International Hepatology

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. Early detection, diagnosis, and intervention can significantly reduce mortality rates. HCC development is driven by a series of complex processes, often starting from hepatitis and cirrhosis. During this progression, subtle changes in cellular gene expression, major shifts in molecular signaling pathways, and significant changes in tissue structure and organ function collectively accelerate HCC formation and progression, leading to changes in liver imaging. Researchers have used radiomics and deep learning technologies to timely and accurately identify and intervene in the formation stage of HCC, named the Transition Stage, potentially revolutionizing early prevention and intervention strategies for HCC.

Chronic hepatitis C virus (HCV) infection is a major cause of cirrhosis and hepatocellular carcinoma (HCC). In recent years, the treatment of HCV infection has undergone revolutionary changes, transforming chronic HCV infection into a curable disease. Although direct-acting antiviral (DAA) therapy can effectively clear HCV, improve liver fibrosis, and reduce the risk of HCC, certain factors such as age, liver fibrosis, metabolic diseases, genetic factors, and treatment regimens still put some patients at high risk for HCC even after HCV clearance. A recent study on the long-term prognosis of patients with advanced chronic liver disease post-HCV cure reveals that these patients continue to face risks of hepatic decompensation and HCC. This finding is crucial for developing long-term management strategies for cured HCV patients.

Liver cancer is a highly prevalent and poorly prognosed malignancy, with a postoperative recurrence rate as high as 60%-70%. Postoperative minimal residual disease (MRD) is the main culprit behind cancer recurrence and metastasis, but currently, methods to detect MRD in liver cancer are very limited. At the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, a prospective study reported by Dr. Jia Fan, Dr. Jian Zhou, and Dr. Xinrong Yang’s team from Zhongshan Hospital affiliated with Fudan University shows that circulating tumor DNA (ctDNA) can serve as an ideal marker for detecting postoperative MRD in liver cancer, effectively warning of recurrence and metastasis. Furthermore, ctDNA monitoring of MRD can guide postoperative adjuvant therapy decisions and monitor the efficacy of drug treatments, thereby aiding in the precise management of liver cancer throughout the postoperative period and significantly improving patient prognosis.

Diabetes and liver disease are common chronic diseases in China. They interact with each other in terms of pathogenesis, clinical manifestations, and therapeutic targets, often serving as mutual risk factors. Effective co-management can help reduce the disease burden. To support the development of diabetes and liver disease co-management in China, this journal, in collaboration with the China Diabetes and Liver Disease Co-Management Initiative (CDL), presents the CDL Literature Monthly Review. Each month, we share relevant literature on the mechanisms of disease, diagnostic and therapeutic advancements concerning diabetes combined with liver disease, and invite experts in the field to provide commentary. We hope this review offers valuable insights and assistance to researchers, clinical practitioners, and front-line medical workers engaged in scientific research and clinical treatment.

In 2023, the Chinese Society of Hepatology of the Chinese Medical Association updated the 2017 guidelines on managing ascites and associated complications in cirrhosis. These revised guidelines, now termed "Guidelines on the Management of Ascites in Cirrhosis," provide comprehensive recommendations for the diagnosis and treatment of cirrhotic ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome (HRS). This article summarizes these guidelines, emphasizing the importance of evidence-based practices and individualized patient care.

In recent years, the burden of non-alcoholic fatty liver disease (NAFLD) and liver cancer has become increasingly heavy, with a growing incidence of NAFLD-related hepatocellular carcinoma (HCC). Recently, Professor Yutao Zhan from Beijing Tongren Hospital delivered a fascinating presentation titled "Advances in Research on NAFLD-Related Liver Cancer." The presentation comprehensively analyzed the prevention and control strategies for NAFLD-related liver cancer from the perspectives of risk factors, monitoring, and prevention. Here, we summarize the key points from Professor Zhan's report.

In the journey of cancer treatment, drug-induced liver injury is a significant issue that cannot be overlooked. The "8th International Forum on Drug-Induced Liver Injury," held on May 25, 2024, focused on the management of drug-induced liver injury caused by anticancer drugs, inviting numerous renowned experts and scholars from around the world for rich academic exchanges. During the forum, we had the honor of interviewing Professor Victor Navarro from the Department of Hepatology at the Einstein Medical Network in Philadelphia, Pennsylvania, USA. He shared his unique insights on the management of drug-induced liver injury in oncology.

Recently, the "8th International Forum on Drug-Induced Liver Injury and the 9th National Conference on Drug-Induced Liver Injury" along withthe release of the 2024 primary care version of  "Chinese Guidelines for the Diagnosis and Treatment of Drug-Induced Liver Injury" was held in the beautiful city of Xiamen. The theme of this conference focused on the management of liver injury caused by anti-tumor drugs, and it featured extensive academic exchanges by numerous renowned experts and scholars from home and abroad. We were honored to have Professor Guruprasad P. Aithal from the University of Nottingham share his insights on the clinical characteristics and treatment strategies for immune checkpoint inhibitor (ICI)-induced liver injury. This in-depth interview with Professor Aithal provides valuable guidance, helping us better understand and manage this potentially severe adverse reaction.

Greetings to all experts and colleagues. In this issue of the CDM Monthly Review, we will share six recent articles in the field of portal hypertension diagnosis and treatment (four on diagnostic monitoring and two on multidisciplinary treatment). This issue features reviews by invited experts: Professor Pengyuan He from the Center for Infectious Disease Control at the Fifth Affiliated Hospital of Sun Yat-sen University, Professor Wei Gou from the Hepatology Department at the Qingdao Sixth People's Hospital, and Professor Airong Hu from the Liver Disease Center at the Ningbo No.2 Hospital.

Hepatic sinusoidal obstruction syndrome (HSOS) is a hepatic vascular disease characterized by edema, necrosis, and detachment of the endothelial cells in the hepatic sinusoids, hepatic venules, and interlobular veins, leading to microthrombi formation, intrahepatic congestion, liver injury, and portal hypertension. Clinical manifestations include abdominal distension, liver pain, ascites, jaundice, and hepatomegaly. In cases of sudden liver enlargement, liver pain, jaundice, and ascites, HSOS should be suspected. This article features a classic HSOS case shared by Professor Shao Ming's team from Shanxi Yuncheng Huiren Hospital, detailing their diagnosis and treatment experience.