橋本 千樹

BACKGROUND: Cancer gene panel testing (CGP) helps comprehensively analyze a large number of genes, extracting genetic information from the genome profile to aid treatment plans and drug therapy. Advances in drug therapy and surgical treatment for intrahepatic cholangiocarcinoma (ICC) have improved patient outcomes; however, it remains a typical intractable cancer with a poor prognosis. ICC is one of the key tumors for which effective treatment may be identified through CGP testing. This study aimed to identify ICC harboring actionable genetic variants using contrast-enhanced ultrasonography (CE-US). METHODS: We enrolled 26 ICC patients who underwent CE-US before chemotherapy or surgery. Three ultrasound specialists reviewed the images by consensus and assessed the imaging features, including vascularity. Pathological data were reviewed after diagnosis using CE-US. We retrospectively analyzed distinctive CE-US findings in patients with ICC with actionable genetic variants. RESULTS: Twelve ICC patients had actionable gene variants, including four FGFR2 fusions, one FGFR2 rearrangement, six IDH1 mutations, and one BRAF V600E mutation. Univariate analysis showed significant differences in bile duct invasion (p = 0.0217) and blood vessel penetration within the tumor (p = 0.0012). Multivariable logistic regression identified blood vessel penetration within the tumor (OR = 18.275; 95% CI: 1.331-250.925; p = 0.0297) as independently associated with actionable gene variants. CONCLUSION: Patients with ICC and blood vessel penetration on CE-US should be considered for CGP testing.

In Japan, the establishment of diagnostic criteria for acute-on-chronic liver failure (ACLF) in 2022 has increased the focus on alcoholic hepatitis. Most hospitals in Japan lack specialized treatment units or psychiatrists for managing alcohol use disorders, leaving hepatologists to handle various aspects of the disease-a challenging task. This study retrospectively investigated the outcomes of alcoholic hepatitis in a typical Japanese hospital setting, stratified by ACLF diagnosis and other features, with the aim of identifying areas for possible improvement. We conducted a retrospective analysis of 88 patients hospitalized with alcoholic hepatitis, reviewing records for the diagnosis of ACLF or related conditions, development of delirium tremens (DT), risk factors, and patient outcomes. Patients meeting the Japanese criteria for ACLF or related conditions had significantly worse survival outcomes. DT developed in 13 patients, with low platelet counts and elevated γ-glutamyl transpeptidase levels identified as risk factors. Prophylactic oral benzodiazepines were found safe and significantly associated with preventing DT. Onset of DT during hospitalization did not measurably impact survival prognosis, but DT patients showed a tendency to break contact with our hospital and critical events may have been missed. While under hepatologist care, patients typically maintained sobriety, but relapse into alcohol-related health problems frequently occurred after follow-up was discontinued. In Japan, hepatologists may be missing important events with alcoholic hepatitis after follow-up discontinuation, especially in patients with DT. Therefore, integrated and collaborative care, particularly a psychosocial approach providing behavioural support, may reduce risk of relapse and improve patient prognosis. TRIAL REGISTRATION: All study protocols were reviewed and approved by the ethics committee at Fujita Health University School of Medicine (approval no. HM23-213).