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Chinese expert consensus on refined diagnosis,treatment,and management of advanced primary liver cancer(2023 edition)

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肝脏研究（英文） 2024年第2期8卷 61-71页

作者： Xiufeng Liu Feng Xia Yue Chen Huichuan Sun Zhengqiang Yang Bo Chen Ming Zhao Xinyu Bi Tao Peng Aizier Ainiwaer Zhiwen Luo Fusheng Wang Yinying Lu National clinical Research Center for Infectious Diseases Society of Hepatology,Beijing Medical Association Translational Medicine Branch,China Association of Gerontology and Geriatrics Department of Medical Oncology Bayi Hospital Affiliated to Nanjing Chinese Medical University NanjingJiangsuChina Department of Hepatobiliary surgery Southwest HospitalArmy Medical University ChongqingChina Senior Department of Hepatology The Fifth Medical Center of PLA General HospitalBeijingChina Department of liver surgery and transplantation Liver Cancer InstituteZhongshan HospitalFudan UniversityShanghaiChina Department of Interventional Therapy National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Radiation Oncology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Minimally Invasive Interventional Therapy Liver Cancer Study and Service GroupSun Yat-sen University Cancer CenterGuangzhouGuangdongChina Department of Hepatobiliary surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Hepatobiliary surgery The First Affiliated Hospital of Guangxi Medical UniversityNanningGuangxiChina Senior Department of Infectious Diseases The Fifth Medical Center of PLA General HospitalBeijingChina Comprehensive liver Cancer Center The Fifth Medical Center of PLA General HospitalBeijingChina

Hepatocellular carcinoma(HCC),commonly known as primary liver cancer,is a major cause of malignant tumors and cancer-related deaths in China,accounting for approximately 85％of all cancer cases in the *** guidelines have been used to diagnose and treat liver ***,these guidelines provide a broad definition for classifying advanced liver cancer,with an emphasis on a singular approach,without considering treatment options for individual ***,it is necessary to establish a comprehensive and practical expert consensus,specifically for China,to enhance the diagnosis and treatment of HCC using the Delphi *** classification criteria were refined for Chinese patients with HCC,and the corresponding optimal treatment regimen recommendations were *** recommendations took into account various factors,including tumor characteristics,vascular tumor thrombus grade,distant metastasis,liver function status,portal hypertension,and the hepatitis B virus replication status of patients with primary HCC,along with treatment *** findings and rec-ommendations provide detailed,scientific,and reasonable individualized diagnosis and treatment strategies for clinicians.

关键词： Hepatocellular carcinoma (HCC) Targeted therapy Immunotherapy Refined diagnosis and treatment Expert consensus

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Advancing immunosuppression in liver transplantation: A narrative review

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 441-448页

作者： Samuele Iesari Francesca Laura Nava Ilaria Elena Zais Laurent Coubeau Mariano Ferraresso Evaldo Favi Jan Lerut General surgery and Kidney transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico15 Via della Commenda20122 MilanItaly Institut de Recherche Expérimentale et Clinique Universitécatholique de Louvain10 Avenue Hippocrate1200 BrusselsBelgium service de Chirurgie et transplantation Abdominale Cliniques Universitaires Saint-Luc55 Avenue Hippocrate1200 BrusselsBelgium Department of clinical Sciences and Community Health Universitàdegli Studi di Milano19 Via della Commenda20122 MilanItaly

Immunosuppression is essential to ensure recipient and graft survivals after liver transplantation(LT). However, our understanding and management of the immune system remain suboptimal. Current immunosuppressive therapy cannot selectively inhibit the graft-specific immune response and entails a significant risk of serious side effects, i.e., among others, de novo cancers, infections, cardiovascular events, renal failure, metabolic syndrome, and late graft fibrosis, with progressive loss of graft function. Pharmacological research, aimed to develop alternative immunosuppressive agents in LT, is behind other solidorgan transplantation subspecialties, and, therefore, the development of new compounds and strategies should get priority in LT. The research trajectories cover mechanisms to induce T-cell exhaustion, to inhibit co-stimulation, to mitigate non-antigen-specific inflammatory response, and, lastly, to minimize the development and action of donor-specific antibodies. Moreover, while cellular modulation techniques are complex, active research is underway to foster the action of T-regulatory cells, to induce tolerogenic dendritic cells, and to promote the function of B-regulatory cells. We herein discuss current lines of research in clinical immunosuppression, particularly focusing on possible applications in the LT setting.

关键词： liver transplantation Immunosuppression Drug development Long-term results clinical operational tolerance

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liver transplantation for hepatocellular carcinoma in India: Are we ready for 2040?

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World Journal of transplantation 2024年第1期14卷 141-153页

作者： Hirak Pahari Amruth Raj Ambreen Sawant Dipak S Ahire Raosaheb Rathod Chetan Rathi Tushar Sankalecha Sachin Palnitkar Vikram Raut Department of liver Transplant and hpb surgery Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of liver Transplant Anaesthesia Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210India Department of Gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Gastroenterology and Hepatology Medicover HospitalsAurangabad 431003India Department of Gastroenterology and Hepatology Medicover HospitalsNashik 422009India Department of Gastroenterology and Hepatology Medicover HospitalsPune 411026India

BACKGROUND liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established *** cornerstone of this treatment lies in the various criteria formulated by expert consensus and *** variations among the criteria are staggering,and the short-and long-term outcomes are *** To study the differences in the current practices of LT for HCC at different centers in India and discuss their clinical implications in the *** We conducted a survey of major centers in India that performed LT in December 2022.A total of 23 responses were *** centers were classified as high-and low-volume,and the current trend of care for patients undergoing LT for HCC was *** Of the 23 centers,35%were high volume center(>500 liver transplants)while 52%were high-volume centers that performed more than 50 transplants/*** 39%of centers had performed>50 LT for HCC while the percent distribution for HCC in LT patients was 5%–15%in approximately 73%of the *** a few,most centers were divided equally between University of California,San Francisco(UCSF)and center-specific criteria when choosing patients with HCC for LT,and most(65%)did not have separate transplant criteria for deceased donor LT and living donor LT(LDLT).Most centers(56%)preferred surgical resection over LT for a Child A cirrhosis patient with a resectable 4 cm HCC ***-emission tomography-computed tomography(CT)was the modality of choice for metastatic workup in the majority of centers(74%).Downstaging was the preferred option for over 90%of the centers and included transarterial chemoembolization,transarterial radioembolization,stereotactic body radiotherapy and atezolizumab/bevacizumab with varied *** alphafetoprotein(AFP)cut-off was used by 74%of centers to decide on transplantation as well as to downstage tumors,even if they met the *** criteria for successful downstaging v

关键词： Hepatocellular carcinoma liver transplant India Downstaging Survey Milan University of California,San Francisco Portal vein tumor thrombus Expanded criteria

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Unveiling hidden outcomes in malignant gastric outlet obstruction research–insights from a"Pancreas 2000"review

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World Journal of Gastrointestinal Endoscopy 2024年第8期16卷 451-461页

作者： Filipe Vilas-Boas Giacomo Emanuele Maria Rizzo Charles De Ponthaud Stuart Robinson Sebastien Gaujoux Gabriele Capurso Giuseppe Vanella Bahadır Bozkırlı Department of Gastroenterology São João University HospitalPorto 4200Portugal Endoscopy service Department of Diagnostic and Therapeutic ServicesScientific Institute for ResearchHospitalization and Healthcare-The Mediterranean Institute for Transplantation and Highly Specialized TherapiesPalermo 90127SiciliaItaly Department of Digestive Hepato-Biliary and Pancreatic Surgery and Liver TransplantationAP-HP Pitié-SalpêtriereSorbonne UniversitéParis 75013Île-de-FranceFrance Department of Hepatobiliary Pancreatic and Transplant SurgeryFreeman HospitalNewcastle NE77DNNewcastle upon TyneUnited Kingdom Division of Pancreato-Biliary Endoscopy and Endosonography Pancreas Translational and Clinical Research CenterIRCCS San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilano 20132Italy Department of General surgery HPB-UnitAcıbadem Maslak HospitalIstanbul 34398Türkiye

Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic *** current treatment options include surgical gastroenterostomy,endoscopic stenting and more recently EUS-guided *** studies comparing the outcomes of the three procedures focus on technical success,clinical success and ***“occult”outcomes relevant to the patient’s viewpoints and perspective may ultimately impact on cancer-related and overall survival,such as body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of *** aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.

关键词： Malignant gastric outlet obstruction Endoscopic ultrasound-guided gastroenterostomy Patient-reported outcomes Body composition Nutrition Quality of life

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Role of neoadjuvant therapy for nonmetastatic pancreatic cancer:Current evidence and future perspectives

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 911-924页

作者： Gianluca Cassese Ho-Seong Han Yoo-Seok Yoon Jun Suh Lee Boram Lee Antonio Cubisino Fabrizio Panaro Roberto Ivan Troisi Department of clinical Medicine and surgery Division of Minimally Invasive HPB Surgery and Transplantation ServiceFederico II University HospitalNaples 80131Italy Department of surgery Seoul National University College of MedicineSeongnam 13620Gyeonggi-doSouth Korea Department of hpb surgery and transplantation Beaujon HospitalClichy 92110France Department of Digestive surgery and liver transplantation CHU MontpellierMontpellier 34100France

Pancreatic adenocarcinoma(PDAC)is one of the most common and lethal human cancers *** followed by adjuvant chemotherapy offers the best chance of a long-term survival for patients with PDAC,although only approximately 20%of the patients have resectable tumors when *** chemotherapy(NACT)is recommended for borderline resectable pancreatic *** studies have investigated the role of NACT in treating resectable tumors based on the recent advances in PDAC biology,as NACT provides the potential benefit of selecting patients with favorable tumor biology and controls potential micro-metastases in high-risk patients with resectable *** such challenging cases,new potential tools,such as ct-DNA and molecular targeted therapy,are emerging as novel therapeutic options that may improve old *** review aims to summarize the current evidence regarding the role of NACT in treating non-metastatic pancreatic cancer while focusing on future perspectives in light of recent evidence.

关键词： Pancreatic cancer Pancreatic duct adenocarcinoma Neoadjuvant chemotherapy Borderline resectable Locally advanced pancreatic cancer

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Uses of a dedicated 3D reconstruction software with augmented and mixed reality in planning and performing advanced liver surgery and living donor liver transplantation(with videos)

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Hepatobiliary & Pancreatic Diseases International 2022年第5期21卷 455-461页

作者： Deniz Balci Elvan Onur Kirimker Dimitri Aristotle Raptis Yujia Gao Alfred Wei Chieh Kow Department of surgery Medical Park Goztepe Hastanesi Organ Nakli Merkezi Nisan SokBahce se hir UniversityNo.23 Merdivenkoy KadıkoyIstanbulTurkiye Department of surgery Ankara UniversityAnkaraTurkiye clinical service of hpb surgery and liver transplantation NHS Foundation TrustRoyal Free London HospitalLondonUK Division of surgery&Interventional Science University College LondonLondonUK Division of Hepatobiliary&Pancreatic surgery Department of SurgeryNational University of SingaporeSingapore liver Transplant Program National University Center for Organ Transplantation(NUCOT)National University Health SystemSingapore

The development of digital intelligent diagnostic and treatment technology has opened countless new opportunities for liver surgery from the era of digital anatomy to a new era of digital diagnostics,virtual surgery simulation and using the created scenarios in real-time surgery using mixed *** this article,we described our experience on developing a dedicated 3 dimensional visualization and reconstruction software for surgeons to be used in advanced liver surgery and living donor liver ***,we shared the recent developments in the field by explaining the outreach of the software from virtual reality to augmented reality and mixed reality.

关键词： Living donor liver transplantation 3D reconstruction software 3D volumetry Precision medicine Augmented reality Mixed reality

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clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 699-715页

作者： Ankit Agarwal Sagnik Biswas Shekhar Swaroop Arnav Aggarwal Ayush Agarwal Gautam Jain Anshuman Elhence Arun Vaidya Amit Gupte Ravi Mohanka Ramesh Kumar Ashwani Kumar Mishra Shivanand Gamanagatti Shashi Bala Paul Subrat Kumar Acharya Akash Shukla Shalimar Department of Gastroenterology and Human Nutrition All India Institute of Medical SciencesNew Delhi 110029DelhiIndia Department of Gastroenterology Seth Gordhandas Sunderdas Medical College and KEM HospitalMumbai 400012MaharashtraIndia Department of Gastroenterology Sir HN Reliance Foundation HospitalMumbai 400004India Department of liver Transplant and hpb Sir HN Reliance Foundation HospitalMumbai 400004India Department of Gastroenterology All India Institute of Medical SciencesPatna 801507India Professor of Biostatistics National Drug Dependence Treatment Centre(NDDTC)All India Institute of Medical SciencesNew Delhi 110029India Department of Radiodiagnosis All India Institute of Medical SciencesNew Delhi 110029DelhiIndia

BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in *** A total of 904 BCS patients from New Delhi,India and 1140 from Mumbai,India were *** prevalence and incidence of HCC were determined,and among patients with BCS-HCC,the viability and outcomes of interventional therapy were *** In the New Delhi cohort of 35 BCS-HCC patients,18 had HCC at index presentation(prevalence 1.99%),and 17 developed HCC over a follow-up of 4601 person-years,[incidence 0.36(0.22-0.57)per 100 person-years].BCS-HCC patients were older when compared to patients with BCS alone(P=0.001)and had a higher proportion of inferior vena cava block,cirrhosis,and long-segment vascular *** median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up(13029 ng/mL vs 500 ng/mL,P=0.01).Of the 35 BCS-HCC,26(74.3%)underwent radiological interventions for BCS,and 22(62.8%)patients underwent treatment for HCC[transarterial chemoembolization in 18(81.8%),oral tyrosine kinase inhibitor in 3(13.6%),and transarterial radioembolization in 1(4.5%)].The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo(P=0.0001).In contrast to the New Delhi cohort,the Mumbai cohort of BCS-HCC patients were predominantly males,presented with a more advanced HCC[Barcelona Clinic liver Cancer C and D],and 2 patients underwent liver *** HCC is not uncommon in patients with *** interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes.

关键词： Budd chiari syndrome Cancer Cirrhosis Thrombosis liver Varices Transarterial chemoembolization Hepatic venous outflow tract obstruction

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Role of colectomy in preventing recurrent primary sclerosing cholangitis in liver transplant recipients

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World Journal of Gastroenterology 2018年第28期24卷 3171-3180页

作者： Bettina M Buchholz Panagis M Lykoudis Reena Ravikumar Joerg M Pollok Giuseppe K Fusai Department of hpb surgery and liver transplantation Royal Free Hospital London

AIM To study the published evidence on the impact of colectomy in preventing recurrent primary sclerosing cholangitis(r PSC). METHODS An unrestricted systematic literature search in Pub Med, EMBASE, Medline Ovid SP, ISI Web of Science, Lista(EBSCO) and the Cochrane library was performed on clinical studies investigating colectomy in liver transplantation(LT) recipients with and without r PSC in the liver allograft. Study quality was evaluated according to a modification of the methodological index for non-randomized studies(MINORS) criteria. Primary endpoints were the impact of presence, timing and type of colectomy on r PSC. Overall presence of inflammatory bowel disease(IBD), time of IBD diagnosis, posttransplant IBD and immunosuppressive regimen were investigated as secondary *** The literature search yielded a total of 180 publications. No randomized controlled trial was identified. Six retrospective studies met the inclusion criteria of which 5 studies were graded as high quality articles. Reporting of IBD was heterogenous but in four publications, either inflammatory bowel disease, ulcerative colitis or in particular active colitis post-LT significantly increased the risk of r PSC. The presence of an intact(i.e., retained) colon at LT was identified as risk factor for r PSC in two of the high quality studies while four studies found no effect. Type of colectomy was not associated with r PSC but this endpoint was underreported(only in 33% of included studies).Neither tacrolimus nor cyclosporine A yielded a significant benefit in disease recurrence of primary sclerosing cholangitis(PSC).CONCLUSION The data favours a protective role of pre-/peri-LT colectomy in r PSC but the current evidence is not strong enough to recommend routine colectomy for r PSC prevention.

关键词： Recurrent primary sclerosing cholangitis Risk factor Ulcerative colitis Colectomy liver transplantation

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It’s time to propose a uniform criteria for determining “clinical complete response” in hepatocellular carcinoma

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Hepatobiliary surgery and Nutrition 2022年第4期11卷 620-622页

作者： Lei Zhao Haitao Zhao Huichuan Sun Department of hpb surgery Shandong Cancer Hospital Affiliated to Shandong First Medical University and Shandong Academy of Medical ScienceJinanChina Department of liver surgery Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of liver surgery and transplantation Liver Cancer Institute and Zhongshan HospitalFudan UniversityShanghaiChina

In the past decade,great progress has been made in the systemic therapies of hepatocellular carcinoma(HCC),represented by the target therapies and immune checkpoint inhibitors(ICIs).In the Imbrave 150 trial,one in ten patients reached complete response(CR)with medical treatment alone(according to HCC-specific modified RECIST;mRECIST)(1).If different systemic regimes were combined with loco-regional therapies,the chance of achieving CR was even *** findings promoted the practice of conversion surgery in HCC(2,3).After tumors were converted and resected,a subgroup of HCC reached its pathological CR(pCR).Similar results were also observed in the latest pioneering trials of neoadjuvant ICIs therapies in HCC(4).

关键词： hepatocellular surgery clinical

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Randomized Trial of Ciclosporin with 2-h Monitoring *** with Trough Monitoring in liver transplantation:DELTA Study

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Journal of clinical and Translational Hepatology 2023年第4期11卷 839-849页

作者： Bastian N.Ruijter Akin Inderson Aad Pvan den Berg Herold J.Metselaar Jeroen Dubbeld Maarten E.Tushuizen Robert J.Porte Wojciech Polak Danny van der Helm Marjolein van Reeven Mar Rodriguez-Girondo Bart van Hoek Department of Gastroenterology and Hepatology LUMC Transplantation CenterLeiden University Medical CenterLeidenThe Netherlands Department of Gastroenterology and Hepatology University Medical Center GroningenGroningenThe Netherlands Department of Gastroenterology and Hepatology Erasmus MC Transplant InstituteErasmus Medical CenterRotterdamThe Netherlands Department of surgery LUMC Transplantation CenterLeiden University Medical CenterLeidenThe Netherlands Department of surgery Section HPB Surgery and Liver TransplantationUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands Department of surgery Division of HPB and Transplant SurgeryErasmus MC Transplant InstituteErasmus Medical CenterRotterdamThe Netherlands Department of Biomedical Data Sciences Leiden University Medical CenterLeidenThe Netherlands.

Background and Aims:Previous trials comparing cyclosporine and tacrolimus after liver transplantation(LT)showed conflicting *** used trough monitoring for cyclosporine(C0),leading to less accurate dosing than with 2-h monitoring(C2).Only one larger trial compared C2 with tacrolimus based on trough level(T0)after LT,with similar treated biopsy-proven acute rejection(tBPAR)and graft loss,while a smaller trial had less tBPAR with C2 compared to ***,it is still unclear which calcineurin inhibitor is preferred after *** aimed to demonstrate superior efficacy(tBPAR),tolerability,and safety of C2 or T0 after first ***:Patients after first LT were randomized to C2 or ***,patient-and graft survival,safety and tolerability were the main endpoints,with analysis by Fisher test,Kaplan-Meier survival analysis and log-rank ***:In intention-totreat analysis 84 patients on C2 and 85 on T0 were *** incidence of tBPAR C2 vs.T0 was 17.7%vs.8.4%at 3 months(p=0.104),and 21.9%vs.9.7%at 6 and 12 months(p=0.049).One-year cumulative mortality C2 vs.T0 was 15.5%vs.5.9%(p=0.049)and graft loss 23.8%vs.9.4%(p=0.015).Serum triglyceride and LDL-cholesterol was lower with T0 than with *** of diarrhea in T0 vs,C2 was 64%vs.31%(p≤0.001),with no other differences in safety and ***:In the first year after LT immunosuppression with T0 leads to less tBPAR and better patient-/re-transplant-free survival as compared to C2.

关键词： Adverse effects Ciclosporin liver transplantation Outcome Randomized controlled trial Rejection Survival Renal function Tacrolimus

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