Antivirals linked to far less cirrhosis and HCC in HBeAg-positive patients outside treatment criteria, and a blood test outperforms ultrasound for early HCC

The edition in brief

In 30,784 people with chronic hepatitis B in 12 Chinese centres who fell outside EASL 2025's strong treatment indications, nucleos(t)ide analogue therapy was associated with much lower cirrhosis (HR 0.18) and HCC (HR 0.03) in young HBeAg-positive, highly replicative patients, and lower cirrhosis (HR 0.50) and HCC (HR 0.25) in HBeAg-positive patients approaching phase transition, over up to five years; no association was seen in HBeAg-negative low-risk groups. In the prospective US ALTUS study of 2,293 adults under HCC surveillance, a multi-target blood test detected 66.7% of early-stage HCCs against 22.2% for ultrasound, but its specificity of 81.8% missed the prespecified 82% target, against 98.6% for ultrasound. A meta-analysis of 13 studies (264,543 patients, mostly retrospective) associated total intravenous anaesthesia with better overall survival after oesophagogastric cancer surgery (HR 0.80), driven by gastrectomy. A 20-patient pilot of a medium-chain fatty acid ketogenic supplement in MASLD reported metabolic and elastography changes, with many between-group comparisons non-significant. The pearl covers hepatitis B phase assessment.