Compensated advanced chronic liver disease (cACLD) encompasses patients with advanced fibrosis/cirrhosis at risk for liver-related complications. The natural history of cACLD has been extrapolated from compensated cirrhosis and historic cohorts, although major advances in diagnosis and management have impacted the clinical course and understanding of disease trajectories. From 2015 to 2022, 1140 consecutive patients with cACLD (first-time liver stiffness measurement [LSM] ≥10 kPa) at the Vienna General Hospital were followed for first and further decompensation, and death. Baseline data (age, sex, etiological cure, LSM, MELD, platelet count, and albumin) were incorporated into a multistate modelling framework to investigate transition-specific associations. 42
Chronic liver disease is a major cause of morbidity and mortality worldwide, accounting for approximately 4
Microvascular invasion (MVI) predicts recurrence after curative hepatocellular carcinoma (HCC) resection, but its accuracy is limited. Dynamic circulating tumor DNA (ctDNA)–minimal residual disease (MRD) monitoring has strong predictive value in solid tumors, yet head-to-head comparisons with MVI in HCC are lacking. This prospective, multicenter cohort study enrolled 152 patients with HCC in Barcelona Clinic Liver Cancer stages 0–B undergoing curative resection. HCC tissue was collected for whole-exome sequencing, and ctDNA sequencing with an 804-gene panel was performed on peripheral blood obtained preoperatively and at 1, 4, and 7 months postoperatively to monitor MRD. The primary endpoint was recurrence-free survival. The predictive performance of MVI, longitudinal ctDNA-MRD, and their combined model was assessed using survival analysis, time-dependent receiver operating characteristic (ROC) curves, concordance index, integrated discrimination improvement, and net reclassification improvement. MVI-positive patients (52.0 https://clinicaltrials.gov/study/NCT06449846?term=NCT06449846 viewType=Card rank=1 .
