AIM:The effect of treatment response to anticoagulant therapy on prognosis of patients with cirrhosis and portal vein thrombosis (PVT) remains unclear. METHODS:Forty-one patients with cirrhosis and first PVT treated with intravenous anticoagulant therapy between January 2015 and April 2018 at 10 Japanese hospitals were included. Treatment response was defined based on change in size of PVT after anticoagulant therapy as the following: complete response (CR, 0%), partial response (PR, ≤ 50%), stable disease (SD, 51%-100%), and progressive disease (PD, ≥ 101%). CR and PR were combined as the effective group and SD and PD formed as the ineffective group. RESULTS:The median age was 69 years, and 56% of the patients had Child-Pugh class B. Overall, 5 (12%) achieved CR, 22 (54%) achieved PR, 12 (29%) had SD and 2 (5%) had PD. During a median follow-up of 31.8 months from the date of assessment of treatment response, 17 patients died. The overall survival rates at 1- and 3-year were 82.5% and 65.1%, respectively. In the multivariate analysis, the model for end-stage liver disease-Na score was significantly associated with overall survival, whereas treatment response was not significant. Twenty-five patients experienced liver-related events with hospitalization, and the 3-year cumulative rate of liver-related events was 63.9%. In the multivariate analysis, treatment response was significantly associated with liver-related events. The 3-year cumulative rates of liver-related events were 56.7% and 75.5% in the effective and ineffective groups, respectively (p = 0.008). CONCLUSIONS:Among patients with cirrhosis, treatment response to anticoagulant therapy for PVT correlated with the incidence of liver-related hospitalization events.
Long-term nucleos(t)ide analog (NUC) treatment improves the outcomes of patients with chronic hepatitis B virus (HBV) infection. However, only a limited number of patients treated with NUC can achieve hepatitis B surface antigen (HBsAg) seroclearance, the so-called “functional cure.” However, it remains unclear how on-treatment viral factors affect HBsAg seroclearance during long-term NUC treatment. We aimed to investigate whether the baseline and on-treatment HBV markers can predict HBsAg seroclearance and reduction in patients treated with long-term NUC treatment. This study included two independent cohorts consisting of 843 patients in the derivation cohort and 1781 patients in the validation cohort. HBsAg seroclearance was infrequent (3.7–6.2
PURPOSE:Our objective was to evaluate the utilization and clinical impact of CONNECT-LR, an asynchronous teleconsultation system for locally recurrent rectal cancer (LRRC), focusing on resectability assessment and clinical trial referral. METHODS:In this multicenter, prospective observational study, we included all cases submitted to CONNECT-LR between August 2019 and March 2025, as well as referring physicians and consultants. Referring physicians securely uploaded anonymized clinical and imaging data through a dedicated platform, and consultants responded within 1 week. Data were collected in predefined categories, including consultation purposes and recommendations, physician and institutional characteristics, and user and consultant surveys assessing satisfaction and clinical course. The analysis comprised descriptive statistics. RESULTS:Overall, 77 consultations were conducted. Most referring physicians were gastrointestinal surgeons (97.4%). The primary purpose of consultation was resectability assessment in 55 cases (71.4%). Of the 34 cases initially judged as unresectable or with uncertain resectability by referring physicians, 24 (70.6%) were reclassified as resectable by consultants, and surgical resection was performed in 15 of these 34 cases (44.1%), predominantly following referral to consultants' institutions. Six patients were enrolled in a randomized controlled trial for resectable LRRC. User satisfaction was high: 93.3% of referring physicians and 76.1% of consultants reported being satisfied or somewhat satisfied. CONCLUSIONS:CONNECT-LR effectively provides expert judgment, often altering resectability assessments and increasing access to curative-intent surgery for patients with LRRC, offering a potential pathway to clinical trial participation. As a feasible, secure, and scalable model, this teleconsultation platform may help reduce regional disparities and expand access to subspecialty care for LRRC.
Abstract Objective This study aimed to evaluate whether the preoperative FAN score—composed of the fibrosis‐4 (Fib‐4) index, albumin–bilirubin (ALBI) score and neutrophil–lymphocyte ratio (NLR)—predicts recurrence‐free, cancer‐specific and overall survival after radical cystectomy for bladder cancer. Patients and Methods We retrospectively analysed 1121 patients who underwent radical cystectomy at 13 institutions between April 2010 and March 2024. Associations between the FAN score and recurrence‐free survival (RFS), cancer‐specific survival (CSS) and overall survival (OS) were evaluated. Prognostic performance was assessed in an independent cohort of 296 patients from three institutions. Results FAN score distribution was 0 (n = 600, 53.5%), 1 (n = 409, 36.5%) and ≥2 (n = 112, 10.0%). Patients with a FAN score ≥2 had significantly worse RFS (median: not reached vs 12.3 months; p < 0.0001), CSS (not reached vs 22.8 months; p < 0.0001) and OS (112.5 vs 16.1 months; p < 0.0001) than those with a FAN score ≤1. On multivariable analysis, a FAN score ≥2 was an independent predictor of poorer RFS (HR 2.12, 95% CI 1.55–2.91; p < 0.0001), CSS (HR 2.80, 95% CI 2.00–3.92; p < 0.0001) and OS (HR 2.70, 95% CI 2.03–3.59; p < 0.0001). These associations were consistently observed in an independent cohort of 296 patients. Conclusions The FAN score is an independent prognostic marker of adverse outcomes after radical cystectomy for bladder cancer and may help stratify patients for perioperative management and follow‐up.
