Liver International最新文献

{"title":"Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Treated With Tenofovir Alafenamide or Tenofovir Disoproxil Fumarate","authors":"Jiwon Yang,&nbsp;Jihye Lim,&nbsp;Ye-Jee Kim,&nbsp;Hwa Jung Kim,&nbsp;Jonggi Choi","doi":"10.1111/liv.70357","DOIUrl":"10.1111/liv.70357","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>In phase 3 trials, tenofovir alafenamide (TAF) showed antiviral efficacy comparable to that of tenofovir disoproxil fumarate (TDF) for chronic hepatitis B (CHB), with an improved safety profile. This study aimed to compare the clinical efficacy of TAF and TDF in terms of the risk of hepatocellular carcinoma (HCC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide historical population cohort study on treatment-naïve adult patients with CHB receiving TAF (<i>n</i> = 29 309) or TDF (<i>n</i> = 58 046) as first-line therapy from 2017 to 2022 using data from the Korean National Health Insurance Service database. Cumulative HCC incidence and associated risk factors were estimated using competing risk factors. Propensity score (PS)-matched analysis was used to minimise the confounding effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 54 185 patients were included in the study, with 20 994 in the TAF group and 33 191 in the TDF group. The annual incidence of HCC was significantly lower in the TAF group (7.5/1000 patient-years [PYs]) than in the TDF group (10.3/1000 PYs; subdistribution hazard ratio [SHR], 0.74; <i>p</i> &lt; 0.001). After PS matching, TAF continued to exhibit a protective effect against HCC (7.5/1000 PYs vs. 9.9/1000 PYs; <i>p</i> &lt; 0.001). Multivariable analysis with Fine–Gray proportional subdistribution hazards model identified TAF as significantly associated with a reduced HCC incidence (SHR: 0.76; <i>p</i> &lt; 0.001). Subgroup analysis confirmed the hepatoprotective effect of TAF against HCC even in patients with cirrhosis (SHR: 0.78; <i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study showed that TAF had a hepatoprotective effect against HCC in patients with CHB, providing valuable guidance for clinicians in selecting the appropriate initial treatment for these patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Hemostatic Treatment Could Improve 30-Day Survival After Spontaneous Rupture of Hepatocellular Carcinoma","authors":"Apolline Commin,&nbsp;Chloé Metivier,&nbsp;Manon Allaire,&nbsp;Jean Lubrano,&nbsp;Amandine Claudinot,&nbsp;Audrey Coilly,&nbsp;Marc-Antoine Allard,&nbsp;Charles Roux,&nbsp;Olivier Scatton,&nbsp;Jean Charles Nault,&nbsp;Olivier Sutter,&nbsp;Nathalie Ganne-Carrié,&nbsp;Thuy Vi Ngo,&nbsp;Valérie Le Goff,&nbsp;Zeineb Ben Ali,&nbsp;Husni Tedlaouti,&nbsp;Josephine Papin,&nbsp;Marion Habireche,&nbsp;Louise Lebedel,&nbsp;Claire Pérignon,&nbsp;Thông Dao,&nbsp;Rémy Morello,&nbsp;Isabelle Ollivier-Hourmand","doi":"10.1111/liv.70332","DOIUrl":"10.1111/liv.70332","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Spontaneous rupture of hepatocellular carcinoma (SRHCC) presents a critical clinical challenge, with early haemostasis often difficult to achieve and limited data available on subsequent treatment strategies. This study aims to evaluate whether the initial hemostatic approach influences early prognosis and facilitates further treatment of HCC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retroprospective multicentric cohort included patients with SRHCC since 2008. Cox and Kaplan–Meier models analysed factors associated with overall survival (OS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>112 patients with SRHCC were included. Hemostatic treatment was administered in 54.4% of cases (83.6% embolization, 9.8% surgery and 6.6% embolization plus surgery). The 30-day mortality rate was 28.6%. Factors associated with 30-day mortality included ALBI score &gt; 2 (HR = 4.23; <i>p</i> = 0.001), shock (HR = 2.37; <i>p</i> = 0.029), acute kidney injury (HR = 4.40; <i>p</i> = 0.003), and BCLC stage C/D (HR = 14.29; <i>p</i> = 0.010). Early hemostatic intervention was associated with improved 30-day survival (HR = 0.42; <i>p</i> = 0.033). Palliative care was initiated in 27% of patients (10% after embolization and 17% upon admission). One-third of patients received subsequent HCC treatment after a median of 84 days [IQR: 39–176] (55.3% surgery and 18.4% systemic therapy). Among these, 63% (<i>n</i> = 24) had undergone early hemostatic treatment.</p>\u0000 \u0000 <p>The one-year OS rate was 39.3%, the median follow-up duration was 136 days (95% CI: 20.3–739.5), and the median OS was 6.6 ± 4.1 months (95% CI: 0–14.8). Delayed HCC treatment following rupture significantly improved OS (HR = 0.35; 95% CI: 0.20–0.61; <i>p</i> &lt; 0.001), particularly when surgery was performed (<i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest that early hemostatic treatment could be beneficial after spontaneous rupture of HCC in well compensated patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>NCT06505291</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Underlying Portal Hypertension on Severity and Course of Acute-On-Chronic Liver Failure","authors":"Vlad Taru,&nbsp;Georg Kramer,&nbsp;Benedikt S. Hofer,&nbsp;Nina Dominik,&nbsp;Lorenz Balcar,&nbsp;Mathias Schneeweiss-Gleixner,&nbsp;Bogdan Procopet,&nbsp;Michael Trauner,&nbsp;Mattias Mandorfer,&nbsp;Philipp Schwabl,&nbsp;Thomas Reiberger,&nbsp;Benedikt Simbrunner","doi":"10.1111/liv.70363","DOIUrl":"10.1111/liv.70363","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>The impact of portal hypertension (PH) during acute-on-chronic liver failure (ACLF) remains unclear. This study investigated the link between underlying PH severity, systemic inflammation (SI), and the course of ACLF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with ACLF (<i>n</i> = 192) who met the EASL-CLIF criteria were retrospectively included. PH severity (hepatic venous pressure gradient, HVPG; platelet count, PLT; and other clinical/radiologic PH surrogates) and SI (white blood cell count; C-reactive protein [CRP], interleukin-6) were assessed at the last pre-ACLF visit, ACLF diagnosis (D0), and after 7 (D7), 28 (D28), and 90 (D90) days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All patients had clinical/radiological signs of PH, and 91 (47%) patients developed ACLF grade 1, 62 (32%) ACLF-2, and 39 (21%) ACLF-3. Patients with different D0-ACLF grades showed similar SI biomarker levels pre-ACLF, whereas these increased significantly during ACLF. Median PLT decreased in parallel with the ACLF grade and from D0 (ACLF-3:72; vs. ACLF-2:81; vs. ACLF-1:91 G/L; <i>p</i> = 0.094) to D7 (ACLF-3:39 vs. ACLF-2:64; vs. ACLF-1:89 G/L; <i>p</i> &lt; 0.001). In multivariable Cox regression models, D0-PLT (aHR: 0.96 per 10 G/L [95% CI: 0.93–0.99], <i>p</i> = 0.015) independently predicted D28 mortality. A logistic regression model including sex, D0-PLT, D0-CRP, and CLIF-C ACLF score predicted D28 mortality (AUROC: 0.79 [0.73–0.86]; <i>p</i> &lt; 0.001) and outperformed (<i>p</i> = 0.036) the MELD-Na score (AUROC: 0.71 [0.63–0.78]; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although PH is a necessary condition for ACLF development, underlying PH severity does not confer a risk for higher ACLF severity but impacts survival after ACLF resolution. PLT emerged as a predictor of D28 mortality, independent of the CLIF-C ACLF score.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifying Treatment Pathway Differences and Exposure Bias in the CHIEF Cohort Study","authors":"Jiaxuan Liu,&nbsp;Wenshuo Li,&nbsp;Haibo Shao","doi":"10.1111/liv.70369","DOIUrl":"10.1111/liv.70369","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Comment on ‘Effects of Remote Ischemic Conditioning on Postoperative Recovery After Hepatectomy’","authors":"Chun Tian,&nbsp;Hongni Tian,&nbsp;Guangyou Duan,&nbsp;He Huang","doi":"10.1111/liv.70360","DOIUrl":"10.1111/liv.70360","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Target Trial Emulations of GLP-1 and Dual GLP-1/GIP Agonists to Reduce Major Adverse Liver Outcomes in Type 2 Diabetes","authors":"Alex E. Henney,&nbsp;David R. Riley,&nbsp;Matthew Anson,&nbsp;Shazli Azmi,&nbsp;Uazman Alam,&nbsp;Daniel J. Cuthbertson","doi":"10.1111/liv.70367","DOIUrl":"https://doi.org/10.1111/liv.70367","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Clinical trials suggest GLP-1 receptor agonists (RAs) and dual glucagon-like peptide-1 (GLP-1)/glucose-dependent insulinotropic polypeptide (GIP) RAs improve metabolic dysfunction associated with steatohepatitis (MASH) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to compare the estimate of the relative effect of tirzepatide, semaglutide, and liraglutide in reducing the risk of major adverse liver outcomes (MALOs) in patients with type 2 diabetes (T2D).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design, Setting and Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We emulated target trials based on a real-world network of electronic health records (EHRs) from over 150 million patients. Three target trials were emulated, among eligible patients with T2D who had no prior MALO diagnosis, by comparing therapy involving tirzepatide, semaglutide, and liraglutide versus DPP4 inhibitor (DPP4i) therapy. We identified the first-ever diagnosis of MALO occurring within a 2-year follow-up period and compared across the treatment groups using Kaplan–Meier survival analyses. Cohorts underwent propensity score matching 1:1 for confounders. We performed sensitivity analyses relating to geographical location, combination with metformin, and by treatment adherence. We also performed head-to-head analyses of the incretin-based therapies.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;After matching, we identified three target trials comprised of 10 165, 56 702, and 8 301 patients treated with tirzepatide, semaglutide, and liraglutide, respectively (1:1 with reference patients) for a 2-year period. Tirzepatide (HR 0.53 [95% CI 0.40, 0.71]) and semaglutide (HR 0.81 [0.72, 0.90]) were associated with a significant reduction in the risk of incident MALO compared with DPP4i, whereas liraglutide was not (HR 1.04 [95% CI 0.79, 1.36]). In head-to-head comparisons, tirzepatide was associated with a significantly lower risk of incident MALO compared with liraglutide (HR 0.56 [95% CI 0.39, 0.79]), but not semaglutide (HR 0.83 [95% CI 0.63, 1.09]). Semaglutide was not associated with a reduced risk compared with liraglutide (HR 0.77 [95% CI 0.57, 1.05]).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Treatment with tirzepatide and, to a lesser extent, semaglutide, in patients with T2D, was associated with a lower incidence of MALO compared with DPP4i after 2 years; largely driven by a reduction in the rates of compensated and decompensated cirrhosis. A reduction in MALO was not demonstrated with the use of liraglutide. These findings h","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis C Eradication Improves Oncologic and Clinical Outcomes in Patients Treated With Atezolizumab Plus Bevacizumab","authors":"Leonardo Stella,&nbsp;Giuseppe Cabibbo,&nbsp;Ciro Celsa,&nbsp;Roberta Ciccia,&nbsp;Alba Sparacino,&nbsp;Fabio Piscaglia,&nbsp;Francesco Tovoli,&nbsp;Andrea Arleo,&nbsp;Bernardo Stefanini,&nbsp;Massimo Iavarone,&nbsp;Roberta D'Ambrosio,&nbsp;Lucia Cerrito,&nbsp;Maria Pallozzi,&nbsp;Francesco Santopaolo,&nbsp;Fabio Marra,&nbsp;Claudia Campani,&nbsp;Chiara Mazzarelli,&nbsp;Raffaella Viganò,&nbsp;Raffaella Tortora,&nbsp;Alessio Aghemo,&nbsp;Stella De Nicola,&nbsp;Tiziana Pressiani,&nbsp;Lorenza Rimassa,&nbsp;Sherrie Bhoori,&nbsp;Salvatore Corallo,&nbsp;Laura Maiocchi,&nbsp;Andrea Martini,&nbsp;Caterina Soldà,&nbsp;Francesco Paolo Russo,&nbsp;Antonio Gasbarrini,&nbsp;Francesca Romana Ponziani","doi":"10.1111/liv.70362","DOIUrl":"https://doi.org/10.1111/liv.70362","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Hepatitis C virus (HCV) is a key driver of hepatocellular carcinoma (HCC). However, the impact of HCV eradication on systemic therapy remains unclear. We aimed to assess the safety and efficacy of direct-acting antivirals (DAA) in patients treated with Atezolizumab plus Bevacizumab (AtezoBev).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective multicentre study included patients with HCV-related unresectable/advanced HCC treated with AtezoBev between 2021 and 2024. Three groups of patients were compared: Group A (<i>n</i> = 22), concurrent DAA with AtezoBev; Group B (<i>n</i> = 95), antiviral therapy before AtezoBev; and Group C (<i>n</i> = 22), active infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Group A showed the longest median overall survival (42.8 months) compared to Group B (26.8 months; <i>p</i> = 0.03) and Group C (19.7 months; <i>p</i> = 0.01). Time to progression and progression-free survival were significantly prolonged in Group A versus Groups B and C. Moreover, Group A exhibited a higher disease control rate than the other groups. Post-DAA decompensation rates were significantly lower in Group A (4.5%) compared to Groups B (26.3%) and C (36.4%). Treatment-related adverse events of grade ≥ 3 were similar across groups. In the multivariate competing risk analysis with adjustment for time-dependent variables, achieving sustained virologic response during AtezoBev showed a protective effect against liver decompensation (sHR 0.02, <i>p</i> = 0.003) or tumour progression (sHR 0.14, <i>p</i> = 0.009), and was also associated with reduced mortality (HR 0.29, <i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Achieving a SVR during AtezoBev seems to improve oncologic outcomes and reduce liver decompensation in patients with unresectable/advanced HCC. An integrated therapeutic approach can optimise systemic treatment efficacy, particularly in patients eligible for conversion strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Protocol ID: 5890</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Comments for ‘Appraisal of AI-Based Fibrosis Quantification in MASH’","authors":"Kutbuddin Akbary,&nbsp;Mazen Noureddin,&nbsp;Ren Yayun,&nbsp;Dean Tai,&nbsp;Pol Boudes","doi":"10.1111/liv.70361","DOIUrl":"10.1111/liv.70361","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility of a Prognostic Scoring System Based on LDH and CRP in HCC Patients Receiving Atezolizumab Plus Bevacizumab","authors":"Kazunari Tanaka,&nbsp;Kunihiko Tsuji,&nbsp;Atsushi Hiraoka,&nbsp;Toshifumi Tada,&nbsp;Masashi Hirooka,&nbsp;Kazuya Kariyama,&nbsp;Joji Tani,&nbsp;Masanori Atsukawa,&nbsp;Koichi Takaguchi,&nbsp;Ei Itobayashi,&nbsp;Shinya Fukunishi,&nbsp;Toru Ishikawa,&nbsp;Kazuto Tajiri,&nbsp;Hideko Ohama,&nbsp;Hidenori Toyoda,&nbsp;Chikara Ogawa,&nbsp;Takashi Nishimura,&nbsp;Takeshi Hatanaka,&nbsp;Satoru Kakizaki,&nbsp;Kazuhito Kawata,&nbsp;Atsushi Naganuma,&nbsp;Hisashi Kosaka,&nbsp;Tomomitsu Matono,&nbsp;Hidekatsu Kuroda,&nbsp;Yutaka Yata,&nbsp;Hiroki Nishikawa,&nbsp;Michitaka Imai,&nbsp;Tomoko Aoki,&nbsp;Hironori Ochi,&nbsp;Yuki Kanayama,&nbsp;Fujimasa Tada,&nbsp;Shinichiro Nakamura,&nbsp;Kazuhiro Nouso,&nbsp;Asahiro Morishita,&nbsp;Norio Itokawa,&nbsp;Tomomi Okubo,&nbsp;Taeang Arai,&nbsp;Akemi Tsutsui,&nbsp;Hironori Tanaka,&nbsp;Hidenao Noritake,&nbsp;Masaki Kaibori,&nbsp;Yoichi Hiasa,&nbsp;Masatoshi Kudo,&nbsp;Takashi Kumada,&nbsp;the Real-life Practice Experts for HCC (RELPEC) Study Group and HCC 48 Group (hepatocellular carcinoma experts from 48 clinics in Japan)","doi":"10.1111/liv.70286","DOIUrl":"10.1111/liv.70286","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim/Background</h3>\u0000 \u0000 <p>This study aimed to validate the CLEAR score, a simple prognostic tool for hepatocellular carcinoma (HCC) patients undergoing atezolizumab plus bevacizumab (Atez/Bev) therapy, based on serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials/Methods</h3>\u0000 \u0000 <p>From 2020 to 2023, 498 Japanese HCC patients receiving Atez/Bev therapy were enrolled. They were divided into a training set (<i>n</i> = 280; 13 designated cancer care hospitals) and a validation set (<i>n</i> = 218; 11 universities and their affiliated Japanese hospitals). In the training set, prognostic factors were analysed, leading to the development of the CLEAR score, which was then evaluated on the validation set.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline LDH beyond the upper normal limit (hazard ratio [HR] 1.97, 95% CI 1.48–2.64) and CRP (≥ 0.50 mg/dL) (HR 1.61, 95% CI 1.19–2.00) were identified as independent prognostic factors on multivariate analysis and used in the CLEAR score. In the training set, the median progression-free survival (PFS) times in patients with scores 0, 1 and 2 were 11.1 months, 9.1 months and 3.3 months, respectively (<i>p</i> &lt; 0.001). The median overall survival (OS) times in patients with scores 0, 1 and 2 were not available, 15.3 months and 10.6 months, respectively (<i>p</i> &lt; 0.001). Similar results were obtained in the validation set (median PFS and OS times for scores 0, 1 and 2 = 9.4, 6.9 and 4.3 and 30.6, 20.8 and 8.9 months, respectively, each <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CLEAR score provides a distinct and simple prediction of the prognosis of HCC patients receiving Atez/Bev therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Risk Factors: Rethinking Hepatitis B and Hepatitis C Screening in Primary Care","authors":"Elena Vargas-Accarino,&nbsp;Ariadna Rando-Segura,&nbsp;María Asunción Úbeda,&nbsp;Imma Valls,&nbsp;Carla Ventosa,&nbsp;Núria García,&nbsp;Ingrid Arcusa,&nbsp;Elena Monserrate,&nbsp;Eva de Diego,&nbsp;Marta Selvi,&nbsp;Adriana Palom,&nbsp;Marina Llorens,&nbsp;Maria Santos,&nbsp;Judit Romero-Vico,&nbsp;Artur Dalfo,&nbsp;Juan Carlos Ruiz-Cobo,&nbsp;Ester Pallares,&nbsp;María Buti","doi":"10.1111/liv.70330","DOIUrl":"10.1111/liv.70330","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Most international guidelines recommend screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) only for individuals with risk factors or elevated ALT levels. However, this approach may not suffice to eradicate viral hepatitis. This study evaluates the application of EASL HBV and HCV screening guidelines in primary care centres (PCCs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included two components: (1) A retrospective review (January 2021–March 2023) of microbiology data to determine testing rates, analyse clinical characteristics, and assess management; and (2) A prospective intervention (March–April 2024) involving HBV and HCV screening and risk factor surveys for all adults attending two PCCs for blood collection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the retrospective analysis of 90 170 patients, HBV and HCV screening rates were 16% and 10%, respectively. Among HBsAg-positive patients (<i>n</i> = 84 (0.5%)), 67% lacked risk factors or elevated ALT. Among anti-HCV-positive (<i>n</i> = 277 (3%)) and HCV RNA-positive (<i>n</i> = 45 (0.5%)) patients, 54% and 46% respectively lacked these indicators.</p>\u0000 \u0000 <p>In the prospective study of 1030 patients (mean age 55, 39.6% men, 73% Spanish), anti-HCV was detected in 1.16% of cases (HCV RNA in 0.19%). Of these, 67% lacked risk factors or elevated ALT. No HBsAg-positive cases were identified, and hepatitis B vaccination status was uncertain for 50% of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Risk factor-based screening for HBV and HCV in primary care is a suboptimal approach. More than half of the patients testing positive lacked identifiable risk factors or elevated ALT levels. Universal one-time screening for all adults could address these limitations and significantly advance viral hepatitis elimination efforts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70330","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}