Clinical and Molecular Hepatology

"Jihyun An"

Review

Tumor-based biomarkers and circulating tumor DNA for precision medicine in advanced hepatocellular carcinoma: Sabrina Sidali, Claudia Campani, Jihyun An, Ju Hyun Shim, Jean-Charles Nault; Received July 8, 2025 Accepted August 18, 2025 Published online August 20, 2025; DOI: https://doi.org/10.3350/cmh.2025.0746 [Accepted]

Abstract
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Hepatocellular carcinoma (HCC) is the most common primary liver cancer and remains a major cause of cancer-related mortality worldwide. Systemic therapies, including targeted therapies and immune checkpoint inhibitors (ICIs), have revolutionized the management of advanced HCC. Although the prognosis of patients with advanced HCC remains poor, significant progress has been made with recent advances in drug development, particularly with the introduction of effective treatments such as atezolizumab plus bevacizumab or durvalumab plus tremelimumab. Indeed, treatment response varies significantly among patients, highlighting the need for robust biomarkers. In addition, the development of molecular driver-targeted therapies remains an active research focus as most genetic alterations observed in HCC are currently undruggable. Meeting these goals will require additional efforts to obtain histological material in clinical trials, in order to enable robust translational research. This review explores the current landscape of biomarkers of response to systemic treatments in HCC, including molecular, immune-based markers as well as circulating tumor DNA and highlights potential paths of improvement.

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Original Articles

Autoimmune liver disease

Diagnostic accuracy of vibration-controlled transient elastography for staging liver fibrosis in autoimmune liver diseases: A systematic review and meta-analysis: Jihyun An, Young Eun Chon, Gunho Kim, Mi Na Kim, Hee Yeon Kim, Han Ah Lee, Jung Hwan Yu, Miyoung Choi, Dae Won Jun, Seung Up Kim, Ji Won Han, Young-Joo Jin; Clin Mol Hepatol 2024;30(Suppl):S134-S146.
Published online August 21, 2024; DOI: https://doi.org/10.3350/cmh.2024.0586

Background/Aims
The assessment of liver fibrosis is crucial for managing autoimmune liver diseases such as primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis (PSC). However, data on the efficacy of noninvasive tests for these diseases are limited. This meta-analysis evaluated the diagnostic accuracy of vibration-controlled transient elastography (VCTE) for staging fibrosis in patients with autoimmune liver disease.
Methods
Searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases to assess the diagnostic accuracy of VCTE against histology as the reference standard in adult patients with autoimmune liver disease. The summary area under the curve (sAUC) and diagnostic odds ratio were calculated for significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis, according to liver biopsy.
Results
Fourteen articles were included, comprising 559 PBC patients from six studies, 388 AIH patients from five studies, and 151 PSC patients from three studies. VCTE demonstrated good performance for fibrosis staging in PBC, AIH, and PSC. In PBC, sAUCs of VCTE were 0.87, 0.89, and 0.99 for staging SF, AF, and cirrhosis, respectively. In AIH, the sAUCs were 0.88, 0.88, and 0.92, respectively, while in PSC, they were 0.88, 0.95, and 0.92, respectively. The cutoff values for AF were 7.5–17.9 kPa in PBC, 8.18–12.1 kPa in AIH, and 9.6 kPa in PSC.
Conclusions
VCTE shows high diagnostic accuracy for staging liver fibrosis in patients with autoimmune liver diseases. This non-invasive method serves as a valuable tool for the evaluation and monitoring of fibrosis in these lifelong diseases.

Citations

Citations to this article as recorded by

Transient elastography for assessing liver fibrosis in autoimmune liver diseases: Excellent performance but limited details: Editorial on “Diagnostic accuracy of vibration-controlled transient elastography for staging liver fibrosis in autoimmune liver di
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Yazhen Zhang, Aifang Xu, Yujiao Jin, Jing Gao, Jiahui He
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6 Web of Science
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Steatotic liver disease

Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis: Young Eun Chon, Young-Joo Jin, Jihyun An, Hee Yeon Kim, Miyoung Choi, Dae Won Jun, Mi Na Kim, Ji Won Han, Han Ah Lee, Jung Hwan Yu, Seung Up Kim; Clin Mol Hepatol 2024;30(Suppl):S117-S133.
Published online August 21, 2024; DOI: https://doi.org/10.3350/cmh.2024.0392

Background/aims
Opinions differ regarding vibration-controlled transient elastography and magnetic resonance elastography (VCTE/MRE) cut-offs for diagnosing advanced fibrosis (AF) in patients with non-alcoholic fatty liver disease (NAFLD). We investigated the diagnostic performance and optimal cut-off values of VCTE and MRE for diagnosing AF.
Methods
Literature databases, including Medline, EMBASE, Cochrane Library, and KoreaMed, were used to identify relevant studies published up to June 13, 2023. We selected studies evaluating VCTE and MRE regarding the degree of liver fibrosis using liver biopsy as the reference. The sensitivity, specificity, and area under receiver operating characteristics curves (AUCs) of the pooled data for VCTE and MRE for each fibrosis stage and optimal cut-offs for AF were investigated.
Results
A total of 19,199 patients from 63 studies using VCTE showed diagnostic AUC of 0.83 (95% confidence interval: 0.80–0.86), 0.83 (0.80–0.86), 0.87 (0.84–0.90), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. Similarly, 1,484 patients from 14 studies using MRE showed diagnostic AUC of 0.89 (0.86–0.92), 0.92 (0.89–0.94), 0.89 (0.86–0.92), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. The diagnostic AUC for AF using VCTE was highest at 0.90 with a cut-off of 7.1–7.9 kPa, and that of MRE was highest at 0.94 with a cut-off of 3.62–3.8 kPa.
Conclusions
VCTE (7.1–7.9 kPa) and MRE (3.62–3.8 kPa) with the suggested cut-offs showed favorable accuracy for diagnosing AF in patients with NAFLD. This result will serve as a basis for clinical guidelines for non-invasive tests and differential diagnosis of AF.

Citations

Citations to this article as recorded by

Correspondence to editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: a systematic review and meta-analy
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Special Issue

Liver fibrosis, cirrhosis, and portal hypertension

KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease: Mi Na Kim, Ji Won Han, Jihyun An, Beom Kyung Kim, Young-Joo Jin, Seung-seob Kim, Minjong Lee, Han Ah Lee, Yuri Cho, Hee Yeon Kim, Yu Rim Shin, Jung Hwan Yu, Moon Young Kim, YoungRok Choi, Young Eun Chon, Eun Ju Cho, Eun Joo Lee, Sang Gyune Kim, Won Kim, Dae Won Jun, Seung Up Kim, on behalf of The Korean Association for the Study of the Liver (KASL); Clin Mol Hepatol 2024;30(Suppl):S5-S105.
Published online August 19, 2024; DOI: https://doi.org/10.3350/cmh.2024.0506

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Beom Kyung Kim
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Original Articles

Hepatic neoplasm

Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus: A systematic review and meta-analysis: Han Ah Lee, Mi Na Kim, Hye Ah Lee, Miyoung Choi, Jung Hwan Yu, Young-Joo Jin, Hee Yeon Kim, Ji Won Han, Seung Up Kim, Jihyun An, Young Eun Chon; Clin Mol Hepatol 2024;30(Suppl):S172-S185.
Published online August 12, 2024; DOI: https://doi.org/10.3350/cmh.2024.0262

Backgrounds/Aims
Despite advances in antiviral therapy for hepatitis C virus (HCV) infection, hepatocellular carcinoma (HCC) still develops even after sustained viral response (SVR) in patients with advanced liver fibrosis or cirrhosis. This meta-analysis investigated the predictive performance of vibration-controlled transient elastography (VCTE) and fibrosis 4-index (FIB-4) for the development of HCC after SVR.
Methods
We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for studies examining the predictive performance of these tests in adult patients with HCV. Two authors independently screened the studies’ methodological quality and extracted data. Pooled estimates of sensitivity, specificity, and area under the curve (AUC) were calculated for HCC development using random-effects bivariate logit normal and linear-mixed effect models.
Results
We included 27 studies (169,911 patients). Meta-analysis of HCC after SVR was possible in nine VCTE and 15 FIB-4 studies. Regarding the prediction of HCC development after SVR, the pooled AUCs of pre-treatment VCTE >9.2–13 kPa and FIB-4 >3.25 were 0.79 and 0.73, respectively. VCTE >8.4–11 kPa and FIB-4 >3.25 measured after SVR maintained good predictive performance, albeit slightly reduced (pooled AUCs: 0.77 and 0.70, respectively). The identified optimal cut-off value for HCC development after SVR was 12.6 kPa for pre-treatment VCTE. That of VCTE measured after the SVR was 11.2 kPa.
Conclusions
VCTE and FIB-4 showed acceptable predictive performance for HCC development in patients with HCV who achieved SVR, underscoring their utility in clinical practice for guiding surveillance strategies. Future studies are needed to validate these findings prospectively and validate their clinical impact.

Citations

Citations to this article as recorded by

Comment: Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus
Xinpu Miao, Haidong Wu, Jinrong Xu, Wei Cheng
Clinical and Molecular Hepatology.2025; 31(1): e23. CrossRef
Hepatocellular carcinoma surveillance after sustained virological response in chronic hepatitis C: Editorial on “Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus: A systematic review and meta-ana
Ho Soo Chun, Minjong Lee
Clinical and Molecular Hepatology.2025; 31(1): 261. CrossRef
Longitudinal Effects of Glecaprevir/Pibrentasvir on Liver Function, Fibrosis, and Hepatocellular Carcinoma Risk in Chronic Hepatitis C: A Prospective Multicenter Cohort Study
Jung Hee Kim, Jae Hyun Yoon, Sung-Eun Kim, Ji-Won Park, Yewan Park, Gi-Ae Kim, Seong Kyun Na, Young-Sun Lee, Jeong Han Kim
Medicina.2025; 61(9): 1601. CrossRef
Precision Strategy for Hepatocellular Carcinoma Surveillance after Hepatitis C Cure: Debates across Guidelines
Masaaki Mino, Eiji Kakazu, Tatsuya Kanto
Gut and Liver.2025; 19(5): 651. CrossRef
Liver Stiffness Measurements After Oral Antivirals Effectively Predict the Risk of HCC in Patients With Chronic Hepatitis C
Yu Rim Lee, Hyun Young Woo, Young Oh. Kweon, Won Young Tak, Se Young Jang, Jung Gil Park, Min Kyu Kang, Jeong Eun Song, Byoung Kuk Jang, Changhyeong Lee, Byung Seok Kim, Jae Seok Hwang, Woo Jin Chung, Jeong Heo, Nae‐Yun Heo, Seung Ha Park, Jun Sik Yoon, J
Journal of Gastroenterology and Hepatology.2025; 40(10): 2568. CrossRef
Diagnostic possibilities of perfusion computed tomography in assessing fibrosis regression in patients with chronic viral hepatitis C: a prospective study
E. A. Ioppa, O. S. Tonkikh, I. Yu. Degtyarev, V. D. Zavadovskaya, E. S. Garganeeva
Diagnostic radiology and radiotherapy.2025; 16(3): 65. CrossRef
Liver Fibrosis Assessment in Chronic Liver Diseases Using Elastography: A Comprehensive Review of Vibration-Controlled Transient Elastography and Shear Wave Elastography
Han Ah Lee
Clinical Ultrasound.2024; 9(2): 70. CrossRef

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Liver fibrosis, cirrhosis, and portal hypertension

Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis: Hee Yeon Kim, Jung Hwan Yu, Young Eun Chon, Seung Up Kim, Mi Na Kim, Ji Won Han, Han Ah Lee, Young-Joo Jin, Jihyun An, Miyoung Choi, Dae Won Jun; Clin Mol Hepatol 2024;30(Suppl):S199-S213.
Published online July 30, 2024; DOI: https://doi.org/10.3350/cmh.2024.0351

Background/Aims
Although important, clinically significant liver fibrosis is often overlooked in the general population. We aimed to examine the prevalence of clinically significant liver fibrosis using noninvasive tests (NITs) in the general population.
Methods
We collected data from four databases (MEDLINE, Embase, Cochrane Library, and KoreaMed) from inception to June 13, 2023. Original articles reporting the prevalence of clinically significant liver fibrosis in the general population were included. The Stata metaprop function was used to obtain the pooled prevalence of liver fibrosis with NITs in the general population.
Results
We screened 6,429 articles and included 45 eligible studies that reported the prevalence of clinically significant liver fibrosis in the general population. The prevalence of advanced liver fibrosis, using the high probability cutoff of the fibrosis-4 (FIB-4) index, was 2.3% (95% confidence interval [CI], 1.2–3.7%). The prevalence of significant liver fibrosis, advanced liver fibrosis, and liver cirrhosis, assessed using vibration-controlled transient elastography (VCTE) among the general population, was 7.3% (95% CI, 5.9–8.8%), 3.5% (95% CI, 2.7–4.5), and 1.2% (95% CI, 0.8–1.8%), respectively. Region-based subgroup analysis revealed that the highest prevalence of advanced fibrosis using the high probability cutoff of the FIB-4 index was observed in the American region. Furthermore, the American region exhibited the highest prevalence of significant liver fibrosis, advanced liver fibrosis, and liver cirrhosis, using VCTE.
Conclusions
Previously undiagnosed clinically significant liver fibrosis is found in the general population through NITs. Future research is necessary to stratify the risk in the general population.

Citations

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Kexin Wang, Yuxin Yang, Bingjie Yue, Mengyang Li, Chu Chen, Junrong Du, Fangyi Long
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Asmaa Ellaithy, Aya Serageldeen, Alhareth Alhusban, Mariam Emad Seif, Mahmoud Essam Abdelhamid, Bushra Al-Shaikh, Asmaa Sayed Ibrahim, Eslam Mohamed Elshennawy, Ibrahim Ellaithy
Annals of Medicine & Surgery.2025; 87(8): 4742. CrossRef
PREVALENCE OF VARIOUS ETIOPATHOGENIC VARIANTS OF CHRONIC DIFFUSE LIVER DISEASES
B. Sakhova, A. Oshibayeva, N. Nuskabayeva, E. Iskandirova, Zh. Rsalieva, N. Karabayev, L. Karimova, L. Ozbakyr
Medicine and ecology.2025; (3): 35. CrossRef
Association between gestational diabetes mellitus and liver cirrhosis and fibrosis: A population‐based cohort study and risk factor analysis
Tan‐Tzu Lo, Wan‐Ting Huang, Chia‐Lung Shih, Pensee Wu
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Modified FIB-4 Index in Type 2 Diabetes Mellitus with Steatosis: A Non-Linear Predictive Model for Advanced Hepatic Fibrosis
Jonghyun Kim, Takanori Ito, Taeang Arai, Masanori Atsukawa, Miwa Kawanaka, Hidenori Toyoda, Takashi Honda, Ming-Lung Yu, Eileen L. Yoon, Dae Won Jun, Kyungjoon Cha, Mindie H. Nguyen
Diagnostics.2024; 14(22): 2500. CrossRef

10,164 View
200 Download
14 Web of Science
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Viral hepatitis

Vibration-controlled transient elastography for significant fibrosis in treatment-naïve chronic hepatitis B patients: A systematic review and meta-analysis: Mi Na Kim, Jihyun An, Eun Hwa Kim, Hee Yeon Kim, Han Ah Lee, Jung Hwan Yu, Young-Joo Jin, Young Eun Chon, Seung Up Kim, Dae Won Jun, Ji Won Han, Miyoung Choi; Clin Mol Hepatol 2024;30(Suppl):S106-S116.
Published online July 23, 2024; DOI: https://doi.org/10.3350/cmh.2024.0371

Backgrounds/Aims
Accurate diagnosis of significant liver fibrosis in patients with chronic hepatitis B (CHB) is crucial when determining whether to initiate antiviral treatment (AVT). We conduct a meta-analysis to assess the diagnostic performance of vibration-controlled transient elastography (VCTE) for significant liver fibrosis in AVT-naïve CHB patients with serum alanine transaminase (ALT) levels within 5-fold the upper limit of normal (ULN).
Methods
The Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases were searched to identify studies that compared the performance of VCTE and liver biopsy (reference standard) when diagnosing significant liver fibrosis (≥F2) in AVT-naïve CHB patients with ALT within 5-fold the ULN. A hierarchical summary receiver operating characteristic curve (HSROC) and bivariate model were performed to evaluate the diagnostic performance of VCTE in the meta-analysis.
Results
Eight studies (2,003 patients) were included. The summary sensitivity and specificity for diagnosis of significant liver fibrosis were 0.78 (95% confidence interval [CI], 0.66–0.86) and 0.72 (95% CI, 0.60–0.82), respectively. The HSROC for the diagnosis of significant liver fibrosis was 0.81 (95% CI, 0.72–0.86). The optimal cutoff value of VCTE for diagnosis of significant liver fibrosis was 7.7 kPa with a sensitivity of 0.64 (95% CI, 0.50–0.76) and specificity of 0.83 (95% CI, 0.72–0.90).
Conclusions
Our study demonstrated that VCTE has an acceptable diagnostic performance for significant liver fibrosis in AVT-naïve CHB patients with ALT within 5-fold the ULN.

Citations

Citations to this article as recorded by

Unraveling Demographic Patterns in Hepatitis B Clinical and Laboratory Profiles: Insights From a Ghanaian Cohort: A Retrospective Study
Napoleon Bellua Sam, Saeed Folorunsho Majeed, Adams Dramani
Health Science Reports.2025;[Epub] CrossRef
Head‐to‐Head Comparison of Long‐Term HCC Risk of Antivirals‐Treated Versus Untreated Low‐Level Viremia in HBV‐Compensated Cirrhosis
Nobuharu Tamaki, Daniel Q. Huang, Hyung Woong Lee, Soo Young Park, Yu Rim Lee, Dong Hyun Sinn, Tae Seop Lim, Hiroyuki Marusawa, Seng Gee Lim, Hironori Ochi, Masahiko Kondo, Yasushi Uchida, Haruhiko Kobashi, Koichiro Furuta, Masayuki Kurosaki, Beom Kyung K
Journal of Gastroenterology and Hepatology.2025; 40(6): 1595. CrossRef
Assessing Liver Fibrosis in Chronic Hepatitis B: Liver Biopsy or Non-Invasive Fibrosis Markers?
Deniz Borcak, Zuhal Yesilbag, Yusuf Emre Ozdemir, Adile Sevde Demir, Esra Salim Dogdas, Aysegul Inci Sezen, Esra Canbolat Unlu, Sevtap Senoglu, Hayat Kumbasar Karaosmanoglu, Kadriye Kart Yasar
Journal of Clinical Medicine.2025; 14(22): 8164. CrossRef
Recent Trends in Noninvasive Tests for Assessing Hepatic Fibrosis in Patients with Chronic Liver Disease
Jung Hwan Yu
The Korean Journal of Medicine.2024; 99(5): 232. CrossRef
Noninvasive Imaging Test to Assess Liver Fibrosis: Vibration-controlled Transient Elastography
Mi Na Kim
The Korean Journal of Gastroenterology.2024; 84(5): 201. CrossRef
Liver Fibrosis Assessment in Chronic Liver Diseases Using Elastography: A Comprehensive Review of Vibration-Controlled Transient Elastography and Shear Wave Elastography
Han Ah Lee
Clinical Ultrasound.2024; 9(2): 70. CrossRef

5,113 View
127 Download
4 Web of Science
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Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using vibration-controlled transient elastography: Systematic review and meta-analysis: Young-Joo Jin, Hee Yeon Kim, Young Ju Suh, Chae Hyeon Lee, Jung Hwan Yu, Mi Na Kim, Ji Won Han, Han Ah Lee, Jihyun An, Young Eun Chon, Dae Won Jun, Miyoung Choi, Seung Up Kim; Clin Mol Hepatol 2024;30(Suppl):S159-S171.
Published online July 23, 2024; DOI: https://doi.org/10.3350/cmh.2024.0163

Backgrounds/Aims
Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) can assess fibrotic burden in chronic liver diseases. The systematic review and meta-analysis was conducted to determine whether LSM using VCTE can predict the risk of development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients.
Methods
A systematic literature search of the Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases (from January 2010 to June 2023) was conducted. Of the 1,345 individual studies identified, 10 studies that used VCTE were finally registered. Hazard ratios (HRs) and the 95% confidence intervals (CIs) were considered summary estimates of treatment effect sizes of ≥11 kilopascal (kPa) standard for HCC development. Meta-analysis was performed using the restricted Maximum Likelihood random effects model.
Results
Among the ten studies, data for risk ratios for HCC development could be obtained from nine studies. When analyzed for the nine studies, the HR for HCC development was high at 3.33 (95% CI, 2.45–4.54) in CHB patients with a baseline LSM of ≥11 kPa compared to patients who did not. In ten studies included, LSM of ≥11 kPa showed the sensitivity and specificity for predicting HCC development were 61% (95% CI, 50–71%) and 78% (95% CI, 66–86%), respectively, and the diagnostic accuracy was 0.74 (95% CI, 0.70–0.77).
Conclusions
The risk of HCC development was elevated in CHB patients with VCTE-determined LSM of ≥11 kPa. This finding suggests that VCTE-determined LSM values may aid the risk prediction of HCC development in CHB patients.

Citations

Citations to this article as recorded by

The use of transient elastography for predicting hepatocellular carcinoma in chronic hepatitis B patients: Editorial on “Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using vibration-controlled transient elastography: S
Mirko Zoncapè, Emmanuel A. Tsochatzis
Clinical and Molecular Hepatology.2025; 31(1): 268. CrossRef
Unraveling Demographic Patterns in Hepatitis B Clinical and Laboratory Profiles: Insights From a Ghanaian Cohort: A Retrospective Study
Napoleon Bellua Sam, Saeed Folorunsho Majeed, Adams Dramani
Health Science Reports.2025;[Epub] CrossRef
A Review of Risk Prediction Model for Hepatocellular Carcinoma in Chronic Hepatitis B
Jiwon Yang, Mark D. Muthiah, Won-Mook Choi
Current Hepatology Reports.2025;[Epub] CrossRef
Head‐to‐Head Comparison of Long‐Term HCC Risk of Antivirals‐Treated Versus Untreated Low‐Level Viremia in HBV‐Compensated Cirrhosis
Nobuharu Tamaki, Daniel Q. Huang, Hyung Woong Lee, Soo Young Park, Yu Rim Lee, Dong Hyun Sinn, Tae Seop Lim, Hiroyuki Marusawa, Seng Gee Lim, Hironori Ochi, Masahiko Kondo, Yasushi Uchida, Haruhiko Kobashi, Koichiro Furuta, Masayuki Kurosaki, Beom Kyung K
Journal of Gastroenterology and Hepatology.2025; 40(6): 1595. CrossRef
Discovering the metabolic pathway of liver disease by breath mass spectrometry combined with machine learning
Xuanzhu Li, Wenbo Zhang, Tongtong Yang, Ying Zhang, Rui Su
Journal of Pharmaceutical and Biomedical Analysis.2025; 265: 116988. CrossRef
Future Perspectives of Liver Research in the Asia‐Pacific Region: Focus on Hepatitis B and C
Beom Kyung Kim
Journal of Gastroenterology and Hepatology.2025; 40(8): 1855. CrossRef
Correspondence to editorial 1 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”
Haiyu Wang, Jinjun Chen
Clinical and Molecular Hepatology.2025;[Epub] CrossRef
EASL 2025 indications revisited: phase-specific outcomes with and without nucleos(t)ide analogue therapy in chronic hepatitis B virus infection
Shichuan Tang, Tingfeng Huang, Ruijing Tang, Kongying Lin, Cong Luo, Yubing Shen, Kailing Zhang, Yidan Tang, Jie Kong, Zhenwei Chen, Jun Fu, Qizhu Lin, Luobin Guo, Yeye Wu, Yuntong Li, Jianxi Zhang, Zhenghong Sun, Penghui You, Daichang Zhang, Yanxin Chen,
Gut.2025; : gutjnl-2025-335449. CrossRef
The Evolving Application of Ultrasound in the Precision Management of Small Hepatocellular Carcinoma
Xin Guan, Xinyuan Hu, Hong Han, Dezhi Zhang, Huixiong Xu
Advanced Ultrasound in Diagnosis and Therapy.2025; 9(4): 375. CrossRef

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10 Web of Science
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Hepatic neoplasm

Loco-regional therapies competing with radiofrequency ablation in potential indications for hepatocellular carcinoma: a network meta-analysis: Ha Il Kim, Jihyun An, Seungbong Han, Ju Hyun Shim; Clin Mol Hepatol 2023;29(4):1013-1028.
Published online July 5, 2023; DOI: https://doi.org/10.3350/cmh.2023.0131

Background/Aims
There is no clear consensus on the relative ranking of interventional and radiation techniques with indications similar to those of radiofrequency ablation (RFA) for the treatment of early hepatocellular carcinoma (HCC). We used a network meta-analysis to compare the efficacy of non-surgical treatments for early HCC.
Methods
We searched databases for randomized trials assessing the efficacy of loco-regional treatments for HCCs ≤5 cm with no extrahepatic spread or portal invasion. The primary outcome was the pooled hazard ratio (HR) for overall survival (OS), and secondary outcomes included overall and local progression-free survival (PFS). A frequentist network meta-analysis was performed, and the relative ranking of therapies was assessed with P-scores.
Results
Nineteen studies comparing 11 different strategies in 2,793 patients were included. Chemoembolization plus RFA improved OS better than RFA alone (HR 0.52, 95% confidence interval [CI] 0.33–0.82; P-score=0.951). Cryoablation, microwave ablation, laser ablation, and proton beam therapy had similar effects on OS compared with RFA. For overall PFS, but not local PFS, only chemoembolization plus RFA performed significantly better than RFA (HR 0.61, 95% CI 0.42–0.88; P-score=0.964). Injection of percutaneous ethanol or acetic acid was significantly less effective than RFA for all measured outcomes, while no differences in progression outcomes were identified for other therapies included in the network.
Conclusions
Our results suggest that chemoembolization combined with RFA is the best option for local treatment of early HCC. Cases with potential contraindications for RFA may benefit from a tailored approach using thermal or radiation modalities.

Citations

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A network meta-analysis of different interventional treatment strategies for unresectable hepatocellular carcinoma
Xing-Yan Le, Jun-Bang Feng, Xiao-Li Yu, Sui-Li Li, Xiaocai Zhang, Jiaqing Li, Chuan-Ming Li
BMC Gastroenterology.2025;[Epub] CrossRef
Association between early job loss and prognosis among hepatocellular carcinoma survivors
B Yun, J Oh, S H Ahn, B K Kim, J-H Yoon
Occupational Medicine.2025; 75(2): 113. CrossRef
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Qitao Hu, Huali Zuo, Jessica C. Hsu, Cheng Zeng, Zhou Tian, Zhouyi Sun, Weibo Cai, Zhe Tang, Weiyu Chen
Advanced Materials.2024;[Epub] CrossRef
Efficacy and Safety of CT-guided Percutaneous Cryoablation for Hepatocellular Carcinoma at High-risk Sites
Weihao Zhang, Yan Wang, Xiaohui Zhao, Wei Gao, Changfu Liu, Tongguo Si, Xueling Yang, Wenge Xing, Haipeng Yu
Academic Radiology.2024; 31(11): 4434. CrossRef
Chemoembolization combined with radiofrequency ablation is the best option for the local treatment of early hepatocellular carcinoma?
Hyo-Cheol Kim
Clinical and Molecular Hepatology.2023; 29(4): 984. CrossRef

8,056 View
180 Download
5 Web of Science
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Reviews

Steatotic liver disease

Pharmacological advances in the treatment of nonalcoholic fatty liver diseases : focused on global results of randomized controlled trials: Jihyun An, Joo Hyun Sohn; Clin Mol Hepatol 2023;29(Suppl):S268-S275.
Published online December 20, 2022; DOI: https://doi.org/10.3350/cmh.2022.0437

Abstract
PDF

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease globally, and its prevalence is rapidly increasing. Nonalcoholic steatohepatitis (NASH), a progressive form of NAFLD, is characterized by hepatocellular injury, inflammation, and fibrosis. Patients with NASH or severe fibrosis should be treated according to international NAFLD guidelines. Currently, regulatory agencies have not approved any pharmaceutical treatment for NAFLD. Vitamin E and pioglitazone are efficacious for NASH resolution; however, their benefits must be weighed against the reported risks. In a phase 2 trial, a glucagon-like peptide-1 agonist commonly used for diabetes and obesity was found to improve liver histology in patients with NASH. Furthermore, therapeutic agents targeting NASH pathogenesis, including bile acid signaling, insulin resistance, and lipid metabolism, are in various phases of clinical development. In this article, we review the benefits and drawbacks of current pharmacotherapy and the efficacy of upcoming treatments for NASH.

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Neurobiology of Stress.2025; 35: 100713. CrossRef
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Therapeutic mechanisms and beneficial effects of non-antidiabetic drugs in chronic liver diseases: Han Ah Lee, Young Chang, Pil Soo Sung, Eileen L. Yoon, Hye Won Lee, Jeong-Ju Yoo, Young-Sun Lee, Jihyun An, Do Seon Song, Young Youn Cho, Seung Up Kim, Yoon Jun Kim; Clin Mol Hepatol 2022;28(3):425-472.
Published online July 1, 2022; DOI: https://doi.org/10.3350/cmh.2022.0186

Abstract
PDF

The global burden of chronic liver disease (CLD) is substantial. Due to the limited indication of and accessibility to antiviral therapy in viral hepatitis and lack of effective pharmacological treatment in nonalcoholic fatty liver disease, the beneficial effects of antidiabetics and non–antidiabetics in clinical practice have been continuously investigated in patients with CLD. In this narrative review, we focused on non-antidiabetic drugs, including ursodeoxycholic acid, silymarin, dimethyl4,4’-dimethoxy-5,6,5’,6’-dimethylenedixoybiphenyl-2,2’-dicarboxylate, L-ornithine L-aspartate, branched chain amino acids, statin, probiotics, vitamin E, and aspirin, and summarized their beneficial effects in CLD. Based on the antioxidant, anti-inflammatory properties, and regulatory functions in glucose or lipid metabolism, several non–antidiabetic drugs have shown beneficial effects in improving liver histology, aminotransferase level, and metabolic parameters and reducing risks of hepatocellular carcinoma and mortality, without significant safety concerns, in patients with CLD. Although the effect as the centerpiece management in patients with CLD is not robust, the use of these non-antidiabetic drugs might be potentially beneficial as an adjuvant or combined treatment strategy.

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Letter to the Editor

Liver fibrosis, cirrhosis, and portal hypertension

Reply: Letter: cervicocerebral atherosclerosis and its hepatic and coronary risk factors in patients with liver cirrhosis: Jihyun An, Ju Hyun Shim; Clin Mol Hepatol 2022;28(2):267-268.
Published online January 18, 2022; DOI: https://doi.org/10.3350/cmh.2022.0013

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67 Download

Original Articles

Liver fibrosis, cirrhosis, and portal hypertension

Cervicocerebral atherosclerosis and its hepatic and coronary risk factors in patients with liver cirrhosis: Jihyun An, Hyung-Don Kim, Seon-Ok Kim, Ha Il Kim, Gi-Won Song, Han Chu Lee, Ju Hyun Shim; Clin Mol Hepatol 2022;28(1):67-76.
Published online October 12, 2021; DOI: https://doi.org/10.3350/cmh.2021.0202

Background/Aims
We aimed to investigate the silent atherosclerotic burden of cervicocephalic vessels in cirrhotic patients compared with the general population, as well as the relevant risk factors including coronary parameters.
Methods
This study included 993 stroke-free patients with liver cirrhosis (LC) who underwent magnetic resonance angiography (MRA) of the head and neck as a pre-liver transplant assessment and 6,099 health checkup participants who underwent MRA examination. The two cohorts were matched for cerebrovascular risk factors, and the prevalence of atherosclerosis in major intracranial and extracranial arteries was compared in 755 matched pairs. Moreover, traditional, hepatic, and coronary variables related to cerebral atherosclerosis were assessed in cirrhotic patients.
Results
Overall, intracranial atherosclerosis was significantly less prevalent in the LC group than in the matched control group (2.3% vs. 5.4%, P=0.002), whereas the prevalence of extracranial atherosclerosis was similar (4.4% vs. 5.8%, P=0.242). These results were maintained in multivariate analyses of the pooled samples, with corresponding adjusted odds ratios [ORs] of LC of 0.56 and 0.77 (95% confidence intervals [CIs], 0.36–0.88 and 0.55–1.09). In the LC group, lower platelet count was inversely correlated with intracranial atherosclerosis (adjusted OR, 0.31; 95% CI, 0.13–0.76). Coronary artery calcium (CAC) score ≥100 was the only predictive factor for both intracranial and extracranial atherosclerosis (adjusted ORs, 4.06 and 5.43, respectively).
Conclusions
LC confers protection against intracranial atherosclerosis, and thrombocytopenia may be involved in this protective effect. High CAC score could serve as a potential surrogate for cervicocerebral vascular screening in asymptomatic cirrhotic patients.

Citations

Citations to this article as recorded by

Letter: cervicocerebral atherosclerosis and its hepatic and coronary risk factors in patients with liver cirrhosis
Yi-Chun Huang, Chih-Wei Chen, James Chun-Chung Wei
Clinical and Molecular Hepatology.2022; 28(2): 265. CrossRef
Reply: Letter: cervicocerebral atherosclerosis and its hepatic and coronary risk factors in patients with liver cirrhosis
Jihyun An, Ju Hyun Shim
Clinical and Molecular Hepatology.2022; 28(2): 267. CrossRef

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186 Download
2 Web of Science
Crossref

Hepatic neoplasm

Stereotactic body radiation therapy for small (≤5 cm) hepatocellular carcinoma not amenable to curative treatment: Results of a single-arm, phase II clinical trial: Sang Min Yoon, So Yeon Kim, Young-Suk Lim, Kang Mo Kim, Ju Hyun Shim, Danbi Lee, Jihyun An, Jinhong Jung, Jong Hoon Kim, Han Chu Lee; Clin Mol Hepatol 2020;26(4):506-515.
Published online July 10, 2020; DOI: https://doi.org/10.3350/cmh.2020.0038

Background/Aims
Stereotactic body radiation therapy (SBRT) is used as an alternative ablative treatment in patients with hepatocellular carcinoma (HCC) not suitable for curative treatments. The purpose of this prospective study was to evaluate the long-term efficacy of SBRT for small (≤5 cm) HCCs.
Methods
A phase II, single-arm clinical trial on SBRT for small HCCs was conducted at an academic tertiary care center. The planned SBRT dose was 45 Gy with a fraction size of 15-Gy over 3 consecutive days. The primary endpoint was 2-year local control rate. Radiologic responses were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1) and the modified RECIST criteria.
Results
Between 2013 and 2016, 50 patients (53 lesions) were enrolled, with a median follow-up period of 47.8 months (range, 2.9–70.6). Patients’ age ranged from 41 to 74 years, and 80% were male. Median tumor size was 1.3 cm (range, 0.7–3.1). The 2- and 5-year local control rates were 100% and 97.1%, respectively. The 5-year overall survival rate was 77.6%. Six months after SBRT, radiologic responses were evident in 44 lesions (83%) according to the RECIST criteria and 49 (92.4%) according to the modified RECIST criteria. None of the patients showed grade ≥3 adverse events.
Conclusions
SBRT showed excellent results as an ablative treatment for patients with small HCCs while showing minimal toxicities. SBRT can be a good alternative for both curative and salvage intents in patients with HCCs that are unsuitable for curative treatments.

Citations

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S Park, J Jung, B Cho, SY Kim, S‐C Yun, Y‐S Lim, HC Lee, J Park, J‐h Park, JH Kim, SM Yoon
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10,868 View
226 Download
62 Web of Science
Crossref

Hepatic neoplasm

Comparison of surgical resection versus transarterial chemoembolization with additional radiation therapy in patients with hepatocellular carcinoma with portal vein invasion: Danbi Lee, Han Chu Lee, Jihyun An, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Young-Hwa Chung, Yung Sang Lee; Clin Mol Hepatol 2018;24(2):144-150.
Published online January 16, 2018; DOI: https://doi.org/10.3350/cmh.2017.0041

Abstract
PDF

Background/Aims
Portal vein invasion (PVI) is a poor prognostic factor in patients with hepatocellular carcinoma (HCC). We intended to compare the effects of surgical resection and transarterial chemoembolization (TACE) with additional radiation therapy (RT) in HCC patients with PVI.
Methods
The subjects comprised 43 patients who underwent surgical resection for HCC with PVI without previous treatment and another 43 patients who received TACE followed by RT (TACE+RT) as initial treatment who were matched for Child-Pugh class, tumor size, and extent of PVI. Disease progression and death after the treatment were examined, and progression-free survival (PFS) and overall survival (OS) were compared between groups. Predisposing factors affecting OS were analyzed using univariate and multivariate analyses in HCC patients with PVI.
Results
The subjects (Age [51, 24-74; median, range], Sex [81/13; male/female], Etiology [78/1/15; hepatitis B virus {HBV}/ hepatitis C virus {HCV}/non-HBV and non-HCV]) were followed for a median of 17 (2-68) months. There were no differences in clinical or tumor characteristics between the resection and TACE+RT groups. The cumulative PFS was not significantly different between groups. The median PFS was 5.6 and 4.0 months in the resection and TACE+RT groups, respectively. However, the cumulative OS was significantly longer in patients treated with resection than in those treated with TACE+RT (P=0.04). The median OS was 26.9 and 14.2 months in the resection and TACE+RT groups, respectively. Univariate and multivariate analyses revealed that surgical resection was an independent predictive factor for better survival outcome.
Conclusions
Surgical resection might be an effective treatment in HCC patients with PVI.

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Viral hepatitis

Current status and strategies for hepatitis B control in Korea: Eun Ju Cho, Sung Eun Kim, Ki Tae Suk, Jihyun An, Soung Won Jeong, Woo Jin Chung, Yoon Jun Kim; Clin Mol Hepatol 2017;23(3):205-211.
Published online September 19, 2017; DOI: https://doi.org/10.3350/cmh.2017.0104

Abstract
PDF

Hepatitis B virus (HBV) infection is the most common cause of chronic liver diseases in Korea. After the introduction of the universal HBV vaccination program, the prevalence of hepatitis B surface antigen was markedly reduced, and Korea is now classified as an area of intermediate endemicity for HBV. However, there are still hurdles for elimination of hepatitis B, such as immunoprophylaxis failure against vertical transmission, occurrence of acute hepatitis B among peoples who did not have vaccination at younger age, and rapid increase of immigrant populations from HBV endemic areas. To achieve the World Health Organization goal of viral hepatitis elimination by 2030 in Korea, we suggest comprehensive policies for more effective control of hepatitis B as following: i) insurance coverage for antiviral prophylaxis in mothers with high viremia, ii) screening for hepatitis B seromarkers and catch-up HBV vaccinations of susceptible persons with hepatitis B, iii) establishment of an independent 'viral hepatitis sector' in Centers for Disease Control & Prevention to organize and execute comprehensive strategy for management of viral hepatitis, iv) encourage of management of HBV infection in immigrant populations, v) national campaign to promote awareness of hepatitis B.

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Original Article

Hepatic neoplasm

Clinical features and outcomes of patients with hepatocellular carcinoma complicated with bile duct invasion: Jihyun An, Kwang Sun Lee, Kang Mo Kim, Do Hyun Park, Sang Soo Lee, Danbi Lee, Ju Hyun Shim, Young-Suk Lim, Han Chu Lee, Young-Hwa Chung, Yung Sang Lee; Clin Mol Hepatol 2017;23(2):160-169.
Published online May 16, 2017; DOI: https://doi.org/10.3350/cmh.2016.0088

Abstract
PDF

Background/Aims
Little is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion.
Methods
A total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included.
Results
The majority of patients had Barcelona Clinic Liver Cancer (BCLC) stage C HCC (66.8%). Portal vein tumor thrombosis was present in 166 (67.2%) patients. Median survival was 4.1 months. Various modalities of treatment were initially employed including surgical resection (10.9%), repeated transarterial chemoembolization (TACE) (42.5%), and conservative management (42.9%). Among the patients with obstructive jaundice (n=88), successful biliary drainage was associated with better overall survival rate. Among the patients with BCLC stage C, overall survival differed depending on the initial treatment for HCC; surgical resection, TACE, systemic chemotherapy, and conservative management showed overall survival rates of 11.5, 6.0 ,2.4, and 1.6 months, respectively. After adjusting for confounders, surgical resection and repeated TACE were significant prognostic factors for HCC patients with bile duct invasion (hazard ratios 0.47 and 0.39, Ps <0.001, respectively).
Conclusions
The survival of HCC patients with bile duct invasion at initial diagnosis is generally poor. However, aggressive treatments for HCC such as resection or biliary drainage may be beneficial therapeutic options for patients with preserved liver function.

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Liver Imaging

Vascular disorders of liver

Focal type of peliosis hepatis: Gil-Sun Hong, Kyoung Won Kim, Jihyun An, Ju Hyun Shim, Jihun Kim, Eun Sil Yu; Clin Mol Hepatol 2015;21(4):398-401.
Published online December 24, 2015; DOI: https://doi.org/10.3350/cmh.2015.21.4.398

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Original Article

Viral hepatitis

Multiplex polymerase chain reaction test for the diagnosis of acute viral hepatitis A: Nae-Yun Heo, Young-Suk Lim, Jihyun An, Sun-Young Ko, Heung-Bum Oh; Korean J Hepatol 2012;18(4):397-403.
Published online December 21, 2012; DOI: https://doi.org/10.3350/cmh.2012.18.4.397

Abstract
PDF

Background/Aims

The early diagnosis of acute hepatitis A (AHA) is hindered because serum IgM against hepatitis A virus (HAV) can yield false-negative results during the window period. This study evaluated the diagnostic accuracy of a polymerase chain reaction (PCR) kit for HAV RNA for the diagnosis of AHA.

Methods

Samples were collected from 136 patients with acute severe hepatitis at their admission to Asan Medical Center between June 2010 and July 2010. Samples were analyzed for serum IgM anti-HAV using an immunoassay test and for qualitative HAV RNA using the Magicplex HepaTrio PCR test kit. The diagnostic accuracies of these methods were tested on the basis of clinical and laboratory diagnoses of AHA.

Results

The concordance rate and kappa value between IgM anti-HAV and HAV RNA PCR were 88.2% and 0.707, respectively. For the diagnosis of AHA, the sensitivity and specificity of IgM anti-HAV were 90.7% and 100%, respectively, when an "equivocal" result was regarded as positive; and 79.1% and 100%, respectively, when an "equivocal" result was regarded as negative. The sensitivity and specificity of HAV RNA PCR were 81.4% and 100%, respectively. All four patients with negative IgM anti-HAV and positive HAV RNA PCR results and all four patients with equivocal IgM anti-HAV RNA and positive HAV RNA PCR results were eventually diagnosed with AHA.

Conclusions

The qualitative HAV RNA PCR test has an equivalent diagnostic accuracy for AHA compared to IgM anti-HAV and may be more sensitive during the window period.

Citations

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Hepatitis A Screening for Internationally Adopted Children From Hepatitis A Endemic Countries
Vanessa N. Raabe, Casey Sautter, Mary Chesney, Judith K. Eckerle, Cynthia R. Howard, Chandy C. John
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61 Download
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Case Report

Drug rash with eosinophilia and systemic symptoms syndrome following cholestatic hepatitis A: a case report: Jihyun An, Joo Ho Lee, Hyojeong Lee, Eunsil Yu, Dan Bi Lee, Ju Hyun Shim, Sunyoung Yoon, Yumi Lee, Soeun Park, Han Chu Lee; Korean J Hepatol 2012;18(1):84-88.
Published online March 22, 2012; DOI: https://doi.org/10.3350/kjhep.2012.18.1.84

Abstract
PDF

Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.

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