Annals of hepatology最新文献

{"title":"Prediction of incident overt hepatic encephalopathy using individual and composite measures of minimal hepatic encephalopathy: The PrO-MHE Study.","authors":"Akash Roy, Utkarsh Bhattad, Shardhya Chakraborty, Shruti Keyal, Awanish Tewari, Nikhil Sonthalia, Sourish Roy, Rajat Khandelwal, Anand Kulkarni, Uday Chand Ghoshal, Jasmohan Bajaj, Rajender Reddy, Mahesh Kumar Goenka","doi":"10.1016/j.aohep.2026.102428","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102428","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Psychometric hepatic encephalopathy score (PHES) is the gold standard for minimal hepatic encephalopathy (MHE), predicts overt HE (OHE), but remains cumbersome for routine care. Point-of-care (POC) tests such as Stroop (EncephalApp) and Animal Naming Test (ANT) are simpler but assess narrower cognitive domains. We evaluated whether integrating POC domains into a composite score could improve the prediction of incident OHE.</p><p><strong>Patients and methods: </strong>153 outpatients underwent PHES, Stroop, and ANT. The primary endpoint was incident OHE within 180 days; death and liver transplantation were competing events. Cognitive predictors were analysed using Fine-Gray competing-risks regression with MELD and prior OHE as prespecified covariates. A composite cognitive risk score (CCRS) was derived from the principal component of standardized Stroop and ANT scores and rescaled from 0 to 10 RESULTS: MHE was present in 48.4% of cases. During follow-up, 29 (18.9%) developed incident OHE. In univariable models, PHES, Stroop time, and the CCRS were associated with incident OHE, whereas ANT was not. In multivariable models adjusted for MELD and prior OHE, PHES was the strongest predictor of incident OHE (sHR 0.77; 95% CI 0.66-0.90; p=0.001).Stroop (per 10-second prolongation) independently predicted OHE (sHR 1.05; 95% CI 1.03-1.07; p < 0.001). CCRS independently predicted OHE (sHR 1.37; 95% CI 1.04-1.82; p = 0.028) and pragmatically stratified patients into risk-based strata.</p><p><strong>Conclusions: </strong>In a competing-risks framework, PHES best predicts incident OHE. Among POC tests, Stroop outperformed ANT. A novel CCRS predicts OHE, risk-stratifies, but does not approximate PHES performance.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102428"},"PeriodicalIF":6.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep disorders in primary biliary cholangitis: A prospective analysis of clinical and patient-reported outcomes.","authors":"Ana Marenco-Flores, Natalia Rojas-Amaris, Victoria Abadi-Ron, Esteban Garita, Javier Polo-Ibarra, Fernando Munguia, Romelia Barba, Daniela Goyes, Esli Medina Morales, Leandro Sierra, Behnam Saberi, Vilas R Patwardhan, Alan Bonder","doi":"10.1016/j.aohep.2026.102431","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102431","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Primary biliary cholangitis (PBC) is associated with impaired quality of life and symptoms such as fatigue, pruritus, and sleep disturbances. However, the relationship between sleep disorders, disease severity, and patient outcomes is not well understood. This study evaluated the prevalence of sleep disorders in patients with PBC and their association with symptoms and clinical outcomes.</p><p><strong>Patients and methods: </strong>Adult patients with PBC enrolled in a prospective autoimmune liver disease registry between 2018 and 2024 were included. Sleep disturbances, fatigue, pruritus, and self-rated health were assessed using the PBC-40 and Chronic Liver Disease Questionnaire (CLDQ). Clinical characteristics, laboratory values, and treatment response were compared between patients with and without sleep disorders. Logistic regression was used to identify factors associated with sleep disturbances.</p><p><strong>Results: </strong>Among 104 patients with PBC, 33% reported sleep disorders. Patients with sleep disorders had higher ALP (p = 0.003) and AST levels (p = 0.018), reported more fatigue (p = 0.016), and had poorer self-rated health (p < 0.001). They were also less likely to meet Paris II response criteria (44% vs. 94%, p < 0.001). In multivariable analysis, higher ALP levels, non-response to UDCA, and poorer self-rated health were independently associated with sleep disorders.</p><p><strong>Conclusions: </strong>Sleep disorders are prevalent among patients with PBC and are associated with greater symptom burden, lower rates of response to UDCA, and poorer self-rated health. Recognition of sleep complaints may help identify patients with a greater disease burden.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102431"},"PeriodicalIF":6.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatocellular carcinoma surveillance in MASLD: from cirrhosis-based screening to personalized risk stratification.","authors":"Rosanna Villani, Gaetano Serviddio","doi":"10.1016/j.aohep.2026.102434","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102434","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and a major risk factor for hepatocellular carcinoma. Compared with viral-related liver cancer, MASLD-associated hepatocellular carcinoma occurs at older age, is often diagnosed at more advanced stages, and may develop in a significant proportion of patients without established cirrhosis. These features profoundly affect surveillance strategies, which have largely been based on cirrhosis-driven eligibility criteria. This review summarizes current evidence on hepatocellular carcinoma risk in MASLD, with a focus on surveillance. We discuss the epidemiology of MASLD-related hepatocellular carcinoma, the clinical relevance of non-cirrhotic disease, and the limitations of current surveillance approaches, particularly in individuals with obesity and hepatic steatosis. Across international guidelines, routine surveillance is recommended for patients with MASLD-related cirrhosis, whereas surveillance in non-cirrhotic MASLD is generally not advised because of the absence of validated selection criteria. Recent epidemiological and real-world data highlight the marked heterogeneity of HCC risk in MASLD populations and the suboptimal performance of ultrasound-based surveillance strategies. Future research should focus on validating risk stratification tools, refining eligibility criteria for surveillance beyond cirrhosis, and evaluating surveillance strategies tailored to individual risk profiles.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102434"},"PeriodicalIF":6.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CD38 in hepatic pathobiology: mechanisms, disease association and therapeutic implications.","authors":"Jason W Eng, Blake R Peterson, Sylvester Black","doi":"10.1016/j.aohep.2026.102433","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102433","url":null,"abstract":"<p><p>CD38 is a highly conserved multifunctional enzyme that regulates intracellular calcium signaling and NAD⁺ metabolism. Although extensively studied in cancer and autoimmune diseases, growing evidence points to a critical role for CD38 in both normal and diseased liver physiology. In hepatic tissue, CD38 is expressed on multiple cell types. Aberrant CD38 activity contributes to increased oxidative stress, inflammation, and diminished tissue repair. Recent studies suggest that CD38 may also promote cellular senescence partly through its regulation of intracellular NAD⁺ and calcium. This review examines the role of CD38 in maintaining hepatic homeostasis and explores its involvement in liver injury, chronic liver diseases, and carcinogenesis. We also highlight the contribution of CD38-mediated signaling to hepatic fibrogenesis and end-stage liver failure as well as its potential role in liver transplantation, particularly post-transplant related conditions including ischemic injury and acute cellular rejection. Given its impact on multiple intracellular processes, CD38 has emerged as a promising therapeutic target. New findings describe how CD38 inhibition preserves NAD⁺ levels, supports tissue recovery, and mitigates disease progression in the liver. Finally, we outline new frontiers for CD38 in liver biology and the advancement of CD38-targeted therapeutic strategies.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102433"},"PeriodicalIF":6.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing chronic Hepatitis B care through digital twin modelling.","authors":"Ruqaiyyah Siddiqui, Naveed Ahmed Khan","doi":"10.1016/j.aohep.2026.102436","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102436","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102436"},"PeriodicalIF":6.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound-guided liver biopsy with portal pressure gradient measurement: a single-session diagnostic approach.","authors":"Froylan D Martínez-Sánchez, Félix I Téllez-Ávila, Ignacio García-Juárez","doi":"10.1016/j.aohep.2026.102435","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102435","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102435"},"PeriodicalIF":6.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of non-invasive tests for fibrosis diagnosis and prognostication of events in metabolic dysfunction-associated steatotic liver disease: A prospective study cohort.","authors":"Marie Louise N Therkelsen, Liv Eline Hetland, Mikkel Parsberg Werge, Mira Thing, Elias Badal Rashu, Puria Nabilou, Nina Kimer, Anders Ellekær Junker, Alejandro Mayorca Guiliani, Morten Asser Karsdal, Diana Julie Leeming, Lise Lotte Gluud","doi":"10.1016/j.aohep.2026.102251","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102251","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Risk stratification is important in the management of metabolic dysfunction-associated steatotic liver disease (MASLD) to prioritize monitoring and treatment resources. We evaluated whether non-invasive tests (NITs) can predict major adverse liver outcomes (MALOs) and diagnose advanced fibrosis in patients with MASLD.</p><p><strong>Patients and methods: </strong>A prospective cohort of 270 patients with MASLD (median age 56 years; 44% female; 41% type 2 diabetes) was evaluated using nine NITs: FIB-4, LSM, Agile3+, Agile4, FAST, ADAPT, ELF, PRO-C3, and C1M. Cox proportional hazards models and ROC analyses were used to assess prognostic performance for MALOs and diagnosis of advanced fibrosis, respectively.</p><p><strong>Results: </strong>Over a four-year follow-up period, 25 patients experienced MALOs. All NITs were associated with MALOs, though confidence intervals were wide given the limited number of events. Most NITs demonstrated positive associations with risk (HR range 1.82-5.39; p < 0.05), whereas C1M was inversely associated (HR 0.63, 95% CI 0.49-0.82; p < 0.001), indicating reduced risk. As a secondary objective, we evaluated whether each NIT could diagnose advanced fibrosis. FIB-4 and LSM effectively ruled out advanced fibrosis, while ELF and the Agile scores showed the strongest overall discriminative performance. For confirming advanced fibrosis, ELF (81%/76%) and Agile3+ (85%/79%) achieved the best sensitivity-specificity balance.</p><p><strong>Conclusions: </strong>Our findings suggest that NITs may hold both diagnostic and prognostic value, helping to identify advanced fibrosis and stratify future risk of MALOs in MASLD which is a clinically heterogenous but clinically relevant outcome. Additional research is needed to evaluate their performance in primary care settings.</p><p><strong>Impact and implications: </strong>In MASLD, NITs have the potential for identification of at-risk patients. Identifying NITs that predict beneficial as well as detrimental outcomes could also add value to monitoring strategies although further evidence is needed to evaluate this potential.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102251"},"PeriodicalIF":6.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Porto-sinusoidal vascular disorder and sinusoidal obstructive syndrome in patients treated with thiopurines: a systematic review.","authors":"Armando Curto, Erica Nicola Lynch, Michele Tanturli, Rocco Gabriele Iamello, Marco Vanni, Enzo Monaco, Tommaso Mello, Tommaso Innocenti, Gabriele Dragoni, Andrea Galli","doi":"10.1016/j.aohep.2026.102439","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102439","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Thiopurines (azathioprine [AZA], 6-mercaptopurine [6-MP], 6-thioguanine [6-TG]) can cause hepatic microvascular injury, presenting chronically as porto sinusoidal vascular disorder (PSVD) or related vascular lesions, or acutely as sinusoidal obstruction syndrome (SOS/veno-occlusive disease). We reviewed evidence across indications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched MEDLINE, EMBASE, Web of Science, SCOPUS, and the Cochrane Library from inception to 12 January 2026. We included studies reporting PSVD, SOS, or hepatic vascular lesions in thiopurine exposed patients, capturing historical terminology and distinguishing clinicopathological PSVD from isolated histopathological lesions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 980 records, 97 studies were included across inflammatory bowel disease, haematological disorders, transplantation, and rheumatological diseases. The strongest causal signal emerged in paediatric acute lymphoblastic leukaemia maintenance, where randomised comparisons showed excess hepatic vascular injury, predominantly SOS and portal hypertension phenotypes, with 6-TG versus 6-MP, prompting protocol amendments and limiting prolonged 6-TG use. Outside haematology, evidence for AZA/6-MP associated PSVD and related vascular lesions came mainly from observational cohorts and case reports. PSVD presented insidiously with preserved synthetic function; early clues included unexplained thrombocytopenia or splenomegaly, with progression to varices, ascites, portal vein thrombosis, and portal-hypertension complications. Dose/exposure intensity and host susceptibility modified risk, supporting a plausible continuum between acute and chronic phenotypes, although direct evidence of progression from SOS to PSVD remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Thiopurines cause a spectrum of hepatic microvascular injury. Evidence most strongly implicates 6-TG, whereas evidence for AZA/6-MP-associated PSVD and related vascular lesions is less consistent but relevant. New thrombocytopenia or splenomegaly should prompt evaluation for portal hypertension; thiopurine withdrawal is recommended when PSVD/SOS is suspected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction and objectives: &lt;/strong&gt;Thiopurines (azathioprine [AZA], 6-mercaptopurine [6-MP], 6-thioguanine [6-TG]) can cause hepatic microvascular injury, which may present chronically as porto-sinusoidal vascular disorder (PSVD) or related vascular lesions, or acutely as sinusoidal obstruction syndrome (SOS/veno-occlusive disease). We systematically reviewed evidence across all clinical indications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We searched MEDLINE (PubMed), EMBASE, Web of Science Core Collection, SCOPUS, and the Cochrane Library from inception to 12 January 2026. We included original studies (case reports/series, observational studies, clinical trials) reporting PSVD or SOS or relevant hepatic vascular lesions historically associated with these entities in thiop","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102439"},"PeriodicalIF":6.2,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in Latin American hepatology: current evidence, implementation barriers, and strategic priorities.","authors":"Ezequiel Ridruejo, Andreas Teufel, Mario Alvares-da-Silva, Juan Turnes","doi":"10.1016/j.aohep.2026.102432","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102432","url":null,"abstract":"<p><p>Chronic liver diseases are an increasing cause of morbidity and mortality in Latin America, driven by the convergence of alcohol and metabolic-associated steatotic liver disease, and viral hepatitis. The region faces structural barriers including fragmented data systems, delayed diagnosis, disparities in access, and limited research capacity. Although artificial intelligence has shown clinical utility across hepatology, evidence supporting its implementation in Latin America remains limited. We reviewed the AI applications most relevant to regional hepatology, the barriers to adoption, and priorities for safe implementation. We conducted a narrative review based on iterative appraisal of peer-reviewed studies, regional epidemiological reports, and digital health policy documents identified through March 2026. Priority was given to evidence reporting external validation, pragmatic clinical testing, or direct relevance to implementation in regional health systems. Discriminative AI is most mature in fibrosis risk stratification, digital pathology for MASH trials, and opportunistic case finding using electrocardiogram-based screening. In a pragmatic cluster-randomized trial of 15,596 adults, AI-enabled electrocardiography doubled the detection of previously undiagnosed advanced chronic liver disease in primary care. Retrieval-augmented generation improves the accuracy of large language models for hepatitis C guideline interpretation, but generative systems still pose hallucination risk. Adoption in Latin America is limited by uneven digital maturity, weak interoperability, scarce local validation, regulatory fragmentation, and insufficient workforce preparation. AI may help address major challenges in Latin American hepatology, but implementation should be phased: first infrastructure and governance, then locally validated discriminative tools, and finally supervised generative AI.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102432"},"PeriodicalIF":6.2,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world hepatocellular carcinoma management and guideline adherence in the Netherlands: A 5-year multicentre prospective cohort study.","authors":"Coosje A M Verhagen, Jochem M Grossouw, Joep de Bruijne, Danny van der Helm, Jeffrey P B M Braak, Judith de Vos-Geelen, Heinz-Josef Klümpen, Frederik J H Hoogwater, Simeon J S Ruiter, Maarten W Nijkamp, Kevin Wiese, Matthijs Kramer, Merve Rousian, Pam E van der Meeren, Wojciech G Polak, Caroline M den Hoed, Otto M van Delden, Bas Groot Koerkamp, Roeland F de Wilde, R Bart Takkenberg, Mark C Burgmans, Minneke J Coenraad","doi":"10.1016/j.aohep.2026.102250","DOIUrl":"10.1016/j.aohep.2026.102250","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Dutch guidelines for hepatocellular carcinoma (HCC) are based on the European Association for the Study of the Liver (EASL) guideline. With the emergence of novel therapies, this study aimed to describe real-world first-line treatment practices in the Netherlands and assess their alignment with the EASL 2018 and 2025 recommendations.</p><p><strong>Methods: </strong>Between 2019 and 2024, treatment-naive patients with HCC were prospectively enrolled across six Dutch tertiary referral centres as part of a cohort study paired with a biobank. Staging was in accordance with the Barcelona Clinic Liver Cancer (BCLC) 2022 classification.</p><p><strong>Results: </strong>A total of 619 patients (79% male; median age 71 years) were included. Cirrhosis was registered in 65%. BCLC stage distribution was 11% BCLC-0, 53% BCLC-A, 14% BCLC-B, 18% BCLC-C, 2.9% BCLC-D, and 1.1% missing data. First-line therapy was most commonly thermal ablation (TA) in BCLC-0/A (48%), transarterial chemoembolization (TACE) in BCLC-B (46%), and systemic therapy in BCLC-C (41%). Adherence to first-line treatment recommendations was 46% per EASL 2018 and 63% per EASL 2025 guidelines. TACE, transarterial radioembolization and atezolizumab + bevacizumab were applied across all stages, ahead of guideline integration. One-year overall survival was 97% (BCLC-0), 91% (BCLC-A), 79% (BCLC-B), 70% (BCLC-C), and 33% (BCLC-D).</p><p><strong>Conclusion: </strong>Treatment practices in the Netherlands adapt in response to emerging evidence. Guideline-adherent first-line treatment was observed in 46% of patients according to the EASL 2018 guidelines and 63% according to the EASL 2025 guidelines. Although guidelines remain the foundational framework for clinical decision-making, treatment decisions in real-world practice often extend beyond guideline recommendations.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102250"},"PeriodicalIF":6.2,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}