Background:Overt hepatic encephalopathy (OHE) is a common complication after transjugular intrahepatic portosystemic shunt (TIPS), adversely affecting quality of life. This study aimed to develop a predictive model integrating manual imaging, radiomics, and clinical data to forecast OHE within 1 year post-TIPS. Methods:This retrospective study included 338 patients who underwent TIPS between November 2015 and January 2022, divided into training and validation sets (7:3). Feature selection was performed using Chi-square test, t-test, least absolute shrinkage and selection operator, and logistic regression. Three models were built using manual CT features (Model M), radiomics (Model R), and clinical data (Model C), respectively. A combined model (Model MRC) integrated all three. Model performance was evaluated via ROC curves, calibration plots, and decision curve analysis. The primary endpoint was OHE occurrence within 1 year post-TIPS. Results:Within 1 year after TIPS, 79 (33.4%) participants in the training group and 34 (33.3%) participants in validation group developed OHE. Three independent models and one combined model were established and evaluated in terms of their performance. The areas under the ROC curve of Model M, Model R, Model C, and Model MRC were 0.858 (95% CI: 0.809-0.907), 0.744 (95% CI: 0.681-0.808), 0.757 (95% CI: 0.692-0.821), and 0.902 (95% CI: 0.863-0.941), respectively. F1 scores were 0.861, 0.765, 0.797, and 0.891, respectively. Model MRC demonstrated superior performance compared to the other three models. Conclusion:Model MRC exhibited a considerable predictive ability for OHE within the first year after TIPS.

ABSTRACT Objective To investigate the clinical significance and peripheral immunological basis underlying the dynamic changes of Gustave Roussy Immune (GRIm) score and the hepatocellular carcinoma‐specific GRIm (HCC‐GRIm) score in unresectable hepatocellular carcinoma (uHCC) patients treated with transarterial chemoembolization (TACE) combined with immune checkpoint inhibitors (ICIs) and antivascular endothelial growth factor (anti‐VEGF) antibodies or tyrosine kinase inhibitors (TKIs). Methods This single‐center retrospective study included uHCC patients treated with TACE combined with ICIs and anti‐VEGF antibodies or TKIs between July 2019 and August 2024. Primary outcomes were the objective response rate (ORR) and disease control rate (DCR), assessed at the first treatment evaluation at the end of the fourth cycle based on mRECIST criteria; secondary outcomes included overall survival (OS) and progression‐free survival (PFS). GRIm and HCC‐GRIm scores were calculated at four key timepoints: baseline (Cycle 0), second cycle (Cycle 2), fourth cycle (Cycle 4), and disease progression (PD). Their distributions and trajectory patterns were analyzed in relation to OS. Peripheral immune markers were measured at each timepoint to characterize immune response dynamics. Comparisons of immune marker levels and trends were performed between GRIm high and low score groups, as well as between objective responders (OR) and nonresponders (nOR) across treatment stages. Principal component analysis (PCA) was applied to derive an integrated immune‐metabolic index (PC1) from GRIm components, and its correlations with immune markers were evaluated. Results A total of 68 uHCC patients treated with TACE plus ICIs and anti‐VEGF antibodies/TKIs were included. At the first evaluation, the ORR was 52.9% and the DCR 86.8%. After a median follow‐up of 18.4 months, the cohort showed a median overall survival (mOS) of 30.1 months and a median progression‐free survival (mPFS) of 10.6 months. GRIm and HCC‐GRIm scores remained stable across treatment phases, with their prognostic value for OS confined to baseline (Cycle 0) assessment (GRIm: p = 0.011; HCC‐GRIm: p = 0.001). Patients with persistently low scores had significantly longer OS than those with increasing trajectories (GRIm: p = 0.025; HCC‐GRIm: p = 0.048). Following treatment initiation, Igλ (p = 0.001), Igκ (p = 0.001), IgG (p = 0.002), and IgA (p = 0.001) levels showed an overall upward trend. At the first evaluation, these markers were significantly elevated in OR compared to baseline (Igλ [p = 0.022], Igκ [p = 0.032], IgG [p = 0.036], IgA [p = 0.019]), whereas no significant changes were observed in nOR (all p > 0.05). Among all timepoints, significant differences between high and low GRIm score groups were noted only at baseline, with higher Igλ (p = 0.001), Igκ (p = 0.014), and IgG (p = 0.009) levels in the high‐score group. In patients with low GRIm scores, linear regression revealed increasing trends in Igλ (p = 0.042), Igκ (p = 0.017), and IgG (p = 0.019) during treatment. PCA showed PC1 correlated positively with Igλ (r = 0.259, p = 0.033), Igκ (r = 0.293, p = 0.015), IgG (r = 0.355, p = 0.003), and complement factor B (CFB; r = 0.314, p = 0.009). Conclusion The GRIm and HCC‐GRIm scores were shown to be effective prognostic indicators only at baseline in uHCC patients treated with TACE combined with ICIs and anti‐VEGF antibodies or TKIs. Patients with low GRIm scores demonstrated treatment‐associated increases in Igλ, Igκ, and IgG levels. Igλ, Igκ, and IgG represent measurable links between GRIm‐defined risk categories, immune activation following treatment, and clinical outcomes. Integration of GRIm dynamics and immunoglobulin monitoring into clinical workflows may enhance risk stratification and support personalized treatment strategies in advanced HCC.

Abstract Objectives To evaluate the prognostic value of peripheral immune markers and their static and dynamic changes during different treatment stages in patients with hepatitis B virus (HBV)‐related unresectable hepatocellula carcinoma (uHCC) receiving transarterial chemoembolisation (TACE) combined with immune checkpoint inhibitors (ICIs) and anti‐vascular endothelial growth factor (anti‐VEGF) antibodies or tyrosine kinase inhibitors (TKIs). Methods This single‐centre retrospective study included patients with HBV‐related uHCC treated with TACE combined with ICls and anti‐VEGF antibodies or TKIs between July 2019 and July 2024. Peripheral blood immune indicators were collected at baseline (Cycle 0), the second treatment cycle (Cycle 2) and the fourth treatment cycle (Cycle 4). The primary outcome was overall survival (OS), while secondary outcomes included progression‐free survival (PFS), objective response rate (ORR) and disease control rate (DCR), with tumour response assessed at the first treatment evaluation (at the end of the fourth treatment cycle) based on mRECIST criteria. Longitudinal changes between adjacent time points were calculated (Δ: Cycle 2 ‐ Cycle 0; Δ2: Cycle 4 ‐ Cycle 2). Both static values and dynamic changes in immune markers were subjected to LASSO‐Cox and stepwise multivariate Cox regression analyses to identify independent predictors of OS. Based on the significant variables, a prognostic nomogram and an immune‐based risk score model were developed. To further assess prognostic heterogeneity, patients were stratified by K‐means clustering according to the temporal patterns of the most predictive immune marker, and survival outcomes were compared across the resulting subgroups. Results A total of 67 HBV‐related uHCC patients treated with TACE plus ICIs and anti‐VEGF antibodies/TKIs were included. The cohort had a median follow‐up of 18.2 months, with a median overall survival (mOS) of 30.4 months and a median progression‐free survival (mPFS) of 11.0 months. At the first evaluation, the objective response rate (ORR) was 53.7%, and the disease control rate (DCR) was 86.6%. LASSO‐Cox regression identified several static and dynamic immune markers associated with OS. Ultimately, CD4⁺/CD8⁺ ratio at Cycle 4 (HR = 0.58, p = 0.035), Δ2 NLR (HR = 1.66, p = 0.014), and Δ2 CD3⁺CD4⁺ (HR = 0.04, p = 0.007) were confirmed by stepwise multivariate Cox regression. A prognostic nomogram incorporating these variables demonstrated favourable predictive performance (C‐index = 0.72; AUCs = 0.750, 0.722 and 0.854 for 1‐, 2‐ and 3‐year OS, respectively). The derived immune‐based risk score effectively stratified patients into high‐ and low‐risk groups with significantly different OS (11.5 vs. 34.0 months, p < 0.001) and PFS (7.5 vs. 13.8 months, p = 0.006). The risk score showed a positive correlation with Δ2 NLR (r = 0.50) and negative correlations with CD4⁺/CD8⁺ ratio (r = −0.64) and Δ2 CD3⁺CD4⁺ (r = −0.45). Based on CD3⁺CD4⁺ trajectory clustering, three distinct immune dynamic subtypes were identified, among which the continuous decline group exhibited the poorest prognosis (p = 0.042). Conclusion This study demonstrates the prognostic relevance of peripheral immune markers in patients with HBV‐related uHCC receiving combination therapy. Immune dynamics observed during later treatment stages, rather than baseline measurements, were more strongly associated with overall survival. A risk model based on the CD4⁺/CD8⁺ ratio at Cycle 4, Δ2 NLR and Δ2 CD3⁺CD4⁺ enabled effective prognostic stratification and may provide a useful framework for risk assessment in this patient population.

Objective:To evaluate the prognostic value of the Gustave Roussy Immune (GRIm) score and the hepatocellular carcinoma-specific GRIm (HCC-GRIm) score in unresectable hepatocellular carcinoma (uHCC) treated with transarterial chemoembolization (TACE) plus immune checkpoint inhibitors (ICIs) and anti-VEGF antibodies/tyrosine kinase inhibitors (TKIs), and to examine their association with hepatitis B virus (HBV) activation and immune markers. Methods:This retrospective study enrolled uHCC patients receiving TACE plus ICIs and anti-VEGF antibodies/TKIs. Baseline blood tests were used to calculate GRIm and HCC-GRIm scores and determine HBV activation (HBV DNA > 60 IU/mL). Patients were stratified by GRIm, HCC-GRIm, and HBV activation. Objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and peripheral immune markers were compared across groups. Cox regression identified independent prognostic factors, and the prognostic value of key predictors was compared with Barcelona Clinic Liver Cancer (BCLC) and China Liver Cancer (CNLC) staging systems. Results:Sixty-seven patients were included. ORR and DCR were 53.7% and 86.6%; median OS was 30.4 months. High GRIm and HCC-GRIm scores were associated with shorter OS than low scores (GRIm: 15.4 vs 34.0 months, P = 0.019; HCC-GRIm: 15.4 vs 36.7 months, P = 0.002). OS and response did not differ significantly by HBV activation within score strata. Igλ, Igκ, and IgG levels were higher in patients with elevated GRIm/HCC-GRIm scores (all P < 0.01). ECOG performance status, GRIm, HCC-GRIm, and CD3⁺CD8⁺ proportion were independent prognostic factors, and CD3⁺CD8⁺ stratification showed better OS discrimination than GRIm, HCC-GRIm, BCLC, and CNLC. Conclusion:GRIm and HCC-GRIm are effective prognostic indicators in uHCC patients treated with TACE plus ICIs and anti-VEGF antibodies/TKIs, reflecting systemic immune and inflammatory status. Both scores retain prognostic value regardless of pre-treatment HBV activation but do not predict tumor response. In this single-center cohort, GRIm provided prognostic discrimination comparable to HCC-GRIm, and CD3⁺CD8⁺ T-cell stratification also showed prognostic value, offering an additional approach for risk assessment. Future larger, multicenter studies are needed to validate these findings and to define the optimal roles of GRIm, HCC-GRIm, and CD3⁺CD8⁺-based stratification in routine clinical practice.

To establish and validate a novel prognostic model to predict outcomes for intermediate hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). Clinical data from intermediate-stage HCC patients who underwent TACE between January 2007 and December 2020 were retrospectively analyzed. Patients were divided into a training cohort and a validation cohort. Univariate and multivariate analyses identified risk factors associated with overall survival (OS), leading to the development of a predictive model. The model's accuracy, consistency, and clinical utility were validated both internally and externally and compared with the Albumin-Bilirubin (ALBI) grading, Platelet-Albumin-Bilirubin (PALBI) grading, Child-Pugh grading, mChild-Pugh grading, and the Model for End-Stage Liver Disease (MELD). A total of 737 intermediate-stage HCC patients were included, with 481 in the training cohort and 256 in the validation cohort. Multivariate analysis identified maximum tumor diameter, tumor number, prealbumin, and total bilirubin as independent factors for OS. A prealbumin-bilirubin (PABI) predictive model was developed. The PABI model's concordance indices (C-index) in the training and validation cohorts were 0.730 (95% CI 0.701-0.759) and 0.706 (95% CI 0.661-0.751), respectively. The area under the curve (AUC) values at 6, 12, 18, and 24 months in both cohorts were above 0.7. Among the six models, the PABI model had the highest C-index (0.713) and the lowest Akaike information criterion (AIC) value (5897.814) and the best performance in clinical decision curve analysis, suggesting better predictive performance and potential clinical utility. The PABI nomogram model appears to accurately predict survival in intermediate-stage HCC patients treated with TACE, providing clinicians with a valuable tool for candidate selection and prognosis stratification.

BACKGROUND:Malnutrition exacerbates the deterioration in patients with advanced gastrointestinal tumors. AIM:To analyze the effect of enteral nutritional support based on Nutrition Risk Screening 2002 (NRS2002) risk assessment on nutritional function in patients with gastrointestinal tumors. METHODS:One hundred twelve patients from April 2022 to April 2024 were included for observation and were divided into a control group and an observation group by random number method, 56 each. Both groups received treatment for four consecutive weeks. The control group received routine enteral nutrition support, while the observation group received enteral nutrition support based on the NRS2002 risk assessment. Nutritional function, intestinal mucosal barrier function, quality of life, and complication rate were compared between the two groups. Statistical analysis was completed using SPSS26.0 and Excel. RESULTS:After nutritional intervention, transferrin, albumin, hemoglobin, and diamine oxidase levels in the observation group were higher than those in the control group, while C-reactive protein, tumor necrosis factor α, and quality of life scores were lower, with significant differences (P < 0.05). There was no significant difference in complications between groups (P > 0.05), but the complication rate was lower in the observation group. CONCLUSION:Enteral nutritional support based on NRS2002 risk assessment for patients with gastrointestinal tumors positively impacts nutritional status and promotes intestinal mucosal barrier function recovery. Patients' quality of life improved, and the incidence of adverse reactions decreased, indicating clinical promotion and application value.

Aims Post-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy and stent dysfunction remain the principal clinical problems restricting the procedure's application. Establishing TIPS in the left branch of the portal vein, as opposed to the right branch, can reduce the incidence of hepatic encephalopathy post-TIPS. This study aimed to analyze the effects of shunt position (including the puncture site of the portal vein and stent position) on the prognosis of patients undergoing TIPS for cirrhotic esophagogastric variceal bleeding (EGVB). Methods Data from 169 patients who underwent TIPS-covered stenting between November 2015 and December 2021 for portal hypertension with EGVB at the First Affiliated Hospital of Soochow University were retrospectively analyzed. The patients were divided into three groups according to the puncture site of the portal vein, named left branch (n = 92), right branch (n = 27), and bifurcation (n = 50) groups, respectively. The patients were also divided into the optimal stent position (O-SP) group (n = 102) and the suboptimal stent position (S-O-SP) group (n = 67) according to the stent position. The primary outcome was the overt hepatic encephalopathy (OHE) rate, and the secondary outcomes were the shunt dysfunction, variceal rebleeding, and liver transplant-free survival rates. Quantitative data are represented as means +/- standard deviations or medians (interquartile ranges), and categorical data are expressed as proportions and percentages. Categorical variables were analyzed using the chi(2) or rank-sum test, while normally distributed continuous variables were compared using the independent samples t-test or one-way analysis of variance, and non-normally distributed continuous variables were assessed using the Mann-Whitney U test or Kruskal-Wallis test. Results TIPS shunts were successfully created in all patients in this study, with a procedural success rate of 100%. The median follow-up time in this study was 30.5 (17.6-48.6) months, and no patients lost follow-up. Based on the puncture site, the left branch group versus the right branch group (32% vs. 67%, chi(2) = 14.529, p < 0.001) and the bifurcation group versus the right branch group (34% vs. 67%, chi(2) = 9.131, p = 0.003) were significantly different in terms of OHE rate, and the right branch group was worse than the other two groups. There was no significant difference in the OHE rate between the left branch and the bifurcation groups (32% vs. 34%, chi(2) = 0.165, p = 0.684). The median times to OHE were 58.3 (95% confidence interval [CI]: 51.6-65.0) months in the O-SP group and 38.2 (95% CI: 29.6-46.8) months in the S-O-SP group, with significant difference between them (chi(2) = 8.890, p = 0.003). The median times to shunt dysfunction were 68.4 (95% CI: 62.2-74.6) months for the O-SP group and 48.9 (95% CI: 40.8-57.0) months for the S-O-SP group, with significant difference between them (chi(2) = 12.717, p < 0.001). In our study, no differences were observed in the variceal rebleeding rate, liver transplant-free survival rate, and postoperative blood ammonia level among the different puncture sites and stent positions (p > 0.05). Univariate and multivariate Cox regression analyses showed that age, intraoperative puncture of the right branch of the portal vein, stent position, prothrombin time, international normalized ratio, and blood sodium were independent risk factors for the postoperative OHE rate. Conclusion TIPS controls cirrhotic EGVB. Puncturing the right portal vein to establish a TIPS shunt may increase the risk of postoperative OHE and impairment of the liver functional reserve. A suboptimal stent position may increase the risk of OHE and shunt dysfunction after TIPS. Both ends of the stent should be optimally positioned whenever possible.

OBJECTIVES:To compare the long-term efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with concurrent antegrade embolization in treating portal hypertension with oesophagogastric variceal bleeding in patients with and without large spontaneous portosystemic shunts (L-SPSSs). MATERIALS AND METHODS:We retrospectively analysed data from patients with portal hypertension who underwent TIPS from November 2015 to April 2022. The patients were screened according to the inclusion criteria and were divided into L-SPSSs group (L-S group) and Non L-SPSSs group (Non L-S group). The primary outcome was the 2-year liver transplantation-free survival (TFS) rate. Secondary outcomes contained the incidence of overt hepatic encephalopathy (OHE), ectopic embolization and the 2-year rebleeding rate. RESULTS:A total of 259 patients were enrolled (64 patients in L-S group and 195 patients in Non L-S group). The average age was 57.2 years, and the success rate of procedure was 100%. Baseline data showed no significant differences between two groups. There was a statistically significant difference in the 2-year liver transplantation-free rate between two groups (L-S vs. Non L-S, 84.38% vs. 71.28%; p = 0.045). OHE occurred in 19 (29.69%) patients with L-SPSSs and 104 (53.33%) patients without L-SPSSs, with a statistically significant difference (p = 0.001). And no statistically significant difference was found in ectopic embolism incidence rate and the 2-year rebleeding rate between two groups. Multivariate Cox regression analysis identified male gender, portal vein thrombosis and preoperative high blood ammonia levels as independent risk factors for long-term survival. CONCLUSION:Compared to Non L-S group, the patients in L-S group achieve longer liver transplantation-free survival and lower incidence rate of OHE without increasing the risk of 2-year rebleeding and ectopic embolization.

目的 比较经动脉化疗栓塞(TACE)同步联合微波消融(MWA)与TACE序贯联合MWA治疗肝细胞癌(HCC)的有效性与安全性.方法 回顾性分析苏州大学附属第一医院单中心2016年2月至2021年3月间行TACE同步或序贯联合MWA治疗的HCC患者临床资料.主要观察指标为无进展生存(PFS)时间和3、6及12个月总体生存(OS)率,次要观察指标为消融针次、消融时间、肿瘤反应及并发症发生率.结果 共63例患者纳入本研究,同步组29例,序贯联合组34例.两组患者的PFS时间[同步组(7.4±2.4)个月vs序贯组(6.2±3.6)个月],3、6、12个月OS率(同步组100％、100％、96.6％vs序贯组100％、97.1％、91.2％),差异均无统计学意义(P>0.05).同步组平均消融针次[(1.5±0.5)次]及消融时间[(9.9±3.9)min]均低于序贯组[(2.1±0.7)次、(14.6±4.5)min],均存在统计学差异(P<0.05).两组患者肿瘤客观反应率(同步组79.4％vs序贯组73.5％)和肿瘤控制率(同步组89.7％vs序贯组88.2％)无统计学差异(P>0.05).两组患者不良反应及并发症发生率无统计学差异(P>0.05).结论 本研究初步结果显示TACE同步联合或序贯联合MWA两种方式均能有效控制HCC肿瘤进展,在近期疗效方面无差异.与序贯联合相比,TACE同步联合MWA治疗能减少消融针次及消融时间,且未增加并发症发生率.

Purpose:To retrospectively evaluate and compare treatment effectiveness and safety between transarterial chemoembolization (TACE) combined with molecularly targeted agents plus immune checkpoint inhibitors (TACE+T+I) and TACE combined with molecularly targeted agents (TACE+T) for unresectable hepatocellular carcinoma (uHCC).Methods:We retrospectively analyzed the data of patients with unresectable HCC from January 2018 to June 2022. The patients were screened based on the inclusion criteria and were divided into the triple combination group (TACE+T+I) and the double combination group (TACE+T). The primary outcomes were overall survival (OS), progression-free survival (PFS), and adverse events (AEs). The secondary outcomes were objective response rate (ORR) and disease control rate (DCR). Risk factors associated with PFS and OS were determined by Cox regression analysis.Results:A total of 87 patients were enrolled in this study, including 42 patients in the TACE+T+I group and 45 patients in the TACE+T group. Over a median follow-up of 29.00 and 26.70 months, patients who received TACE+T+I therapy achieved a significantly longer median OS (24.00 vs. 21.40 months, p = 0.007) and median PFS (9.70 vs. 7.00 months, p = 0.017); no grade 4 AEs or treatment-related death occurred in the two groups. Grade 3 AEs attributed to systemic agents in the two groups showed no significant difference (19.0% vs. 15.6%, p = 0.667). Patients in the TACE+T+I group demonstrated better tumor response when compared with patients in the TACE+T group, with an ORR of 52.4% vs. 17.8% (p = 0.001). No significant difference was observed in DCR between the two groups (83.3% vs. 77.8%, p = 0.514). Cox regression analysis showed that only the treatment method was an independent factor of OS, and both age and treatment method were independent factors related to PFS.Conclusion:Compared with TACE plus molecularly targeted agents (TACE+T), the triple therapy (TACE+T+I) could improve survival and tumor response in unresectable HCC with manageable toxicities.

目的 探讨TACE联合靶向免疫药物治疗晚期肝细胞癌(HCC)的疗效和安全性.方法 回顾性分析 2019 年 1 月至 2021 年 9 月苏州大学附属第一医院收治的 37 例晚期HCC患者的临床资料.采用TACE联合靶向免疫药物治疗(联合组)16 例,单纯靶向免疫治疗(单纯组)21 例.Kaplan-Meier法绘制生存曲线,比较两组的中位无进展生存期(mPFS)、中位总生存期(mOS).根据mRECIST标准进行疗效评估,比较两组的客观缓解率(ORR)、疾病控制率(DCR).观察两组患者的不良反应发生情况.结果 联合组的mOS和mPFS分别为 14.0 个月(95％CI:4.59～23.41)和 6.0 个月(95％CI:4.04～7.96),单纯组分别为11.6个月(95％CI:4.53～18.67)和 4.5个月(95％CI:3.38～6.63),差异有统计学意义(P=0.047、0.045).联合组的ORR和DCR分别为 68.75％和 87.5％,较单纯组(4.76％和 33.3％)均明显提高(P＜0.01).两组患者严重不良事件的发生差异无统计学意义(P=0.634).结论 与单纯靶向免疫治疗相比,TACE联合靶向免疫药物治疗晚期HCC的疗效明显提高,且不会增加严重不良反应的发生.

Purpose: To investigate the safety and effectiveness of emergent transjugular intrahepatic portosystemic shunt (TIPS) as first-line therapy in patients with advanced cirrhosis with acute variceal hemorrhage.Materials and Methods: From July 2016 to June 2019, 76 patients with advanced cirrhosis and acute variceal hemorrhage were included in this retrospective study. All patients underwent emergent TIPS as first-line therapy within 24 hours. Gastroesophageal varices in patients with cirrhosis were diagnosed with contrast-enhanced computed tomography because emergent endoscopy has not been routinely performed in this center. The primary outcomes were the control rate of bleeding and the rate of rebleeding. Secondary outcomes were the technical success rate of procedure, transplantationfree survival, the mean hospitalization time, the time of stay in the intensive care unit, and adverse events. Results: All patients underwent TIPS creation successfully and were transferred to general wards. The median follow-up time was 21.7 months (interquartile range, 12.6-28.1 months). The control rate of bleeding (<= 5 days) was 100%. The rates of early (>5 days to 6 weeks) and late (>6 weeks to 2 years) rebleeding were 6.6% and 1.3%, respectively. The 6-week, 1-year, and 2-year transplantation-free survival rates were 94.7%, 93.4%, and 84.6%, respectively. The incidences of acute liver failure, hepatic encephalopathy, and shunt dysfunction were 5.3%, 25%, and 5.3%, respectively.Conclusions: Emergent TIPS as a first-line therapy in patients with advanced cirrhosis with acute variceal hemorrhage is safe and effective. This study provides an alternative approach for medical centers without emergent endoscopy facility to manage the condition.

Objectives: To evaluate the feasibility of computed tomography portal venography (CTPV) in the preoperative evaluation of emergent transjugular intrahepatic portosystemic shunt (TIPS) creation for cirrhotic patients with acute variceal bleeding (AVB). Methods: One hundred and forty-eight cirrhotic patients with AVB undergoing emergent TIPS creation from January 2016 to December 2022 in our institution were enrolled in the retrospective study. The primary outcome was the consistency between CTPV and endoscopy in the classification and grading of gastroesophageal varices (GEVs). The second outcome was extraluminal CTPV findings. The consistency of CTPV and endoscopy in the classification and grading of GEVs was determined by Kappa values. Results: Emergent TIPS creation was technically successful in all patients. Forty-five patients underwent preoperative endoscopy. The results of CTPV diagnosis of GEVs classification were that 112, 28, and 8 patients were classified as gastroesophageal varices type 1 (GOV1), GOV2, and isolated gastric varices type 1 (IGV1), respectively. In diagnosing the classification and grading of GEVs, CTPV showed substantial agreement with preoperative endoscopy, with Kappa values of 0.823 and 0.625, respectively. CTPV provided the afferent and afferent vessels of GEVs for emergent TIPS creation. Conclusion: CTPV is feasible and effective to act as an alternative preoperative evaluation method to endoscopy for cirrhotic patients with AVB undergoing emergent TIPS creation.

Objectives To estimate the safety and effectiveness of emergent transjugular intrahepatic portosystemic shunt (TIPS) creation for acute variceal bleeding (AVB) in cirrhotic patients with hepatocellular carcinoma (HCC). Materials and methods Data of thirty-three patients with AVB and HCC undergoing emergent TIPS creation from January 2016 to January 2022 were enrolled and were retrospectively analyzed. The primary outcomes were the safety of emergent TIPS creation, the bleeding control rate, and the rebleeding rate. The secondary outcomes included overall survival (OS), liver function, overt hepatic encephalopathy (HE), and shunt dysfunction. Results Emergent TIPS creation was technically successful in 33 patients (100%) and one (3.0%) patient suffered a major procedure-related adverse event. The control rate of bleeding (within 5 days) was 100%. During a median follow-up period of 26.3 months, rebleeding occurred in 6 (18.2%) patients. The median OS was 20.0 months. The 6-week and 1-year survival rates were 87% and 65%, respectively. Laboratory tests showed no significant impairment of liver function following TIPS creation. The incidences of overt HE and shunt dysfunction were 24.2% and 6.1%, respectively. Conclusion Emergent TIPS creation is feasible and effective for treatment of AVB in cirrhotic patients with HCC.

目的 观察CT门静脉成像(CTPV)用于TIPS治疗门静脉高压(PH)的价值.方法 纳入267例接受TIPS治疗的肝硬化失代偿期PH患者,分析其治疗前CTPV资料,观察肝内有无肿瘤、肝静脉与门静脉的相对空间位置、门静脉通畅度,曲张静脉分型、程度及有无异常分流道等.结果 在267例中,23例合并肝脏肿瘤,79例存在门静脉血栓,14例门静脉海绵样变性.门静脉分叉部、左支、右支裸露者占比分别为13.11％(35/267)、5.62％(15/267)及2.25％(6/267),肝静脉与门静脉之间的垂直距离为(22.83±9.56)mm,前后距离为(28.23±10.06)mm.术前增强CT及CTPV显示227例胃左静脉曲张、111例胃后/胃短静脉曲张及72例自发性门体静脉分流,其与术中DSA的一致率分别为98.24％(223/227)、85.59％(95/111)及100％(72/72).264例TIPS成功(264/267,98.88％),对其中58例采用辅助手段穿刺门静脉成功.结论 CT PV对于指导实施T IPS治疗P H具有重要价值.

Background: The CRAFITY (C-reactive protein and alpha-fetoprotein in immunotherapy) score has demonstrated prognostic significance in hepatocellular carcinoma (HCC) patients undergoing immunotherapy. The study aimed to validate accuracy of CRAFITY score on predicting prognosis for patients with HCC treated with transarterial chemoembolization (TACE) combined with PD-(L)1 inhibitors and molecular targeted therapy.Methods: Eighty-five HCC patients who underwent TACE in combination with molecular targeted therapy (MTT) and PD-(L)1 Inhibitors were consecutively enrolled from November 2019 to November 2022. Patients were divided into CRAFITY 0 score (n=32), CRAFITY 1 score (n=31), and CRAFITY 2 score (n=22), respectively. The primary outcomes were overall survival (OS) and progression-free survival (PFS), and the secondary outcomes included tumor response rate and treatment-related adverse events (TRAEs). Factors affecting survival were identified via Cox regression analysis.Results: The median overall survival (OS) for HCC patients with CRAFITY scores of 0, 1, and 2 was 33.4 months (95% confidence interval [CI]: 27.1-39.7), 34.5 months (95% CI: 23.1-45.9), and 24.2 months (95% CI: 13.9-39.3), respectively, there were statistical differences among the three groups (p<0.05). The progression-free survival (PFS) was 14.1 months (95% CI: 10.0-18.2), 14.1 months (95% CI: 9.0-19.2), and 9.3 months (95% CI: 7.2-11.4) for patients with CRAFITY scores of 1, 2, and 3, respectively, with a significant difference between the three groups (p<0.05). In patients with CRAFITY scores of 1, 2, and 3, the disease control rates (DCR) were 94%, 84%, and 73%, respectively (p < 0.05), while the overall response rates (ORR) were 78.1%, 67.7%, and 59.1%, respectively (p = 0.318). A higher CRAFITY score showed a correlation with an increased frequency of fatigue and grade 3 fever (p<0.05). Moreover, CRAFITY 2 score was an independent risk factor for both OS (HR = 2.610(1.281-4.564), p = 0.014) and PFS (HR = 2.419(1.281-4.564), p = 0.006).Conclusion: The CRAFITY score may provide an efficient predictive capacity for prognosis in HCC patients undergoing TACE combined with PD-(L)1 inhibitors and molecular targeted therapy.

Hepatocellular carcinoma (HCC) is one of the most common and deadly malignancies worldwide. Approximately, 80% of patients are initially diagnosed at intermediate or advanced stages, which means that curative therapies are unable to be performed. In most cases, systemic treatment is ineffective, especially when conventional cytotoxic agents are used. Sorafenib has been the only systemic agent proven to be effective in treating advanced HCC for over a decade. The rapid development of immunotherapy has remarkably revolutionized the management of advanced HCC. Besides, the combination of immunotherapy with molecular targeted agents or locoregional treatments is emerging as an effective tool for enhancing immunity. In the review, an overview of immunotherapy and its combination therapies for HCC is presented.

PurposeTo explore the safety and efficacy of transarterial chemoembolization (TACE) in combination with immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) for the treatment of unresectable hepatocellular carcinoma (uHCC).Materials and MethodsFrom August 2019 to July 2020, patients who received TACE combined with ICIs and TKIs were retrospectively analyzed. Treatment-related adverse events (AEs) were recorded. The Kaplan–Meier method was used to estimate time to progression (TTP) and progression-free survival (PFS).ResultsIn total, 31 patients with uHCC were included. Eleven patients were classified as BCLC-C. Nineteen patients had multiple lesions, and the cumulative targeted lesions were 69 mm (range, 21-170 mm) according to mRECIST. Twenty-nine (93%) patients experienced at least one AE during the treatment. Four (12.9%) patients developed AEs of higher grade (grade≥3). The objective response rate (ORR) and disease control rate (DCR) were 64.5% and 77.4%, respectively. The median time to response was 7 weeks (range, 4-30 w), and the duration of response was 17.5 weeks (range, 2-46 w). From the first ICIs, TTP and PFS were 6.5 months (95% CI, 3.5-11) and 8.5 months (95% CI, 3.5-NE), respectively.ConclusionsTACE combined with ICIs and TKIs shows an acceptable safety profile and considerable efficacy in patients with HCC.

Objective: This study aimed to evaluate the effectiveness and safety of transarterial chemoembolization (TACE) in combination with immune checkpoint inhibitors (ICIs) plus tyrosine kinase inhibitors (TKIs) (TACE+IT) versus ICIs plus TKIs (IT) for advanced hepatocellular carcinoma (HCC).Materials and Methods: Data of consecutive advanced HCC patients receiving TACE+IT or IT between January 2019 and December 2021 were included and were retrospectively analyzed. Propensity score matching (PSM) was performed to reduce bias due to confounding variables. The primary outcome of the study was overall survival (OS). The secondary outcomes were progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs), respectively.Results: Sixty-four patients were enrolled in the study, among which 24 and 40 received TACE+IT and IT, respectively. The PSM cohort included 24 patients receiving TACE+IT (TACE+IT group) and 24 patients receiving IT (IT group) alone. During a median follow-up of 23 months, patients in TACE+IT group had significantly longer OS (median, 17.3 vs 11.8 months, P = 0.023), better ORR (41.7% vs 12.5%, P = 0.023) and DCR (79.2% vs 50.0%, P = 0.035) than those in the IT group, whereas a non-significant trend in PFS (median, 7.4 vs 6.7 months, P = 0.23) was observed. According to multivariable cox regression analysis, it was found that treatment modality was the only independent risk factor for OS (HR = 0.404, 95% CI = 0.179-0.911, P < 0.05). There were no remarkable differences in AEs associated with ICIs and TKIs between the two groups, with the exception of gastrointestinal reaction.Conclusion: TACE combined with ICIs plus TKIs significantly improved OS, ORR, and DCR and showed a relatively longer PFS trend over ICIs combined with TKIs for advanced HCC.