of Guangxi Medical University.
文摘We read with great interest the multinational retrospective study by Scheiner and coworkers1 on patients with advanced hepatocellular carcinoma who achieved complete remission after first-line systemic immunotherapy.Their excellent study provides strong evidence in support of systemic immunotherapy for certain patients with advanced disease,as well as for using modified Response Evaluation Criteria In Solid Tumours(mRECIST)rather than stricter RECIST 1.1 guidelines when deciding how to manage these patients.
基金funded by Natural Science Foundation of Chongqing,grant number CSTC2021JCYJ-MSXMX1095Chongqing Technology Innovation and Application Development Special Key Project,grant number CSTB2023TIAD-KPX0049-4.
文摘Hepatobiliary surgeries,particularly hepatectomy and liver transplantation,are critical interventions for hepatic malignancies and end-stage liver diseases.These complex procedures face challenges due to the liver's intricate anatomy and vascularization.The integration of Mixed Reality(MR),Augmented Reality(AR),and Artificial Intelligence(AI)is increasingly enhancing the precision,safety,and outcomes of these surgeries.MR and AR improve visualization of anatomical structures,assist in preoperative planning,and support patient education through immersive 3D models.AI-driven technologies provide real-time intraoperative feedback and navigation,optimizing surgical decisions and minimizing risks.Postoperatively,these technologies aid in patient education and recovery management,ultimately improving outcomes.This review explores the applications of MR,AR,and AI in liver surgeries and their potential to transform surgical practice by enhancing precision,safety,and patient engagement.
文摘Liver diseases,including liver inflammation,fatty liver disease,cirrhosis,and hepatocellular carcinoma,represent significant global health challenges.Traditional treatments often emphasize symptom management,leading to increased interest in natural bioactive compounds for their potential therapeutic benefits.This review examines the role of natural bioactive compounds in managing hepatic disorders,with a particular focus on their mechanisms of action and supporting clinical evidence.Compounds such as curcumin,silymarin,resveratrol,triterpenoids,apigenin,and delphinidin derivatives have demonstrated promising hepatoprotective effects in preclinical studies,largely due to their anti-inflammatory,antioxidant,and anti-fibrotic properties.Nevertheless,further research is necessary to determine optimal dosing,safety profiles,and long-term effects.Understanding the mechanisms of action and therapeutic potential of these bioactive compounds may provide critical insights into their role in the treatment of hepatic diseases.
基金supported by the Shenzhen Fundamental Research Program(JCYJ20240813112004006)the Shenzhen Health Talent Program(2022)+2 种基金the Shenzhen Municipal Science and Technology Foundation(JCYJ20240813141046059)the GuangDong Basic and Applied Basic Research Foundation(2023A1515110688,2024A1515220011)the Guangdong Medical Science and Technology Research Fund(A2024025).
文摘Liver cancer is a leading cause of cancer-related death worldwide,and its complexity and heterogeneity pose considerable challenges to conventional treatment.In recent years,the rise of organoid technology has provided new perspectives and tools for precision medicine in oncology.The use of high-fidelity organoids capable of recapitulating patients'genotypic and phenotypic features can further facilitate personalised treatment.In this review,we discuss 1)the advantages of liver cancer organoids as disease models over traditional models;2)the origin and establishment of liver cancer organoids;3)the application of liver cancer organoids technology in tumour precision medicine;4)the technical tools of liver cancer-derived organoids;and 5)current solutions for the deficiencies and challenges of liver cancer organoids.This review should provide both a deeper under-standing of the research progress and application prospects of liver cancer organoids,as well as theoretical support and practical guidance for more complete integration of liver cancer research and precision medicine.
文摘Liver diseases continue to pose formidable challenges to global health in 2025,characterized by their broad disease spectrum and therapeutic complexity.Among the diverse array of hepatic disorders,hepatocellular carcinoma(HCC)ranks as the sixth most common cancer and third leading cause of cancer-related mortality worldwide.1 Reflecting changing global health patterns and lifestyle factors,the landscape of liver diseases is experiencing profound changes:while successful viral hepatitis control programs in many regions have led to a gradual decline in virus-related HCC incidence.
基金supported by Beijing Natural Science Foundation Haidian Original Innovation Joint Fund(L222134).
文摘Background and aims:Metabolic dysfunction-associated fatty liver disease(MAFLD)is associated with coronary artery disease(CAD),but existing risk assessment tools lack precision and scalability.We developed an AI-driven multimodal framework integrating traditional Chinese medicine(TCM)tongue-based diagnosis with clinical biomarkers to stratify CAD risk in MAFLD.Methods:In this cross-sectional study with prospective data collection,which comprised 1073 MAFLD patients stratified by CAD status(MAFLD without CAD,n=942;MAFLD with CAD,n=131),baseline characteristics were compared using chi-square tests for categorical variables and Mann-Whitney U tests for continuous vari-ables,with p<0.05 considered significant.We developed two distinct deep learning models:Model-1(non-invasive)using ResNet18 combined tongue image features with demographic and comorbidity data,and Model-2(comprehensive)incorporated blood biomarkers alongside the features used in Model-1.Multimodal feature fusion was achieved through a dedicated cross-attention network.Model performance was rigorously evaluated using 10-fold cross-validation,with area under the curve(AUC),sensitivity,and specificity as primary metrics.Focal loss was employed to address class imbalance.Results:The coexistence of CAD was associated with significantly higher rates of hypertension,diabetes,and familial cardiovascular history in patients with MAFLD(p<0.001),along with distinct metabolic profiles:elevated systemic inflammation(neutrophil-lymphocyte ratio),advanced fibrosis(FIB-4),elevated fasting glucose levels,and attenuated hepatic inflammation(ALT and AST).Model-1 achieved an AUC of 0.858(sensitivity 0.778,specificity 0.908),while Model-2 demonstrated superior discrimination(AUC 0.933),particularly in tertiary care.Conclusion:Our AI-driven dual-model framework addresses the critical unmet need for CAD identification in MAFLD patients,providing a community-scalable screening tool(Model-1)and a precision clinical assessment model(Model-2),while offering empirical support for TCM tongue diagnosis.Pending external validation to confirm its generalizability,this approach may serve as a cost-efficient non-invasive screening strategy for this high-risk population.
基金supported by Guangxi Science and Technology Program under Grant No.AD25069077.
文摘Breast cancer is the most prevalent malignancy in women globally,with metastatic disease accounting for approximately 90%of breast cancer-related deaths.The development of breast cancer liver metastases in patients not only significantly reduces survival rates but also severely impairs quality of life.This review systematically examines therapeutic advances in the treatment of breast cancer liver metastases from 2010 to 2023,focusing on novel targeted agents(CDK4/6 inhibitors,PI3K/mTOR pathway inhibitors),immune checkpoint inhibitors,and local interventions.We provide evidence-based recommendations to optimize personalized treatment strategies and improve clinical outcomes for patients with breast cancer liver metastases.
基金supported in part by the Natural Science Foundation of Beijing Municipality(grant number 7212139)the Natural Science Foundation of Hainan Province(grant number 821MS0821).
文摘Background and aims:Contrast-enhanced ultrasound(CEUS)is widely used in the diagnosis of complications after liver transplantation.This study compared the diagnostic efficacy of CEUS with that of contrast-enhanced computed tomography(CECT)for focal liver lesions in liver transplant recipients.Methods:We retrospectively reviewed 115 liver transplant recipients who were diagnosed to have focal liver lesions at our hospital between June 2015 and June 2023.All patients were examined by CEUS and CECT and had a definitive pathological diagnosis.Based on the diagnostic outcomes,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of these imaging modalities in differentiating between benign and malignant lesions were calculated using a four-table method.Differences in diagnostic efficacy between CEUS and CECT with respect to pathological findings were compared using the chi-squared test and Fisher's exact test.The consistency of diagnosis between these modalities was assessed using the linear weighted kappa test.Results:CEUS identified 79 malignant and 36 benign lesions,while CECT detected 81 malignant and 34 benign lesions.The sensitivity,specificity,positive predictive value,negative predictive value,and overall accuracy of CEUS and CECT in diagnosis of focal lesions in transplanted livers were 95.7%vs 97.2%,97.2%vs 96.1%,97.9%vs 97.5%,97.2%vs 98.6%,and 96.4%vs 97.1%,respectively.Both CEUS and CECT demonstrated comparable diagnostic efficacy(κ¼0.899).CEUS showed strong diagnostic consistency with pathological results(κ¼0.912)and was more effective than CECT in diagnosing focal normal liver tissue and fat infiltration(p<0.05).Both methods were equally effective for diagnosis of focal inflammatory lesions,infarction,and hemangioma.Conclusion:CEUS is as effective as CECT for diagnosis of benign and malignant lesions in transplanted livers but surpasses CECT in differentiating benign lesions,particularly focal normal liver tissue and fat infiltration.
基金supported by grants from the National Natural Science Foundation of China(No:82472801,82103566)Basic and Applied Basic Research of Guangzhou Science and Technology Plan Project(No:2023A04J2123).
文摘Background:This study sought to evaluate the efficacy and safety of programmed cell death protein-1(PD-1)inhibitor immunotherapy specifically in metabolic dysfunction-associated fatty liver disease(MAFLD)-associated intrahepatic cholangiocarcinoma(ICC)patients,in comparison to those without MAFLD.Methods:We retrospectively included 161 ICC patients,both with and without MAFLD,who underwent PD-1 inhibitors between March 2019 and August 2024.Subsequent locoregional interventions(e.g.,hepatic arterial infusion chemotherapy)and second-line systemic agents(e.g.,lenvatinib)were allowed.The primary endpoints included overall survival(OS)and progression-free survival(PFS),while the secondary endpoints comprised objective response rate(ORR),disease control rate(DCR),and adverse events(AEs).Results:The MAFLD group included 20 patients,while the Non-MAFLD group comprised 141 patients.The OS was 18.0 months for the MAFLD group and 20.1 months for the Non-MAFLD group,while the median PFS was 8.0 and 11.5 months,respectively.According to the modified RECIST(mRECIST)criteria,the Non-MAFLD group exhibited a greater clinical benefit,reflected in higher ORR and DCR(45.4%vs.20.0%,p=0.031;92.9%vs.75.0%,p=0.024).Multivariate Cox proportional hazard analysis identified carcinoembryonic antigen(CEA),tumor number,and C-reactive protein(CRP)as independent prognostic factors for OS,whereas CEA and tumor number were significant predictors of PFS.Additionally,the overall incidence of AEs was notably lower in the Non-MAFLD group compared to the MAFLD group.Conclusion:This study demonstrated that PD-1 inhibitors resulted in similarly prolonged OS and PFS between ICC patients with and without MAFLD,but a superior tumor response was observed in patients without MAFLD.Additionally,the Non-MAFLD group experienced a significantly lower incidence of AEs than the MAFLD group undergoing PD-1 inhibitors.
基金funded by the Nantong Natural Science Founda-tion(JC2024078)the Scientific Research Project of Jiangsu Society of Traditional Chinese Medicine(ZXFZ2024100)the Hubei Chen Xiaoping Science and Technology Development Foundation Project(CXPJJH123009-079).
文摘Laennec's capsule is a dense fibrous membrane that has recently been confirmed to exist across the entire liver surface,Glissonean pedicles,and major hepatic veins,forming a continuous fibrous system.Minimally invasive anatomical liver resection based on Laennec's capsule-guided dissection leverages natural avascular planes to enable safe and efficient resection.This approach significantly reduces intraoperative bleeding,improves sur-gical precision and R0 resection rates,and contributes to better long-term survival in patients.This review discusses the anatomical concept of Laennec's capsule and its clinical application in minimally invasive anatomical liver resection.It outlines the advantages,limitations,and strategic use of various preoperative navigation techniques;analyses the indications for intrafascial/extrafascial Glissonean approaches and the technical aspects of their selection;analyses outer/inner dissection of Laennec's capsule around the hepatic veins according to the type of tumour;and proposes technical refinements based on outflow control and precision surgery.Finally,it explores the debate about the origins of Laennec's capsule and suggests directions for future bastardization and research.This review aims to provide hepatobiliary surgeons with a comprehensive reference based on recent technical advances and application strategies for Laennec's capsule-based anatomical liver resection.
基金funded by the General Project of the Natural Science Foundation of Chongqing(cstc2021jcyj-msxmX0604)the Chongqing Doctoral“Through Train”Research Program(CSTB2022BSXM-JCX0045).
文摘Background and aims:Hepatocellular carcinoma(HCC)presents a significant challenge in tumor management because of its low resection rates.Conversion therapy aims to transform unresectable tumors into resectable ones through local treatments,thereby providing surgical options for some patients with HCC.However,the overall strategies and efficacy of conversion therapy for HCC remain inadequately defined.This study was performed to evaluate the efficacy of hepatic arterial infusion chemotherapy(HAIC)combined with sintilimab and bevacizumab in patients with unresectable liver cancer.Methods:We conducted a retrospective analysis of patients with initially unresectable HCC who received HAIC in conjunction with sintilimab and bevacizumab.Preoperative demographic data,tumor markers,tumor size,tumor count,conversion outcomes,and surgery-related clinical data were collected and analyzed before and after treatment.Results:Twelve patients were included in this study.All patients exhibited satisfactory antitumor effects.Ten patients underwent one or two treatment cycles,while two completed four cycles.The mean alpha-fetoprotein level decreased from 73,471±138,239 to 2374±6325 ng/mL,and the mean tumor size decreased from 11.4±2.2 to 7.6±1.0 cm.Following evaluation,10 patients were successfully converted,with 6 ultimately undergoing curative liver cancer resection;of these 6 patients,4 achieved a pathological complete response.Conclusion:The combination of HAIC with sintilimab and bevacizumab represents a safe and effective strategy for tumor conversion.This approach can achieve significant tumor reduction and favorable effects on portal vein tumor thrombus within a short timeframe,facilitating curative resection of liver cancer.
文摘Background and aims:This research aimed to develop an innovative predictive model for estimating overall survival(OS)in patients with ampullary carcinoma and to evaluate the clinical benefits of postoperative chemotherapy(POCT)tailored to individual risk profiles.Methods:Data from patients with ampullary carcinoma were retrospectively analyzed.Multivariable analysis identified key prognostic factors,which were incorporated into a predictive nomogram.The impact of POCT on OS was assessed within risk groups stratified by the nomogram.Results:Data for 3921 patients were included,with 2744 in the training cohort and 1177 in the validation cohort.A nomogram incorporating age,sex,tumor grade,T stage,N stage,and tumor size outperformed the TNM staging system,with areas under the curve for 3-year,5-year,and 8-year OS of 0.755 vs 0.687,0.752 vs 0.694,and 0.750 vs 0.694,respectively,in the training cohort and 0.705 vs 0.664,0.717 vs 0.679,and 0.734 vs 0.703 in the validation cohort.Calibration plots showed excellent agreement between predicted and observed survival outcomes.Decision curve analysis indicated a net benefit across threshold probabilities above that of TNM staging.Risk stratification based on the model indicated that high-risk patients had a significantly increased mortality risk(p<0.001).Notably,POCT significantly improved OS in high-risk patients(p<0.001)but not in low-risk patients.Conclusion:Not all patients benefit from POCT.The proposed nomogram predicts survival effectively and can guide treatment decisions,optimizing outcomes by providing additional chemotherapy for high-risk patients while sparing low-risk patients from unnecessary treatment.
基金supported by grants from the National Natural Science Foundation of China(No.82372834).
文摘Anatomic resection remains a fundamental principle in the surgical management of hepatobiliary diseases,whether performed through traditional open surgery or advanced minimally invasive approaches such as laparoscopic or robotic-assisted techniques.However,a universally accepted and clearly defined anatomical framework for intraoperative anatomical delineation remains lacking.The growing clinical adoption of Laennec membrane-guided anatomical strategies has been associated with notable improvements in surgical efficacy and anatomical precision.This approach facilitates clear identification of anatomical layers,enhances visualization of key landmarks,and enables the execution of precise anatomical resections.As a result,it promotes standardi-zation and reproducibility across surgical procedures.This article presents a comprehensive review of operative techniques and critical technical considerations for Laennec membrane-guided anatomical procedures in hep-atobiliary surgery,establishing a three-dimensional anatomical foundation for clinical practice to support the standardization and broader adoption of precision-oriented hepatobiliary surgical methodologies.
基金supported by Beijing Natural Science Foundation,China(L244027).
文摘With the global incidence of hepatocellular carcinoma(HCC)on the rise,precise staging has become critical for guiding treatment decisions and improving long-term outcomes.The Barcelona Clinic Liver Cancer(BCLC)staging system,widely used for HCC classification,incorporates factors such as Child–Pugh A or B liver function,tumor size and number,absence of cancer-related symptoms,and lack of vascular invasion or extrahepatic metastasis.For intermediate-stage HCC,transarterial chemoembolization(TACE)remains the globally recom-mended standard.However,the substantial heterogeneity in tumor burden and liver function among patients means that not all individuals benefit equally from TACE.As a result,a uniform treatment approach is insuffi-cient.Preserving liver function is now recognized as equally important as achieving high objective response rates,with the ultimate goal of prolonging overall survival.In response,researchers have proposed advanced stratification methods for stage B HCC to optimize therapeutic outcomes.While these stratification criteria remain under debate,there is a growing shift from TACE-centric strategies toward personalized targeted ther-apies for specific subpopulations.This review explores advanced stratification concepts,evaluates corresponding treatment strategies,analyzes ongoing clinical trials,and assesses their potential to transform the management of intermediate-stage HCC—while also outlining future directions for its treatment.
基金funded by Special clinical project of Shanghai Municipal Health Commission(No.20224Y0299 and No.20244Y0233)National Natural Science Foundation Incubation Project(No.2022MS039 and 2022GZR005)+2 种基金the National Natural Science Foundation of China(82372813 for Wang MD)the Natural Science Foundation of Shanghai(No.22ZR1477900 for Wang MD)Shanghai Science and Technology Committee Rising-Star Program(No.22QA1411600 for Wang MD,24YF2758600 for Diao YK).
文摘Background and aims:Hepatocellular carcinoma(HCC)is a prevalent malignancy with poor prognosis.This study uses integrated bioinformatic analyses to explore potential competing endogenous RNA(ceRNA)network chains in HCC.Methods:HCC expression profile data were obtained from the Gene Expression Omnibus dataset,and differential expression analysis was conducted to identify differentially expressed mRNAs(DEmRNAs),microRNAs(DEmiRNAs),and long non-coding RNAs(DElncRNAs)between HCC and normal liver tissue samples.Univariate Cox regression analysis was performed to identify mRNAs associated with the prognosis of HCC patients.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were used to classify the identified genes functionally.Cytoscape software was used to construct a protein–protein interaction network.Using the intersection method,a ceRNA network was established to align data from two databases(miRTarBase and miRcode).Pearson correlation analysis was conducted to evaluate the relationships between lncRNAs and mRNAs.Results:A total of 106 prognosis-related DEmRNAs were identified between HCC and normal samples.A total of 132 DEmiRNAs and 42 DElncRNAs were dysregulated in HCC.A ceRNA network of three lncRNAs,six miRNAs,and eight mRNAs was constructed.High expression of MCM10,CDKN3,RRM2,KIF3A,and ALYREF correlated with a poor prognosis,while high expression of CPEB2,COLEC10,and PBLD was associated with a better prognosis for HCC patients.Expression analysis confirmed the differential expression of these genes in HCC samples.Correlation analysis revealed that a MAGI2-AS3/hsa-miR-450b-5p/COLEC10 axis might play a crucial role in the progression of HCC.Conclusion:The ceRNA network constructed could provide insight into HCC tumorigenesis and might lead to new molecular biomarkers for diagnosing and treating HCC.
基金supported by grants from the National Natural Science Foundation of China(No.82270694)the Beijing Nova Program(#20220484197).
文摘Background and aims:Duodenal varices(DVs)are a rare complication of portal hypertension.This study analyzed the clinical characteristics of DVs and examined the efficacy of endoscopic cyanoacrylate injection for duodenal variceal bleeding.Methods:The clinical data of patients with DVs treated in our hospital from March 2013 to May 2024 were retrospectively analyzed.Results:During the study period,80,850 patients underwent gastroscopy for a total of 122,040 endoscopy sessions.DVs were diagnosed in 52 patients.Eight patients with DVs exhibited duodenal variceal bleeding(15.4%).The overall prevalence of DVs was 0.08%.The prevalence of DVs among patients with upper gastrointestinal varices was 0.16%.The most common etiology of DVs was liver cirrhosis(92.3%).DVs location was the descending segment of the duodenum in 34 patients(65.4%).Forty-four patients(84.6%)had concomitant esophageal and gastric varices.Successful hemostasis was achieved at the time of endoscopy in all patients undergoing emergency endoscopic treatment using cyanoacrylate injection.The 6-week mortality rate was 12.5%.The rebleeding rate was 12.5%.Conclusions:DVs are uncommon,even in hospitals where liver disease is prevalent.Emergency endoscopic cyanoacrylate embolization appears to be highly effective.Complete vein embolization may be considered for patients in poor condition.Age>65 years and low hemoglobin concentration are predictors of duodenal variceal bleeding.
