Clinical and Molecular Hepatology最新文献_第3页

Chronic viral hepatitis with concurrent metabolic dysfunction-associated steatotic liver disease: dual etiology challenges. 慢性病毒性肝炎并发MASLD：双重病因挑战。

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-09-01 Epub Date: 2026-06-25 DOI: 10.3350/cmh.2026.0387

Shang-Chin Huang, Yi-Fen Shih, Chun-Jen Liu

{"title":"Chronic viral hepatitis with concurrent metabolic dysfunction-associated steatotic liver disease: dual etiology challenges.","authors":"Shang-Chin Huang, Yi-Fen Shih, Chun-Jen Liu","doi":"10.3350/cmh.2026.0387","DOIUrl":"10.3350/cmh.2026.0387","url":null,"abstract":"The overlapping epidemics of chronic viral hepatitis and metabolic dysfunction-associated steatotic liver disease (MASLD) present a complex challenge in modern hepatology. In chronic hepatitis B, a unique \"steatosis paradox\" emerges: while isolated hepatic steatosis provides a suppressive microenvironment that promotes hepatitis B viral clearance, the concomitant systemic cardiometabolic burden acts dose-dependently to drive fibrogenesis and hepatocellular carcinoma (HCC). Conversely, chronic hepatitis C and host metabolic dysfunctions exhibit synergistic destruction. Hepatitis C virus actively hijacks lipid metabolism and induces insulin resistance. Even after viral eradication via direct-acting antivirals, residual steatosis and glycemic abnormalities remain formidable drivers of HCC. Consequently, the traditional virocentric paradigm is no longer sufficient. Clinical management should pivot toward precision risk stratification and a multidisciplinary dual-target approach, equally prioritizing sustained viral suppression and aggressive metabolic remission. This review summarizes the divergent virus-MASLD interactions, optimal clinical strategies, current challenges and future opportunities.","PeriodicalId":10275,"journal":{"name":"Clinical and Molecular Hepatology","volume":" ","pages":"e2026.0387"},"PeriodicalIF":21.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Therapeutic landscape evolution for steatotic liver disease: from lifestyle interventions to precision pharmacotherapy. 治疗景观演变：从生活方式干预到精准药物治疗。

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-09-01 Epub Date: 2026-04-03 DOI: 10.3350/cmh.2026.0125

Shirley Huey Shin Bong, Kevin Kim Jun Teh, Vincent Wai-Sun Wong

{"title":"Therapeutic landscape evolution for steatotic liver disease: from lifestyle interventions to precision pharmacotherapy.","authors":"Shirley Huey Shin Bong, Kevin Kim Jun Teh, Vincent Wai-Sun Wong","doi":"10.3350/cmh.2026.0125","DOIUrl":"10.3350/cmh.2026.0125","url":null,"abstract":"Steatotic liver disease (SLD) is a growing global epidemic, with metabolic dysfunction-associated steatotic liver disease now the most common chronic liver disease worldwide and closely linked to adverse cardiovascular outcomes. Lifestyle modification remains the cornerstone of management, with the Mediterranean diet as the preferred dietary intervention and emerging evidence supporting additional dietary and exercise strategies. Pharmacotherapy has advanced rapidly in recent years, with two U.S. Food and Drug Administration-approved options, resmetirom and semaglutide, for noncirrhotic metabolic dysfunction-associated steatohepatitis with moderate-to-advanced fibrosis, alongside multiple agents in development targeting different disease mechanisms. In metabolic dysfunction- and alcohol-associated liver disease, evidence remains limited, but management essentially focuses on alcohol cessation and optimization of cardiometabolic risk factors, with resmetirom, incretin-based therapies, and fibroblast growth factor-21 analogues representing promising therapeutic agents that have yet to be fully evaluated in clinical trials. The field is increasingly moving toward a precision medicine paradigm integrating pharmacologic and lifestyle interventions, tailored to disease phenotype, genetic risk, and gut microbiome. Key challenges include heterogeneity in treatment response, assessment of alcohol intake, and real-world implementation barriers. This review summarizes current and emerging therapies and highlights the role of precision medicine in advancing individualized care across the SLD spectrum.","PeriodicalId":10275,"journal":{"name":"Clinical and Molecular Hepatology","volume":" ","pages":"e2026.0125"},"PeriodicalIF":21.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk assessment in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-related liver disease: current approaches and future directions. MASLD和MetALD的风险评估：目前的方法和未来的方向。

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-09-01 Epub Date: 2026-08-28 DOI: 10.3350/cmh.2026.0398

Huapeng Lin, Haixia Wang, Kangsen Yang, Min Li, Yanting Wang, Terry Cheuk-Fung Yip, Seung Up Kim

{"title":"Risk assessment in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-related liver disease: current approaches and future directions.","authors":"Huapeng Lin, Haixia Wang, Kangsen Yang, Min Li, Yanting Wang, Terry Cheuk-Fung Yip, Seung Up Kim","doi":"10.3350/cmh.2026.0398","DOIUrl":"10.3350/cmh.2026.0398","url":null,"abstract":"Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction and alcohol-related liver disease (MetALD) exist on a continuous spectrum in which fibrosis stage remains the dominant predictor of liver‑related complications. Contemporary non‑invasive risk stratification uses simple serum scores (e.g., Fibrosis‑4 index [FIB‑4]) as a first step, followed by vibration‑controlled transient elastography (VCTE) or liver‑specific blood tests (enhanced liver fibrosis [ELF], procollagen III N‑terminal propeptide [PRO‑C3]) to refine risk and triage referrals. Magnetic resonance elastography (MRE) provides higher accuracy than ultrasound‑based elastography, though limited by its availability. Composite models (Agile 3+/4, steatosis‑associated fibrosis estimator [SAFE]) can reduce indeterminate classifications but may require additional calibration for alcohol exposure for use in MetALD. Prognosis should incorporate dynamic, longitudinal measurement of non‑invasive tests, and integrate extrahepatic risks, particularly cardiovascular and kidney disease. In MetALD, quantitative alcohol assessment can be improved by incorporating objective biomarkers such as phosphatidylethanol (PEth) as part of a triangulation approach that integrates self‑reported alcohol intake, the Alcohol Use Disorders Identification Test‑Consumption (AUDIT‑C), and clinical history. Challenges remain, particularly for MetALD, and future research will focus on integrating dynamic biomarkers, predicting treatment response, and utilizing artificial intelligence (AI) for personalized risk and treatment prediction, combining genetic modifiers and polygenic risk scores with clinical and imaging data, with validation across diverse populations.","PeriodicalId":10275,"journal":{"name":"Clinical and Molecular Hepatology","volume":" ","pages":"e2026.0398"},"PeriodicalIF":21.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical significance of gross morphological type beyond tumor burden in hepatocellular carcinoma treated with atezolizumab plus bevacizumab. 阿特唑单抗联合贝伐单抗治疗肝癌的大体形态类型超出肿瘤负荷的临床意义。

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-08-21 DOI: 10.3350/cmh.2026.0866

Seonjeong Woo, Donghyeon Kim, Chansik An, Sanghoon Jung, Su Jin Jang, Won Suk Lee, Hong Jae Chon

引用次数: 0

Letter regarding "Lack of Association Between Rifaximin and Drug-resistant Infections: A global multicenter inpatient cirrhosis cohort". 关于“利福昔明与耐药感染之间缺乏关联：一项全球多中心肝硬化住院患者队列”的信函。

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-08-20 DOI: 10.3350/cmh.2026.0761

Lijun Ge, Yu Xu, Jinfang Yan

引用次数: 0

2026 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. 2026 KLCA-NCC韩国肝细胞癌管理实践指南。

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-08-19 DOI: 10.3350/cmh.2026.0943

引用次数: 0

Long-Term Liver Outcomes in Wilson's Disease: Predictors of Survival and Hepatocellular Carcinoma. 肝豆状核变性的长期肝脏预后：生存和肝细胞癌的预测因素

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-08-11 DOI: 10.3350/cmh.2026.0402

Chien-Ting Hsu, Sung-Pin Fan, Jia-Feng Wu, Chin-Chang Huang, Tung-Hung Su, Tai-Chung Tseng, Ni-Chung Lee, Chin-Hsien Lin, Huey-Ling Chen, Yen-Hsuan Ni

{"title":"Long-Term Liver Outcomes in Wilson's Disease: Predictors of Survival and Hepatocellular Carcinoma.","authors":"Chien-Ting Hsu, Sung-Pin Fan, Jia-Feng Wu, Chin-Chang Huang, Tung-Hung Su, Tai-Chung Tseng, Ni-Chung Lee, Chin-Hsien Lin, Huey-Ling Chen, Yen-Hsuan Ni","doi":"10.3350/cmh.2026.0402","DOIUrl":"https://doi.org/10.3350/cmh.2026.0402","url":null,"abstract":"Background/aims: Wilson's disease (WD) is an inherited and treatable disorder of copper metabolism with hepatic or neurological manifestations. It continues to pose challenges in clinical management, and long-term outcome data remain limited. This study investigated hepatic involvement and clinical outcomes in cohorts from Taiwan.Methods: Longitudinal data from 146 patients with WD, retrieved from the medical database of a tertiary referral center, were analyzed (mean age at diagnosis 20.7 ± 12.4 years; mean follow-up 16.8 ± 10.8 years; maximum 51.8 years). All patients received standard treatment and care.Results: Nine patients (6.2%) underwent liver transplantation, 6 patients (4.1%) died, and 3 patients (2.1%) developed hepatocellular carcinoma (HCC). Thrombocytopenia <100 K/μL at diagnosis was associated with reduced survival (P=0.0001). Univariate Cox regression identified thrombocytopenia at diagnosis as a strong predictor of liver transplantation or death (P = 0.0001; hazard ratio (HR): 8.41; 95% CI: 2.97-23.78). Consistently, thrombocytopenia <100 K/μL was associated with reduced survival (P < 0.0001) in an external cohort of 155 patients. In the original cohort, the estimated annual HCC risk was 0.12% (95% CI: 0.03-0.36), increasing to 0.86% (95% CI: 0.18-2.5) in those with thrombocytopenia at diagnosis (P=0.029). An exploratory Firth penalized logistic regression showed that older age at diagnosis was associated with higher odds of developing HCC (odds ratio: 1.096; 95% CI: 1.009-1.191; P = 0.031).Conclusion: WD patients have a high rate of liver fibrosis, regardless of whether they present with neurological and hepatic symptoms, and are at risk of developing HCC, warranting lifelong hepatic surveillance.","PeriodicalId":10275,"journal":{"name":"Clinical and Molecular Hepatology","volume":" ","pages":""},"PeriodicalIF":21.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comprehensive Radiopathological and Molecular Review of HCC: Expanding on the WHO, 6th Edition. 肝细胞癌放射病理和分子综合综述：扩展于WHO，第6版。

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-08-11 DOI: 10.3350/cmh.2026.0431

Hyungjin Rhee, Young Nyun Park

{"title":"Comprehensive Radiopathological and Molecular Review of HCC: Expanding on the WHO, 6th Edition.","authors":"Hyungjin Rhee, Young Nyun Park","doi":"10.3350/cmh.2026.0431","DOIUrl":"https://doi.org/10.3350/cmh.2026.0431","url":null,"abstract":"Hepatocellular carcinoma (HCC) exhibits substantial molecular and morphological heterogeneity. The recently updated 6th edition of the World Health Organization Classification of Digestive Tumours recognizes nine specific HCC subtypes, each characterized by distinct morphomolecular and clinical profiles. Although these subtypes account for approximately 35% of all HCC cases, the remaining 65% are classified as conventional HCCs. These subtypes are categorized based on their prognostic implications: the unfavorable prognosis group comprises macrotrabecular-massive, sarcomatoid, and neutrophil-rich HCCs; the comparable prognosis group includes steatohepatitic, fibrolamellar, and chromophobe HCCs; and the favorable prognosis group consists of lymphocyte-rich and clear cell HCCs. By contrast, scirrhous HCC is associated with various clinical outcomes. Furthermore, this classification includes two newly recognized patterns: vessels encapsulating tumor clusters and CTNNB1-mutated HCC. The imaging features of HCC are significantly correlated with its molecular-pathological characteristics. In particular, aggressive subtypes frequently present with specific imaging hallmarks such as rim arterial phase hyperenhancement, diffuse arterial phase hypo-enhancement, and intratumoral necrosis on T2-weighted imaging, which serve as critical noninvasive predictors of clinical outcomes. However, a definitive diagnosis of specific subtypes based solely on imaging remains challenging. This review provides a comprehensive overview of the molecular, pathological, and radiological characteristics of HCC subtypes and patterns, emphasizing that a detailed understanding of these features is essential for informed therapeutic decision-making and accurate prognostic assessment.","PeriodicalId":10275,"journal":{"name":"Clinical and Molecular Hepatology","volume":" ","pages":""},"PeriodicalIF":21.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Viral load rather than transaminase: an international perspective on the KASL-EALA 2026 guideline for chronic hepatitis B. 病毒载量而非转氨酶：慢性乙型肝炎KASL-EALA 2026指南的国际视角

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-08-05 DOI: 10.3350/cmh.2026.0908

Tatsuya Kanto, Fabien Zoulim, Ming-Lung Yu

引用次数: 0

External beam radiotherapy versus local ablation therapy for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis. 外束放疗与局部消融术治疗肝癌：一项系统回顾和荟萃分析。

IF 21.7 1区医学

Clinical and Molecular Hepatology Pub Date : 2026-07-30 DOI: 10.3350/cmh.2026.0535

Sun Hyun Bae, Seo Hee Choi, Sang Min Yoon, Jeong Il Yu, Hyun-Cheol Kang, Nalee Kim, Tae Hyun Kim, Hee Chul Park

{"title":"External beam radiotherapy versus local ablation therapy for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis.","authors":"Sun Hyun Bae, Seo Hee Choi, Sang Min Yoon, Jeong Il Yu, Hyun-Cheol Kang, Nalee Kim, Tae Hyun Kim, Hee Chul Park","doi":"10.3350/cmh.2026.0535","DOIUrl":"https://doi.org/10.3350/cmh.2026.0535","url":null,"abstract":"Background/aims: Local ablation therapies (LATs), including radiofrequency (RFA) and microwave ablation (MWA), are established for small hepatocellular carcinoma (HCC) as standard treatment. External beam radiotherapy (EBRT), including stereotactic body radiotherapy (SBRT) and proton beam therapy (PBT), has emerged as a non-invasive alternative; however, direct comparative evidence remains limited. We conducted a systematic review and meta-analysis comparing the efficacy and safety of EBRT versus LAT in patients with HCC.Methods: PubMed/MEDLINE, Embase, Cochrane Library, and KoreaMed were searched through June 2025 per PRISMA guidelines. Eligible studies included retrospective or prospective comparisons of EBRT (SBRT/PBT) with LAT (RFA/MWA) reporting recurrence or survival. Hazard ratios (HRs) and odds ratios (ORs) were pooled using random-effects models.Results: Twelve studies (2,768) patients were included. Compared with LAT, EBRT was associated with significantly lower local recurrence (OR 0.36, 95% confidence interval [CI] 0.25-0.50; P<0.001; I² = 0%) and improved local progression-free survival (HR 0.41, 95% CI 0.34-0.50; P <0.001), regardless of tumor size. Progression-free survival favored EBRT (HR 0.80, 95% CI 0.64-1.00; P = 0.049), whereas overall survival did not differ significantly between modalities (HR 1.24, 95% CI 0.83-1.84; P = 0.291). Severe toxicities (grade ≥3) were comparable between groups for acute (OR 0.78, 95% CI 0.27-2.24) and late events (OR 1.29, 95% CI 0.85-1.95).Conclusions: EBRT was associated with better local control without significant differences in survival or toxicity compared with LAT. These findings support the safety and efficacy of EBRT for local treatment of patients with liver-confined HCC.","PeriodicalId":10275,"journal":{"name":"Clinical and Molecular Hepatology","volume":" ","pages":""},"PeriodicalIF":21.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0