Pretreatment prediction of Immunoscore in hepatocellular cancer:a radiomics-based clinical nomogram based on GdEOB-DTPA enhanced-MRI

Objective:To develop and validate a radiomics nomogram based on gadolinium-ethoxybenzyl-diethylenetriamine(GdEOB-DTPA)enhanced magnetic resonance imaging(MRI)for pretreatment prediction of Immunoscore(0–2 vs.3–4)in hepatocellular carcinoma(HCC)patients.

Specific metabolic impairments indicate loss of sustained liver improvements in metabolic dysfunction-associated steatotic liver disease treatment

Background:High liver fat content(LFC)induces increased risks of both hepatic and extrahepatic progression in metabolic dysfunction-associated steatotic liver disease(MASLD),while maintaining a significant decline in magnetic resonance imaging-based proton density fat fraction(MRI-PDFF)(≥30%decline relative to baseline)without worsening fibrosis results in improved histological severity and prognosis.However,the factors associated with the loss of sustained responses to treatment remain unclear,and we aim to identify them.Methods:Consecutive treatment-naïve MASLD patients between January 2015 and February 2022,with follow-up until April 2023,were included in this prospective cohort study.LFC quantified by MRI-PDFF and liver stiffness measurements(LSM)determined by two-dimensional shear wave elastography(2D-SWE)were evaluated at weeks 0,24 and 48.MRI-PDFF response was defined as a≥30%relative decline in PDFF values,and LSM response was defined as a≥1 stage decline from baseline.Results:A total of 602 MASLD patients were enrolled.Of the 303 patients with a 24-week MRI-PDFF response and complete follow-up of 48 weeks,the rate of loss of MRI-PDFF response was 29.4%,and multivariable logistic regression analyses showed that 24-week insulin resistance(IR),still regular exercise and caloric restriction after 24 weeks,and the relative decline in LFC were risk factors for loss of MRI-PDFF response.Loss of LSM response at 48 weeks occurred in 15.9%of patients,and multivariable analysis confirmed 24-week serum total bile acid(TBA)levels and the relative decline in TBA from baseline as independent predictors.No significant association was found at 48 weeks between loss of MRI-PDFF response and loss of LSM response.Conclusions:MASLD patients with IR and high TBA levels are at higher risks of subsequent diminished sustained improvements of steatosis and fibrosis,respectively.

The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms(2020)

Pancreatic neuroendocrine neoplasms(pNENs)are highly heterogeneous,and the management of pNENs patients can be intractable.To address this challenge,an expert committee was established on behalf of the Chinese Pancreatic Surgery Association,which consisted of surgical oncologists,gastroenterologists,medical oncologists,endocrinologists,radiologists,pathologists,and nuclear medicine specialists.By reviewing the important issues regarding the diagnosis and treatment of pNENs,the committee concluded evidence-based statements and recommendations in this article,in order to further improve the management of pNENs patients in China.

Discrepancies between Nonalcoholic and Metabolic-associated Fatty Liver Disease by Multiple Steatosis Assessment

Background and Aims:The redefinition of metabolic-as-sociated fatty liver disease(MAFLD)from nonalcoholic fat-ty liver disease(NAFLD)has caused a revolution in clinical practice,and the characteristics of patients with steatosis but not MAFLD remain unclear.The aims were to compare the diagnosis rate of MAFLD in NAFLD using different steato-sis methods and explore the features of non-MAFLD-NAFLD and MAFLD-non-NAFLD.Methods:A cross-sectional study enrolling consecutive individuals was conducted at three medical centers in southern China from January 2015 to September 2020.Steatosis was evaluated by liver biopsy or magnetic resonance imaging-based proton density fat frac-tion(MRI-PDFF),ultrasound,controlled attenuation param-eter(CAP),and fatty liver index(FLI).Fibrosis was assessed by the NAFLD fibrosis score,transient elastography,or shear wave elastography.Results:The study enrolled 14,985 Chi-nese adults.The agreement of MAFLD and NAFLD diagnoses were 83%for FLI,95%for ultrasound,94%for both CAP and MRI-PDFF,and 95%for liver biopsy.The body mass index,blood pressure and lipid levels among non-MAFLD-NAFLD pa-tients were similar metabolic parameters(p>0.05 for all),but not the alanine aminotransferase and the proportion of pa-tients with insulin resistance,which were significantly higher in non-MAFLD-NAFLD with significant fibrosis.Conclusions:The new MAFLD definition ruled out 5-17%of NAFLD cases.NAFLD and MAFLD-NAFLD involved more severe metabolic abnormalities than MAFLD and MAFLD-non-NAFLD.Non-MAFLD-NAFLD patients with significant fibrosis had more se-vere liver injury and increased glycemic dysregulation within the normal range.Attention should be paid to its progression.

Comparison of clinical efficacy between LAPS and ALPPS in the treatment of hepatitis B virus-related hepatocellular carcinoma

Background:Insufficient post-operative future liver remnant(FLR)limits the feasibility of hepatectomy for patients.Staged hepatectomy is an effective surgical approach that can improve the resection rate of hepatocellular carcinoma(HCC).This study aimed to compare the safety and efficacy of laparoscopic microwave ablation and portal vein ligation for staged hepatectomy(LAPS)and classical associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in the treatment of hepatitis B virus(HBV)-related HCC.Methods:Clinical data of patients with HBV-related HCC who underwent LAPS or ALPPS in our institute between January 2017 and May 2022 were retrospectively analysed.Results:A total of 18 patients with HBV-related HCC were retrospectively analysed and divided into the LAPS group(n=9)and ALPPS group(n=9).Eight patients in the LAPS group and eight patients in the ALPPS group proceeded to a similar resection rate(88.9%vs 88.9%,P=1.000).The patients undergoing LAPS had a lower total comprehensive complication index than those undergoing ALPPS but there was not a significant different between the two groups(8.66 vs 35.87,P=0.054).The hypertrophy rate of FLR induced by ALPPS tended to be more rapid than that induced by LAPS(24.29 vs 13.17 mL/d,P=0.095).The 2-year recurrence-free survival(RFS)was 0%for ALPPS and 35.7%for LAPS(P=0.009),whereas the 2-year overall survival for ALPPS and LAPS was 33.3%and 100.0%(P=0.052),respectively.Conclusions:LAPS tended to induce lower morbidity and FLR hypertrophy more slowly than ALPPS,with a comparable resection rate and better long-term RFS in HBV-related HCC patients.