Turkish Journal of Gastroenterology最新文献

{"title":"Unraveling the Causal Links Between Immune Traits and Hepatocellular Carcinoma: Insights From a Bi-Directional Mendelian Randomization Study.","authors":"Jie Li, Gechun Wang, Xiaonan Xiang, Jiaguo Wang","doi":"10.5152/tjg.2025.24558","DOIUrl":"10.5152/tjg.2025.24558","url":null,"abstract":"<p><strong>Background/aims: </strong>Hepatocellular carcinoma (HCC) is significantly influenced by the immune system, which plays a key role in its development, progression, treatment, and prognosis. While observational studies have revealed correlations between circulating immune traits and HCC, their genetic basis and causal links remain unclear. This study aims to investigate the genetic associations and bidirectional causal relationships between immune traits and HCC risk using Mendelian randomization (MR) approaches.</p><p><strong>Materials and methods: </strong>Genome-wide association study summary statistics from the FinnGen cohort (R9, including 453 HCC cases and 287137 controls) were used to perform a bidirectional two-sample MR analysis. The causal effects of immune traits on HCC, as well as reverse causality, were assessed. Sensitivity analyses, including heterogeneity and pleiotropy tests, were used to ensure the robustness and validity of the results.</p><p><strong>Results: </strong>Thirty-nine immune traits were identified to be significantly associated with HCC risk. Elevated levels of 10 immune traits were positively associated with increased HCC risk, while the abundance of 29 immune traits was inversely correlated with HCC incidence. Furthermore, the reverse MR analysis revealed significant causal effects of HCC on 11 immune traits.</p><p><strong>Conclusion: </strong>This study provides strong evidence of genetic links between systematic immune cell profiles and HCC, shedding light on the mechanisms underlying its onset and progression. These findings identify potential immune biomarkers for early diagnosis and immune-targeted therapies.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PPARγ Activates Autophagy by Suppressing the PI3K-AKT1-FOXO3 Signaling Pathway and thus Alleviates Hepatic Ischemia-Reperfusion Injury.","authors":"Xinyu Liu, Hengguan Cui, Xianqing Song, Weixing Shen, Bin Yan","doi":"10.5152/tjg.2025.24529","DOIUrl":"10.5152/tjg.2025.24529","url":null,"abstract":"<p><strong>Background/aims: </strong>Hepatic ischemia-reperfusion injury (HIRI) refers to the damage caused by metabolic imbalance post-ischemia upon reperfusion, often occurring in scenarios like hemorrhagic shock, liver resection, and liver transplantation. Due to the complex nature of the mechanisms underlying metabolic imbalance, specific treatment options are lacking. Peroxisome proliferator activated receptor gamma (PPARγ) is a group of metabolic regulatory receptors that can influence HIRI by regulating autophagy, although the precise mechanism remains contentious.</p><p><strong>Materials and methods: </strong>In vivo and in vitro experiments were conducted to simulate hypoxic conditions, evaluating the effects of PPARγ overexpression plasmids, autophagy inhibitors, phosphatidylinositol 3-kinase (PI3K) activators, and PPARγ agonists on HIRI. The activation status of the PI3K-AKT1-FOXO3 signaling pathway, autophagy levels, inflammatory responses, and liver cell/organ damage were analyzed using western blot, ELISA, flow cytometry, H&E staining, and TUNEL experiments.</p><p><strong>Results: </strong>Peroxisome proliferator activated receptor gamma can mitigate cell damage caused by hypoxia by activating autophagy, with the activation of autophagy being associated with the inhibition of the PI3K-AKT1-FOXO3 signaling pathway. Additionally, pretreatment of mice with the PPARγ agonist rosiglitazone can alleviate HIRI induced by ischemia by inhibiting the activation of the PI3K-AKT1-FOXO3 signaling pathway to induce autophagy.</p><p><strong>Conclusion: </strong>Peroxisome proliferator activated receptor gamma inhibited the PI3K-AKT1-FOXO3 signaling pathway, which in turn activated autophagy to alleviate HIRI.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":"649-657"},"PeriodicalIF":1.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12520150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Huge Gastric Adenoma Composed of Pyloric Gland Adenoma and Foveolar-Type Adenoma with Serrated Dysplasia Cured by Endoscopic Submucosal Dissection.","authors":"Shuai Han, Shouxin Yin, Zongguo Sun, Shuangshuang Ren, Zhi Wei","doi":"10.5152/tjg.2025.24799","DOIUrl":"10.5152/tjg.2025.24799","url":null,"abstract":"","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":"537-539"},"PeriodicalIF":1.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling the Causal Links Between Immune Traits and Hepatocellular Carcinoma: Insights From a Bi-Directional Mendelian Randomization Study.","authors":"Jie Li, Gechun Wang, Xiaonan Xiang, Jianguo Wang","doi":"10.5152/tjg.2025.24558","DOIUrl":"10.5152/tjg.2025.24558","url":null,"abstract":"<p><p>Background/Aims: Hepatocellular carcinoma (HCC) is significantly influenced by the immune system, which plays a key role in its development, progression, treatment, and prognosis. While observational studies have revealed correlations between circulating immune traits and HCC, their genetic basis and causal links remain unclear. This study aims to investigate the genetic associations and bidirectional causal relationships between immune traits and HCC risk using Mendelian randomization (MR) approaches. Materials and Methods: Genome-wide association study summary statistics from the FinnGen cohort (R9, including 453 HCC cases and 287137 controls) were used to perform a bidirectional two-sample MR analysis. The causal effects of immune traits on HCC, as well as reverse causality, were assessed. Sensitivity analyses, including heterogeneity and pleiotropy tests, were used to ensure the robustness and validity of the results. Results: Thirty-nine immune traits were identified to be significantly associated with HCC risk. Elevated levels of 10 immune traits were positively associated with increased HCC risk, while the abundance of 29 immune traits was inversely correlated with HCC incidence. Furthermore, the reverse MR analysis revealed significant causal effects of HCC on 11 immune traits. Conclusion: This study provides strong evidence of genetic links between systematic immune cell profiles and HCC, shedding light on the mechanisms underlying its onset and progression. These findings identify potential immune biomarkers for early diagnosis and immune-targeted therapies.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":"36 7","pages":"420-430"},"PeriodicalIF":1.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum miR-146a and miR-155 as Predictors of Virological Control After Entecavir Withdrawal in HBeAg-Positive Chronic Hepatitis B Patients.","authors":"Ming Li Xu, Li Huan Wang","doi":"10.5152/tjg.2025.24685","DOIUrl":"10.5152/tjg.2025.24685","url":null,"abstract":"<p><strong>Background/aims: </strong>Distinct virological relapse (VR) has occurred after stopping the use of nucleos(t)ide analogues treatment in patients with chronic hepatitis B (CHB) who are positive for Hepatitis B e antigen (HBeAg). Here, we aimed to identify serum miR-146a and miR155 in HBeAg-positive patients with CHB and their relationship with VR after entecavir (ETV) discontinuance.</p><p><strong>Materials and methods: </strong>Ninety-eight patients with CHB and positive for HBeAg before initiating treatment were analyzed. Virological relapse was defined as 2 consecutive examinations (3 months apart) after treatment discontinuance, both showing an HBV DNA load of more than >2000 IU/mL.</p><p><strong>Results: </strong>Compared to control, CHB patients were observed with increases in serum miR-146a and miR-155 before starting ETV treatment (P < .001). There were 52 patients (53.1%) experiencing VR at 12 months after discontinuance of ETV treatment. The VR group was demonstrated with increases in serum miR-146a and miR-155 than the non-VR group before starting ETV treatment (P < .001). Whether at the beginning of ETV discontinuance or at 12 months after ETV discontinuance, the VR group was noted with elevations in serum miR-146a and miR-155 than the non-VR group (P < .001).</p><p><strong>Conclusion: </strong>The findings demonstrated that miR-146a and miR-155 levels in the circulation may be promising assessment tools for identifying sustained-virological responders after ETV discontinuance in CHB patients.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":"583-589"},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can the Mucosa Heal Histologically in Celiac Disease? What are the Indicators of Remission in Celiac Patients?","authors":"Berat Ebik, Ferhat Bacaksiz, Mustafa Zanyar Akkuzu, Ahmet Yavuz, Ümit Karabulut, Muhsin Kaya","doi":"10.5152/tjg.2025.24518","DOIUrl":"10.5152/tjg.2025.24518","url":null,"abstract":"<p><strong>Background/aims: </strong>The effect of a gluten-free diet on the small intestinal mucosa in patients with celiac disease (CD) is unclear. The occurrence of mucosal healing and the permanence of villous atrophy in celiac patients under a gluten-free diet were investigated.</p><p><strong>Material and methods: </strong>The symptoms, laboratory values, autoantibody levels, and endoscopic mucosal biopsy samples of 115 celiac patients, 56 of whom were in remission at different time periods since diagnosis, were examined.</p><p><strong>Results: </strong>Although 61.8% of patients said they were compliant with the gluten-free diet, 48.7% were in remission. Sixty-seven percent (n = 77) of patients with CD reported at least one symptom. Only weight loss was associated with disease activity (P = .019). While only 5 (8.9%) of the patients in remission were endoscopically and histopathologically normal, villous atrophy was detected in 69.9% of the patients. Villous atrophy was present in 86% of patients within the first 5 years of diagnosis, while this rate was 59% in patients older than 10 years. Logistic regression analysis showed that compliance with diet (odds ratio [OR]: 4.39; P < .001) and normal endoscopic appearance of the mucosa (OR: 13.01; P < .001) were the strongest predictive factors of remission.</p><p><strong>Conclusion: </strong>Diet compliance and remission rates of celiac patients increase over time. However, histologically, intraepithelial lymphocytosis almost never improves, and villous atrophy persists in most patients even if they comply with the diet. Although the asymptomatic nature of the patients, their autoantibody titers, and their dietary compliance are considered important indicators of remission, these parameters do not clearly reflect the histological status of the mucosa.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":"523-530"},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Percutaneous Endoscopic Gastrostomy A Solution for Aspiration Pneumonia, or Just An Illusion?","authors":"Aycan Yüksel, Dorina Esendağlı, Polina Nezalzova, Gaye Ulubay","doi":"10.5152/tjg.2025.24632","DOIUrl":"10.5152/tjg.2025.24632","url":null,"abstract":"<p><strong>Background/aims: </strong>Aspiration pneumonia is a pulmonary infection that occurs when food, liquid, saliva, or vomit is aspirated into the lungs. Percutaneous enteral gastrostomy (PEG) prevents aspiration pneumonia while ensuring the patient receives adequate nutrition. The authors aimed to evaluate the incidence and risk factors of post-PEG aspiration pneumonia.</p><p><strong>Materials and methods: </strong>Elderly patients who underwent PEG between January 2019 and December 2023 were included in this retro- spective study. The incidence of aspiration pneumonia was compared between the periods before and after PEG. Mortality rates and risk factors of post-PEG aspiration pneumonia were investigated.</p><p><strong>Results: </strong>A total of 430 out of 534 patients who underwent PEG were included. The aspiration pneumonia rate was 30.1% (n = 133) before PEG and 21.9% (n = 94) after PEG (P = .003). The 1-year mortality rate of post-PEG aspiration pneumonia was 58.5% (n = 55). Age ≥ 80 years (OR: 3.11; 95% CI, 1.12-8.76), home residency (OR: 3.31; 95% CI, 0.99-10.8), discontinuation of primary caregiver who had been trained about PEG (OR: 5.8; 95% CI, 1.4-25.2), chronic lung disease (OR: 3.016; 95% CI, 1.17-7.77), history of recurrent aspiration pneumonia prior to PEG (OR: 3.401; 95% CI, 1.073-10.779), spending ≥20 hours of the day in supine position (OR: 6.512; 95% CI, 1.879-28.103), requiring PEG due to stroke (OR: 2.46; 95% CI, 1.062-5.69), and esophagus cancer (OR: 3.047; 95% CI, 1.174-8.88) were associated with post-PEG aspiration pneumonia.</p><p><strong>Conclusion: </strong>Percutaneous enteral gastrostomy reduces aspiration pneumonia in general, but there remain risks, particularly in patients with stroke or esophageal cancer. Supine position and discontinuation of primary caregiver who had been trained about PEG are major risk factors.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":"609-617"},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of Intestinal Barrier Function and Wnt/β- Catenin Pathway by Sanzi Formula in Colorectal Adenoma Development.","authors":"Wanqiu Peng, Zhongyi Li, Shuting Zou, Hui Li, Yaozhou Tian, Yongzhi Hua, Lanfu Wei, Zhenhai Zhang, Yi Gu, Tingting Xu","doi":"10.5152/tjg.2025.24712","DOIUrl":"10.5152/tjg.2025.24712","url":null,"abstract":"<p><strong>Background/aims: </strong>Colorectal adenoma is a high-risk precursor lesion of colorectal cancer. Sanzi formula (SZF), a traditional Chinese medicine compound for the treatment of this disease, inhibits the growth of colorectal adenomas. This study aimed to investigate the mechanism by which SZF blocks the growth of colorectal adenomas in Apcmin/+ mice.</p><p><strong>Materials and methods: </strong>C57BL/6J mice were used as the control group and were fed a normal diet. To create the colorectal adenoma model, Apcmin/+ mice were fed high-fat chow. Each administration group was given the appropriate drug by gavage at the same time as the modeling. The body weight, adenoma size, and adenoma number of mice in each group were recorded, and the colorectal tissue was subjected to HE staining and histopathological evaluation. The effect of SZF on inflammatory factors, tight junction (TJ) proteins, pathway proteins, and mRNA content in colorectal adenoma was examined by enzyme-linked immunosorbent assay, western blotting, immunofluorescence analysis, and quantitative real-time polymerase chain reaction.</p><p><strong>Results: </strong>The results showed that all dose groups of SZF improved the size, number, and histopathological damage of adenomas. All dose groups of SZF resulted in lower inflammatory factors, higher levels of TJ proteins, and lower levels of pathway proteins and mRNA. Particularly, the high-dose group of SZF was more effective.</p><p><strong>Conclusion: </strong>Sanzi formula interfered with the progression of colorectal adenoma in Apcmin/+ mice by repairing the intestinal barrier function and blocking the Wnt/β-catenin signaling pathway, which provided a new idea and scientific basis for clinical treatment.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":"547-555"},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Berberine Alleviates 1-Methyl-3-Nitro-1-Nitrosoguanidine- Induced Chronic Atrophic Gastritis in Rats.","authors":"Lingling Wang, Liqun Xie","doi":"10.5152/tjg.2025.24065","DOIUrl":"https://doi.org/10.5152/tjg.2025.24065","url":null,"abstract":"<p><strong>Background/aims: </strong>Berberine (BBR), an isoquinoline alkaloid derived from Berberis plants, exhibits anti-inflammatory, anti-cancer, and antioxidant properties. This study explored the role of BBR in chronic atrophic gastritis (CAG).</p><p><strong>Materials and methods: </strong>The 1-methyl-3-nitro-1-nitrosoguanidine and an irregular diet were used to establish the CAG model. Chronic atrophic gastritis rats were administered BBR at different doses via gavage, and teprenone (TEP) served as the positive control drug. We monitored and measured changes in body weight and food intake, pepsin activity, and gastric acid levels in the rats. Hematoxylin and eosin staining was utilized to scan the pathological condition in the gastric mucosal tissue of rats, while enzyme-linked immunosorbent assay was utilized to analyze alterations in serum inflammatory factors and hormone levels. Western blot was employed to evaluate protein expression. Additionally, 16S rRNA was conducted to assess changes in the intestinal flora of CAG rats.</p><p><strong>Results: </strong>Berberine increased body weight and food intake, improved gastric atrophy, and enhanced pepsin activity and total acidity of gastric juice in CAG rats. BBR treatment led to decreased levels of inflammation factors and motilin, while gastrin and somatostatin levels were elevated in CAG rats. Additionally, BBR inhibited the NF-κB and MAPK pathway in these rats. Berberine treatment also regulated the composition and abundance of intestinal flora. These microbiome alterations suggest a possible role in modulating gut inflammation associated with CAG.</p><p><strong>Conclusion: </strong>Berberine may alleviate CAG injury by reducing inflammation and regulating intestinal flora, which may be closely associated with the NF-κB and MAPK pathways.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Second-Line Treatments After Atezolizumab and Bevacizumab in Advanced Hepatocellular Carcinoma and Related Prognostic Factors: A Multicenter Study by the Turkish Oncology Group (TOG).","authors":"Nargiz Majidova, Sendag Yaslıkaya, Maral Martin Mıldanoglu, Alper Coskun, Duygu Ercan Uzundal, Taha Koray Sahin, Arif Akyildiz, Sinem Akbas, Ufuk Camanlı, Elif Sahin, Huseyin Atacan, Ismail Bayrakcı, Teoman Sakalar, Ceren Mordag Cicek, Damla Gunenc, Nurullah İlhan, Olcun Umit Unal, Ozkan Alan, Buket Hamitoglu, Esra Ozen Engin, Nadiye Sever, Ali Kaan Guren, Ahmet Unsal, Murat Araz, Bulent Erdogan, Musa Barıs Aykan, Fatih Selcukbiricik, Deniz Can Guven, Nuriye Ozdemir, Ahmet Bilgehan Sahin, Ahmet Bilici, Ismail Oguz Kara, Suayip Yalcın, Osman Kostek","doi":"10.5152/tjg.2025.24784","DOIUrl":"10.5152/tjg.2025.24784","url":null,"abstract":"<p><strong>Background/aims: </strong>The treatment of hepatocellular carcinoma (HCC), which accounts for 90% of all liver cancers, is highly varied. The use of second-line treatments following progression on first-line atezolizumab and bevacizumab (Atez/Bev) for advanced HCC remains controversial. The aim of this study was to analyze the real-world clinical results of second-line treatments in progression after Atez/Bev and to determine the factors affecting prognosis.</p><p><strong>Materials and methods: </strong>Fifty-eight patients treated with second-line sorafenib, regorafenib, and cabozantinib for progression after first-line Atez/Bev for advanced/metastatic HCC from 20 centers in Türkiye between October 2020 and June 2024 were retrospectively analyzed. Responses were evaluated by Response criteria, specifically Response Evaluation Criteria in Solid Tumors (RECIST v1.1) criteria. Median overall survival (OS) and progression-free survival (PFS) were computed with the Kaplan-Meier method. The Cox regression model was utilized to analyze multivariate analyses.</p><p><strong>Results: </strong>About 82.8% of the patients were male and the median age of the whole group was 62 (range, 18-78) years. All patients progressed after first-line Atez/Bev and were given second-line treatment. The most commonly used second-line treatment option was sorafenib (70.7%), followed by regorafenib (12.1%) and cabozantinib (10.3%). Both median PFS (4.1 months) and median OS (7.8 months) were longer in patients treated with sorafenib compared to other treatments. In univariate analyses, Child-Pugh score B, high alpha-fetoprotein (AFP) levels (>200 ng/mL), extrahepatic spread, and Prognostic Nutritional Index (PNI) < 47.6 substantially raised the risk of overall mortality. Multivariate analysis showed that extrahepatic spread (HR (Hazard ratio): 0.41, P = .012), PNI level (HR: 0.24, P = .005), and AFP level (HR:1.97, P = .049) were independent predictors of OS.</p><p><strong>Conclusion: </strong>Although second-line therapies after Atez/Bev show different degrees of efficacy, survival rates are consistent with the literature. Extrahepatic spread, AFP level, and PNI level are the main prognostic factors. In light of this information, personalized treatment strategies may improve outcomes for this challenging patient group.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":"36 5","pages":"293-301"},"PeriodicalIF":1.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}