Resolution of Metabolic Dysfunction-associated Steatohepatitis With No Worsening of Fibrosis After Bariatric Surgery Improves 15-year Survival: A Prospective Cohort Study.

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Guillaume Lassailly, Robert Caiazzo, Armelle Goemans, Mikael Chetboun, Viviane Gnemmi, Julien Labreuche, Gregory Baud, Helene Verkindt, Camille Marciniak, Naima Oukhouya-Daoud, Line-Carolle Ntandja-Wandji, Massih Ningarhari, Emmanuelle Leteurtre, Violeta Raverdy, Sébastien Dharancy, Alexandre Louvet, François Pattou, Philippe Mathurin
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引用次数: 0

Abstract

Background & aims: The aim of this study was to investigate the consequences of the histological progression of metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis on long-term survival after bariatric surgery.

Methods: From 1994 to 2021, 3028 patients at the University Hospital of Lille were prospectively included. Baseline liver biopsies were systematically performed with proposed follow-up biopsies 1 year after surgery, mainly in patients with MASH. We evaluated the association of the baseline and 1-year histologic progression of MASH and fibrosis status and long-term survival using Cox regression models.

Results: At baseline, 2641 patients (89%) had a biopsy, including 232 with MASH (8.7%) and 266 (10.8%) with significant fibrosis (grade F2-F4). The median follow-up was 10.1 years. At 1 year, 594 patients had qualitative paired biopsies. Survival was shorter at the 15-year follow-up in patients with baseline MASH, than in those without (hazard ratio [HR], 2.21; 95% confidence interval [CI], 1.38-3.53) and in F2 to F4 than in F0 to F1 (HR, 3.38; 95% CI, 2.24-5.10). At the 1-year landmark analysis, compared with patients without baseline MASH, mortality increased in those with persistent MASH and/or if fibrosis worsened (adjusted HR, 2.54; 95% CI, 1.06-6.10), but not if MASH resolved without the worsening of fibrosis (adjusted HR, 0.73; 95% CI, 0.28-1.87). Similarly, compared with patients without significant fibrosis at baseline, patients with persistent significant fibrosis had increased mortality (adjusted HR, 4.03; 95% CI, 1.86-8.72) but not if fibrosis improved from F2 to F4 to F0 to F1 (adjusted HR; 1.49; 95% CI, 0.52-4.24).

Conclusion: Histologic remission of MASH or significant fibrosis improves survival after bariatric surgery.

一项前瞻性队列研究:减肥手术后MASH的解决并无纤维化恶化可提高15年生存率。
目的:研究代谢相关脂肪性肝炎(MASH)和纤维化的组织学进展对减肥手术后长期生存的影响。方法:前瞻性纳入1994 - 2021年在里尔大学医院就诊的3028例患者。系统地进行基线肝活检,并建议术后1年随访活检,主要是在MASH患者中。我们使用Cox回归模型评估了基线和1年MASH组织学进展与纤维化状态和长期生存的关系。结果:在基线时,2641例患者进行了活检(89%),其中232例为MASH(8.7%), 266例(10.8%)为显著纤维化(F2-F4级)。中位随访时间为10.1年。1年时,594例患者进行了定性配对活检。基线MASH患者在15年随访时的生存期比无基线MASH患者短(风险比(HR), 2.21;95%可信区间(CI)为1.38 ~ 3.53),F2-F4组比F0-F1组(HR, 3.38;(95%CI, 2.24 ~ 5.10)。在1年的里程碑分析中,与没有基线MASH的患者相比,持续性MASH和/或纤维化恶化的患者死亡率增加(调整后的风险比为2.54 (95% CI, 1.06至6.10),但如果MASH在没有纤维化恶化的情况下消退,死亡率则没有增加(调整后的风险比为0.73 (95% CI, 0.28至1.87))。同样,与基线时无显著纤维化的患者相比,持续显著纤维化的患者死亡率增加(校正后危险度,4.03 [95% CI, 1.86 - 8.72]),但如果纤维化从F2-F4改善到F0-F1(校正后危险度;1.49;95%CI, 0.52 ~ 4.24)。结论:组织学上的MASH缓解或显著纤维化可提高减肥手术后的生存率。
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来源期刊
CiteScore
16.90
自引率
4.80%
发文量
903
审稿时长
22 days
期刊介绍: Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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